Cal. Code Regs. Tit. 10, § 2698.95.12 - Definitions

Current through Register 2021 Notice Reg. No. 52, December 24, 2021

For the purposes of these regulations:

(a) "Application" means the written document submitted to the Commissioner by which a local district attorney requests program funding, including a plan setting forth the district attorney's intended use of funds to enhance investigation and prosecution of disability insurance fraud.

(b) "Assessment" means the surcharge collected from insurers and self-insured employers to support the program to enhance investigation and prosecution of disability insurance fraud.

(c) "Case" means the file set up by the California Department of Insurance Fraud Division (formerly, the Bureau of Fraudulent Claims), and/or district attorney in the course of and for the purpose of investigation, development of evidence and prosecution of individual or consolidated activities of suspected disability insurance fraud.

(d) "Claim" means the request for payment of disability benefits which has been submitted to an insurer.

(e) "Commissioner" means the Insurance Commissioner of the state of California.

(f) "County Plan" means the plan submitted to the Commissioner as part of the application process by the local district attorney which details the projected use of the funds sought pursuant to these regulations.

(g) "Department" means the California Department of Insurance.

(h) "District Attorney" means the prosecuting officer of a California county jurisdictional district.

(i) "Fraud Division" or "Division" means the California Department of Insurance Fraud Division, formerly known as the Bureau of Fraudulent Claims. The former Bureau was designated a Division subsequent to the original enactment of section 1872.85 of the Insurance Code.

(j) "Funding cycle" means a period of one fiscal year.

(k) "Grantee" means a grant-funded applicant.

(l) "Incidental Expenses", as used in Insurance Code section 1872.85(a), means those costs incurred by the California Department of Insurance to administer the program and may include reasonable costs for collection of assessments, administrative support of the Fraud Division program component, and management of the distribution and oversight of monies allocated to the district attorneys.

(m) "Program" means those activities conducted by the Department, or any other agency, which are directed toward the enhanced investigation and prosecution of disability insurance fraud and which require funding or administration through assessments and the distribution of funds to the Fraud Division and to district attorneys.

(n) "Insurer" shall have the same meaning as used in Insurance Code section 23.

(o) "Regulations" means these regulations, California Code of Regulations Title 10, Chapter 5, Subchapter 9, Article 8.

(p) "Suspected Fraudulent Claim" means a claim which has been referred to the Division because the insurer reasonably believes that the claim involves a person who has committed a fraudulent act related to disability insurance.

Notes

Cal. Code Regs. Tit. 10, § 2698.95.12

Note: Authority cited: Section 1872.85, Insurance Code;CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989) 48 Cal.3d 805 and 824. Reference: Section 1872.85, Insurance Code.

1. New section filed 11-3-2005; operative 12-3-2005 (Register 2005, No. 44).