Get Fd1 Form

The Fd1 Form is an essential document used for reporting suspected fraudulent claims to the California Department of Insurance. This guide will provide clear and straightforward instructions on how to fill out this form online, ensuring your submission is accurate and complete.

Follow the steps to complete the Fd1 Form effectively.

1. Click the ‘Get Form’ button to access the Fd1 Form and open it in your preferred document editor.
2. Begin by completing the case identification section at the top of the form. Enter the case number, county code, and SFC number as required. Select the appropriate category for the suspected fraud: automobile, workers' compensation, or healthcare.
3. In Section I, input your reporting party information. Fill in the relevant codes and check whether this is a new or amended referral. Provide your company name, address, city, state, zip code, and email address if applicable.
4. Proceed to Section II to provide loss or injury information. List the alleged victim’s details, including their company name, claim number, policy number, and the date of loss or injury. Ensure to document the address or location where the loss or injury occurred.
5. In Section III, describe the suspected fraudulent claim activity. Summarize the facts that support your suspicion, detailing the who, what, when, where, how, and why aspects. Attach additional sheets if necessary.
6. If applicable, indicate if the suspicious activity is related to a natural disaster in this section. Check the relevant box for earthquakes, floods, firestorms, or other events.
7. In Section IV, provide information about any reports made to other agencies, including the names of law enforcement agencies or district attorney's offices involved.
8. Fill out Section V with your contact information and the contact details of the file handler, if different. Make sure to include your phone numbers and the date the form is completed.
9. After completing all sections, review the information for accuracy and clarity. You can then save your changes, download, print, or share the form as required.

Complete your Fd1 Form online today for efficient processing and reporting.