Get Uniform Suspected Insurance Fraud Form Fillable

This guide provides clear instructions on how to complete the Uniform Suspected Insurance Fraud Form Fillable online. Following these steps will ensure that users accurately fill out all necessary information for reporting suspected insurance fraud.

Follow the steps to effectively fill out the form online.

1. Select the ‘Get Form’ button to access the Uniform Suspected Insurance Fraud Form Fillable. This will open the form in an online editor for completion.
2. Begin by entering your personal information in the 'Reporting Person' section. Include your name, status, insurance company details, mailing address, phone number, and email address.
3. Next, provide the details regarding the incident. Fill in the 'Date of Loss / Injury,' 'Address of Loss / Injury,' 'Claim #,' 'Reserve Amount,' 'Amount Paid,' 'Loss Amount,' and 'Settlement Amount.' Ensure to include the appropriate figures.
4. Indicate the 'Dates of Services' for the provided description of services, and include the relevant policy and procedure code numbers.
5. In the 'Subject Information' area, provide details about the individual or entity involved in the incident. This includes their name, date of birth, age, social security number, and address.
6. Fill out the 'Additional Party Involved' section if there are any other individuals relevant to the case. Provide their information as instructed.
7. In the 'Suspected Fraud Types' section, check all applicable types of suspected fraud. This is crucial for categorizing the report.
8. Complete the 'Identify Other Agency' section if applicable, providing agency type, name, address, and contact information.
9. Review your completed form thoroughly for any errors or missing information. Make necessary corrections.
10. Once all sections are completed and reviewed, save your changes. You may then download, print, or share the form as required.

Complete your forms online today to ensure accurate reporting of suspected insurance fraud.