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31.04.15.00.htm 31.04.15.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 04 INSURERS Chapter 15 Antifraud Plans Authority: Health-General Article, §19-706(e) Insurance Article, §2-109, 8-321.1, and 27-803; Annotated Code of Maryland
31.04.15.01.htm 31.04.15.01. 01 Purpose.. The purpose of this chapter is to establish minimum standards for antifraud plans as required by Insurance Article, §27-803, Annotated Code of Maryland.
31.04.15.02.htm 31.04.15.02. 02 Applicability.. This chapter is applicable to every authorized insurer that conducts business and writes contracts of insurance in Maryland.
31.04.15.03.htm 31.04.15.03. 03 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Administration" means the Maryland Insurance Administration.. 2) "Antifraud plan" means antifraud plans as provided for in Insurance Article, §27-803, Annotated Code of Maryland.3) "Commissioner" means the Insurance Commissioner of Maryland.. 4) Insurer.. a) “Insurer” means authorized insurers and includes dental plans, fraternal benefit societies, the M
31.04.15.04.htm 31.04.15.04. 04 Procedures and Requirements.. A. Antifraud Plan.. 1) This section does not apply to an insurer that has filed an antifraud plan with the Administration, and the plan has been approved by the Commissioner.2) An insurer authorized to write insurance business that has in force policies or certificates of insurance in this State shall institute, implement, and maintain an insurance antifraud plan.3) An insurer shall submit an antifraud plan within 90 days of the insurer
31.04.15.05.htm 31.04.15.05. 05 Plan Components.. A. Education/Training.. 1) An antifraud plan shall contain procedures for the provision of education or training, or both, to the insurer's employees regarding the detection of insurance fraud.2) Training in the recognition and referral of suspicious claims shall be:. a) Required of new and existing claims personnel, underwriters, auditors, insurance producers, and consumer service personnel; and
31.04.15.06.htm 31.04.15.06. 06 Reporting of Fraud-Related Data.. A. An insurer shall maintain appropriate records for the Commissioner to determine the effectiveness of its antifraud plan.B. A report shall be developed and provided to the Administration on an annual basis regarding the plan's effectiveness and the effectiveness of the investigative and prosecutorial efforts.C. The report shall be filed with the Administration by March 31 of each year, reporting the previous year's statistics. The
31.04.15.9999.htm 31.04.15.9999. Administrative History Effective date:. Regulations .01―06 adopted as an emergency provision effective October 1, 1996 (23:21 Md. R. 1465) adopted permanently effective December 30, 1996 (23:26 Md. R. 1859) ―Chapter recodified from COMAR 09.31.17 to COMAR 31.04.15, July 1998. Regulation .03B amended effective March 21, 2011 (38:6 Md. R. 397) February 27, 2017 (44:4 Md. R. 255)Regulation .04 amended effective March 21, 2011 (38:6 Md. R. 397).
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