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
means the surcharge collected from insurers and self-insured employers to
support the program to enhance investigation and prosecution of disability
(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
(d) "Claim" means
the request for payment of disability benefits which has been submitted to an
(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
(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
the Insurance Code.
cycle" means a period of one fiscal year.
(k) "Grantee" means a grant-funded
Expenses", as used in Insurance Code section
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
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
(n) "Insurer" shall have
the same meaning as used in Insurance Code section
(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.