Report Suspected Fraud (Insurance Companies)



The State Fire Marshals Office invites anyone with information regarding Insurance Fraud to submit information about the crime through this website online tip form.  The information will be relayed directly to the State Fire Marshals Office.  The information you provide will be maintained in the strictest of confidence.

NOTE! This form is intended to be utilized by insurance companies reporting insurance fraud. 

Fraud Tip Line: 1-800-654-0775

*  Required
*  COUNTY where the crime occurred:  
*  CITY where the crime occurred:  
* ADDRESS where the crime occurred:  
ZIP CODE where the crime occurred:
  DATE the crime occurred (As Known):  (MM/DD/YYYY)

Reporting Agency
 * Company Submitting Report:   
  * Company Address:   
 * City, State, Zip:          
* SIU Contact's First Name:   
MI:
* SIU Contact's Last Name:   
* Contact's Title:   
* Contact's Telephone:   
* Contact's Email Address:     
   

 
Primary Suspect
 
 * First Name:   
MI:
* Last Name:   
 * Date of Birth: (MM/DD/YYYY)  
Telephone:
 * Known Address:  
 * City, State, Zip:             
 * Claim No:  
 * Policy No:  
   

Secondary Suspect
 
First Name:
MI:
Last Name:
Date of Birth: (MM/DD/YYYY)
Telephone:
Known Address:
City, State, Zip:  
Claim No:
Policy No:

* Status of the Claim:   
* Total payments made, to date:  (Ex. 5000)  
* Total financial exposure:  (Ex. 5000)  
* Has the person retained legal representation?   
Evidence available:
 
 
 
If other, give description:
 
* Short summary as to why this is fraud: