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Outline

The New York Ifb 1 form is a crucial document utilized by the New York State Department of Financial Services' Insurance Frauds Bureau. This form serves as a means for individuals and organizations to report suspected fraudulent transactions related to insurance claims. It captures essential information, including the details of the suspect transaction, such as the date and amount of loss, as well as the type of loss involved—be it auto, no-fault, medical, or workers' compensation. The form also requires the identification of the parties involved in the transaction, along with any relevant vehicle identification numbers (VIN) or license plate information when applicable. Additionally, the Ifb 1 form prompts the reporter to provide their policy, claim, or reference numbers associated with the transaction, ensuring that all relevant details are linked for effective investigation. A designated individual within the reporting company must be identified, providing their contact information for follow-up inquiries. Furthermore, the form inquires whether the transaction has been reported to any other law enforcement agency, facilitating a coordinated approach to tackling insurance fraud. By gathering this comprehensive information, the Ifb 1 form plays a vital role in helping authorities combat fraudulent activities and protect the integrity of the insurance system.

Sample - New York Ifb 1 Form

NEW YORK STATE

DEPARTMENT OF FINANCIAL SERVICES INSURANCE FRAUDS BUREAU

25 BEAVER STREET

NEW YORK, NY 10004

DATE:

1). Information furnished by:__________________________

Address: _______________________________________

_______________________________________

NAIC # _______________________________________

Previously submitted? Yes ____ Log # ___________ No_____

PLEASE PRINT/TYPE INFORMATION

2)Brief statement of suspect transaction. Date of loss ___________ Amount of loss ____________ County_____

Type of loss: Auto___ No-Fault___ Medical___ Workers Comp. __ Fraudulent ID cards__ Other_____________

If Auto or No-Fault, was this policy application submitted via NYAIP? Y N

STATEMENT

3)Identify parties to suspect transaction: Name(s) Address(es)

Additional information on suspect(s)

If Auto or Fraudulent cards give VIN # _________________________ Plate or License # ____________________

4) Identify your policy, claim or reference number under which the above transaction is recorded:

Claim # __________________________ Claim status_____________________________________________

Reference #_____________________________ Policy # _________________________ SIU #_______________

5)Name, title, address & telephone number of individual in your company who can provide detailed information:

NAME__________________________________________ TITLE _________________________________

ADDRESS __________________________________________________ TELEPHONE # _____________

6)Have you reported this transaction to any other law enforcement agency? Yes ____________ No____________

If yes, please furnish: Agency _________________________________________________________________

Address ___________________________________________________________________________________

Person contacted _________________________ Telephone #____________________Date of report _________

Continue on reverse or attach additional sheets as necessary.

Signed: _______________________________

Title: ________________________________

http://www.dfs.ny.gov

IFB-1 REV 8/11

Form Information

Fact Name Fact Description
Governing Authority The New York Ifb 1 form is governed by the New York State Department of Financial Services.
Purpose This form is used to report suspected insurance fraud in New York.
Submission Date The form requires the date of submission, which is critical for record-keeping.
Information Requirements Reporters must provide detailed information about the suspect transaction, including the date and amount of loss.
Types of Loss Various types of loss can be reported, including auto, no-fault, medical, and workers' compensation.
Contact Information The form requires contact details of a representative who can provide further information regarding the report.
Law Enforcement Notification Reporters must indicate if the transaction has been reported to any other law enforcement agency.
Revisions The current version of the form is IFB-1, revised in August 2011.

Detailed Guide for Filling Out New York Ifb 1

Completing the New York IFB 1 form is a straightforward process that requires specific information about a suspected fraudulent transaction. Once filled out, this form will be submitted to the New York State Department of Financial Services Insurance Frauds Bureau for further investigation.

  1. Begin by entering the date at the top of the form.
  2. In the first section, provide your name and address. Include your NAIC number and indicate whether you have submitted this information previously. If so, write down the log number.
  3. Next, briefly describe the suspect transaction. Fill in the date of loss, amount of loss, and county. Check the appropriate type of loss box (Auto, No-Fault, Medical, Workers Comp., Fraudulent ID cards, or Other). If the loss is related to Auto or No-Fault, indicate whether the policy application was submitted via NYAIP.
  4. Identify the parties involved in the suspect transaction. List their names, addresses, and any additional information. If applicable, provide the VIN number and plate or license number.
  5. In the next section, enter your policy, claim, or reference number associated with the transaction. Include the claim status, reference number, and policy number. If you have an SIU number, include that as well.
  6. Provide the name, title, address, and telephone number of an individual in your company who can provide more detailed information about the case.
  7. Indicate whether you have reported this transaction to any other law enforcement agency. If yes, provide the agency name, address, contact person, and their telephone number along with the date of the report.
  8. Finally, sign the form and include your title.

