Suspected Fraudulent Claim Referral

Suspected Fraudulent Claim Referral

  • State the facts (who, what, when, where, how, why) that support your suspicion of fraudulent claim activity including any material misrepresentation(s). Provide details regarding any prior history of fraudulent insurance claim by any of the parties. If known, include relevant claim numbers.
  • Drop files here or
    Max. file size: 5 MB, Max. files: 20.
      Maximum number of files is 20. Maximum file size is 5MB.