Obtain Answers on New York Ifb 1

  1. What is the purpose of the New York IFB 1 form?

    The New York IFB 1 form is designed for reporting suspected insurance fraud to the Insurance Frauds Bureau of the New York State Department of Financial Services. This form helps individuals and companies document and report fraudulent activities related to various types of insurance, including auto, medical, and workers' compensation claims. By submitting this form, you contribute to the prevention of fraud and help maintain the integrity of the insurance system.

  2. Who should fill out the IFB 1 form?

    The form should be completed by individuals or representatives of companies who suspect fraudulent activity related to an insurance transaction. This could include insurance agents, claims adjusters, or anyone who has knowledge of suspicious activities involving insurance claims. It is important that the person filling out the form provides accurate and detailed information to assist in the investigation.

  3. What information is required on the IFB 1 form?

    The IFB 1 form requires several key pieces of information:

    • Your contact information, including name, address, and title.
    • A brief statement describing the suspect transaction, including the date and amount of loss.
    • Details about the parties involved in the transaction, including names and addresses.
    • Your policy, claim, or reference number associated with the transaction.
    • Information about whether the transaction has been reported to any other law enforcement agency.

    Providing complete and accurate details will enhance the effectiveness of the investigation.

  4. How do I submit the IFB 1 form?

    After filling out the IFB 1 form, it should be submitted directly to the Insurance Frauds Bureau. This can typically be done via mail or, in some cases, electronically. Ensure that you keep a copy of the completed form for your records. If you have any questions about the submission process, you may contact the Bureau directly for guidance.

  5. What happens after I submit the IFB 1 form?

    Once the IFB 1 form is submitted, the Insurance Frauds Bureau will review the information provided. They may conduct an investigation based on the details you reported. You may be contacted for further information or clarification. It is essential to cooperate with any follow-up inquiries to assist in the investigation. The Bureau aims to address fraud efficiently and effectively, ensuring that appropriate actions are taken.

Common mistakes

Completing the New York IFB-1 form requires careful attention to detail. One common mistake is failing to provide complete information in the section asking for personal details. Individuals often leave the fields for their name, address, or NAIC number blank or incomplete. This can lead to delays in processing the report, as the Insurance Frauds Bureau needs accurate information to follow up.

Another frequent error is not clearly stating the nature of the suspect transaction. When filling out the brief statement section, some submitters provide vague descriptions or omit crucial details. It's essential to be as specific as possible regarding the type of loss and the circumstances surrounding the incident. A well-detailed statement can significantly aid in the investigation.

People also tend to overlook the importance of identifying all parties involved in the transaction. Incomplete or inaccurate information about suspects can hinder the investigation process. Ensure that all names and addresses are provided clearly, and if applicable, include additional information that could be relevant to the case.

Additionally, many individuals fail to include their policy, claim, or reference numbers. This oversight can lead to confusion and delays, as the Bureau relies on these identifiers to track the related transactions. Always double-check that these numbers are entered correctly and are up to date.

Moreover, some applicants neglect to provide contact information for the individual within their organization who can offer further details. This omission can cause frustration for investigators who may need to reach out for clarification. Make sure to include a name, title, address, and phone number for prompt communication.

Lastly, failing to disclose whether the transaction has been reported to other law enforcement agencies is a critical mistake. If the answer is yes, it's vital to provide the agency's name and contact details. This information helps avoid duplication of efforts and ensures that all relevant parties are informed. Each of these mistakes can complicate the process, so reviewing the form thoroughly before submission is essential.

Documents used along the form

The New York IFB 1 form is a crucial document used for reporting suspected insurance fraud. However, it is often accompanied by other forms and documents that provide additional context or information regarding the suspected fraudulent activity. Below is a list of related forms that may be required or beneficial when submitting the IFB 1 form.

  • Fraud Investigation Report: This document outlines the details of the investigation conducted by the insurance company or relevant agency. It includes findings, evidence collected, and any conclusions drawn regarding the suspected fraud.
  • Claim File Documentation: This collection of documents includes all paperwork related to the insurance claim in question. It may contain policy details, previous correspondence, and any other relevant information that can help in assessing the legitimacy of the claim.
  • Witness Statements: Statements from individuals who may have witnessed the transaction or have pertinent information about the parties involved can be critical. These documents provide firsthand accounts that may support or contradict the claims made in the IFB 1 form.
  • Law Enforcement Report: If the suspected fraud has been reported to law enforcement, a copy of the report generated by the agency can be included. This document may contain additional details that are essential for the investigation.
  • Policyholder Affidavit: This sworn statement from the policyholder can clarify their understanding of the transaction and their involvement. It can serve as an important piece of evidence in determining the legitimacy of the claim.

In summary, while the New York IFB 1 form serves as a primary tool for reporting insurance fraud, the inclusion of these additional documents can enhance the clarity and comprehensiveness of the report. Each form plays a distinct role in providing a fuller picture of the situation at hand, ultimately aiding in the investigation process.

Similar forms

The New York Ifb 1 form is used to report suspected insurance fraud. It shares similarities with several other documents in the realm of insurance and fraud reporting. Here’s a look at seven documents that are similar to the Ifb 1 form:

  • Fraud Reporting Form: This document is often used by various insurance companies to report suspected fraudulent activities. Like the Ifb 1, it requires details about the suspect and the transaction.
  • Insurance Claim Form: This form is submitted when a claim is made. It gathers information about the loss and parties involved, much like the Ifb 1.
  • Incident Report Form: Used in various sectors, this form captures details of an incident, including parties involved and a description of the event, similar to how the Ifb 1 collects information on suspect transactions.
  • Suspicious Activity Report (SAR): Financial institutions use this to report suspicious activities. It contains similar elements, such as details about the transaction and parties involved.
  • Loss Notice Form: This document is submitted to notify an insurer of a loss. It includes information about the loss and parties, akin to the structure of the Ifb 1.
  • Witness Statement Form: This form collects accounts from witnesses regarding a particular event. It parallels the Ifb 1 in gathering detailed information about involved parties.
  • Claim Investigation Report: Insurance adjusters use this to summarize findings from an investigation. It shares the purpose of detailing transactions and parties, similar to the Ifb 1.

Dos and Don'ts

When filling out the New York IFB 1 form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are six important dos and don’ts to consider:

  • Do provide complete and accurate information in all fields. This includes names, addresses, and transaction details.
  • Do use clear and legible handwriting or type the information. This helps prevent misunderstandings and ensures that all details are easily readable.
  • Do include any relevant documentation that supports your report. Attach copies of any pertinent records or evidence.
  • Do check for any errors before submitting the form. Review all entries to confirm that they are correct and complete.
  • Don’t leave any required fields blank. Omitting information can delay processing and may lead to complications.
  • Don’t submit the form without signing it. A signature is necessary to validate the report and confirm that the information provided is accurate to the best of your knowledge.

By adhering to these guidelines, individuals can help facilitate a smoother reporting process and contribute to effective investigations of insurance fraud.

Misconceptions

The New York IFB 1 form is a crucial document for reporting suspected insurance fraud. However, several misconceptions surround it. Here are ten common misunderstandings:

  1. It is only for large-scale fraud cases. Many believe the IFB 1 form is only necessary for major fraud incidents. In reality, it applies to all suspected fraudulent activities, regardless of scale.
  2. Only insurance companies can submit the form. While insurance companies frequently use the form, individuals and other entities can also report suspected fraud.
  3. Submitting the form guarantees an investigation. Filing the IFB 1 form does not automatically initiate an investigation. The Insurance Frauds Bureau will review the information provided to determine if further action is warranted.
  4. All information submitted is confidential. Although efforts are made to protect privacy, some information may be subject to disclosure under public records laws.
  5. The form must be submitted in person. The IFB 1 form can be submitted via mail or electronically, making it accessible for those unable to visit in person.
  6. Only specific types of fraud can be reported. Many think the form is limited to certain types of fraud, such as auto insurance. However, it can be used to report various fraudulent activities, including medical and workers' compensation fraud.
  7. There is a deadline for reporting fraud. While timely reporting is encouraged, there is no strict deadline for submitting the IFB 1 form. However, prompt action may improve the chances of a successful investigation.
  8. Anonymous reports are not allowed. Individuals can report suspected fraud anonymously, although providing contact information may help with follow-up inquiries.
  9. All submissions lead to criminal charges. Not every report results in criminal prosecution. The Bureau evaluates each case based on the evidence provided.
  10. Only suspicious claims should be reported. The IFB 1 form can also be used to report suspicious activities or behaviors that may not directly involve a claim.

Understanding these misconceptions can help ensure that suspected fraud is reported accurately and effectively. Timely and correct reporting is essential for addressing insurance fraud in New York.

Key takeaways

When filling out and using the New York IFB 1 form, consider the following key takeaways:

  • Accurate Information is Essential: Ensure that all details, including names, addresses, and transaction specifics, are filled out accurately to avoid delays.
  • Identify the Transaction Clearly: Provide a brief statement of the suspect transaction, including the date and amount of loss, to give a clear context.
  • Know Your Reference Numbers: Include your policy, claim, or reference number to help streamline the investigation process.
  • Designate a Contact Person: Clearly state the name, title, and contact information of someone in your organization who can provide further details if needed.
  • Report to Other Agencies: If you have reported the transaction to any other law enforcement agency, include that information to ensure comprehensive communication.

Completing the form thoroughly and accurately can significantly aid in the investigation of insurance fraud cases.