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The New York Ifb 1 form serves as a crucial tool for reporting suspected insurance fraud to the New York State Department of Financial Services' Insurance Frauds Bureau. This form collects essential information regarding the nature of the suspected fraudulent transaction, including the date and amount of loss, as well as the type of loss, such as auto, no-fault, medical, or workers' compensation. It requires detailed identification of the parties involved in the transaction, including names, addresses, and any relevant vehicle identification numbers or license plate information. Additionally, the form prompts the reporter to provide their policy, claim, or reference numbers associated with the incident, ensuring that all pertinent details are linked to the correct records. The individual reporting the fraud must also supply their contact information, making it easier for investigators to reach out for further clarification. Furthermore, if the transaction has been reported to other law enforcement agencies, this information must be disclosed, enhancing the collaborative efforts to combat insurance fraud. Timely and accurate completion of the Ifb 1 form is vital in the fight against fraudulent activities, as it helps streamline investigations and protect consumers.

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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 Specifications

Fact Name Description
Governing Authority The New York IFB-1 form is governed by the New York State Department of Financial Services.
Purpose This form is utilized to report suspected insurance fraud to the Insurance Frauds Bureau.
Submission Requirements Information must be printed or typed, including details about the suspect transaction and parties involved.
Law Enforcement Notification Submitters must indicate if they have reported the transaction to any other law enforcement agency.
Contact Information The form requires the name, title, address, and phone number of a company representative who can provide further details.

New York Ifb 1: Usage Guidelines

Filling out the New York IFB 1 form requires careful attention to detail. This form is essential for reporting suspected insurance fraud, and it's important to provide accurate information to facilitate the investigation. Follow these steps to complete the form correctly.

  1. Begin by entering the date at the top of the form.
  2. In the section labeled "Information furnished by," write your name and address. Include your NAIC number if applicable. Indicate whether this information has been previously submitted and provide the log number if it has.
  3. In the "Brief statement of suspect transaction" section, fill in the date and amount of the loss. Specify the county and select the type of loss from the options provided. If the loss is related to auto or no-fault insurance, 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 about the suspects. If the case involves auto insurance or fraudulent ID cards, include the Vehicle Identification Number (VIN) and the plate or license number.
  5. Provide your policy, claim, or reference number related to the transaction. Fill in the claim number, status, reference number, policy number, and SIU number if applicable.
  6. Include the name, title, address, and telephone number of a contact person in your company who can provide more information about the case.
  7. Indicate whether you have reported this transaction to any other law enforcement agency. If yes, provide the agency's name, address, the person contacted, their telephone number, and the date of the report.
  8. Finally, sign the form and include your title.

Once you have completed the form, review it for accuracy before submitting. Make sure all necessary information is included, and if more space is needed, continue on the reverse side or attach additional sheets. Properly submitting this form can help address potential fraud effectively.

Your Questions, Answered

What is the New York Ifb 1 form?

The New York Ifb 1 form is a document used to report suspected insurance fraud to the New York State Department of Financial Services. It collects information about fraudulent transactions, including details about the parties involved and the nature of the fraud. This form is crucial for helping authorities investigate and address insurance fraud effectively.

Who should fill out the Ifb 1 form?

The Ifb 1 form should be filled out by individuals or companies that suspect fraudulent activity related to insurance claims. This may include insurance companies, claims adjusters, or other parties who have knowledge of suspicious transactions. It is important that the information provided is accurate and complete to facilitate a thorough investigation.

What information is required on the Ifb 1 form?

The form requires several key pieces of information. You must provide details about the suspect transaction, including the date of loss, amount of loss, and type of loss. Additionally, you need to identify the parties involved, provide policy and claim numbers, and include contact information for someone who can offer further details. If applicable, information about any other law enforcement agencies contacted should also be included.

What types of fraud can be reported using the Ifb 1 form?

The Ifb 1 form can be used to report various types of insurance fraud. This includes auto fraud, no-fault fraud, medical fraud, workers' compensation fraud, and fraudulent identification cards. If you suspect other types of fraud, you can specify them in the “Other” section of the form.

Is it necessary to report the transaction to other law enforcement agencies?

How do I submit the Ifb 1 form?

You can submit the Ifb 1 form by mailing it to the New York State Department of Financial Services at the address provided on the form. Ensure that all sections are filled out completely and accurately before sending it. If you have additional information, you may attach extra sheets as necessary.

What happens after I submit the Ifb 1 form?

After submission, the Department of Financial Services will review the information provided. They may reach out for additional details or clarification if needed. The department will then investigate the claim and take appropriate action based on their findings. You may not receive updates on the investigation due to privacy and confidentiality regulations.

Can I remain anonymous when reporting fraud?

The Ifb 1 form does require your contact information, but you may choose not to provide your name if you feel uncomfortable. However, providing your contact details can help authorities reach you for more information, which may be vital for the investigation.

What should I do if I have more questions about the Ifb 1 form?

If you have further questions, you can contact the New York State Department of Financial Services directly. They can provide guidance on completing the form and answer any specific questions you may have regarding the reporting process.

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to delays. Ensure every section is addressed, especially the name and address sections.

  2. Illegible Handwriting: If you choose to handwrite the form, make sure your writing is clear. Illegible text can cause confusion and might require resubmission.

  3. Incorrect Dates: Double-check the date of loss. An incorrect date can affect the investigation and may lead to the form being rejected.

  4. Missing Claim or Policy Numbers: Not providing the correct claim or policy number can hinder the processing of your report. Always verify these numbers before submission.

  5. Omitting Additional Information: If there are details about the suspect or the transaction that could be relevant, include them. This helps the authorities better understand the situation.

  6. Failure to Sign: Remember to sign the form at the end. A missing signature can result in the form being considered incomplete.

  7. Not Reporting to Other Agencies: If you have reported the incident to another law enforcement agency, be sure to include that information. This can provide valuable context.

  8. Ignoring the Instructions: Each section has specific requirements. Read the instructions carefully to avoid common pitfalls.

Documents used along the form

The New York Ifb 1 form is a critical document used to report suspected insurance fraud. It is often accompanied by several other forms and documents that provide additional context and information related to the fraud investigation. Below is a list of commonly used forms that complement the Ifb 1.

  • Insurance Claim Form: This document outlines the specifics of the insurance claim, including the nature of the claim, the parties involved, and the amount being claimed. It serves as a foundational document for the Ifb 1 form.
  • Fraud Investigation Report: Created by investigators, this report details the findings of an inquiry into the suspected fraudulent activity. It includes evidence collected, witness statements, and conclusions drawn from the investigation.
  • Witness Statement Form: This form is used to gather firsthand accounts from individuals who may have witnessed the fraudulent activity. It helps to corroborate the details provided in the Ifb 1 form.
  • Incident Report: Often filed with law enforcement, this document provides an official record of the incident that prompted the fraud report. It includes information such as dates, times, and descriptions of the events.
  • Policy Declaration Page: This page summarizes the insurance policy terms, coverage limits, and the insured parties. It is essential for verifying the legitimacy of the policy in question.
  • Supplemental Information Form: This form allows the reporting party to provide additional details or context that may not have been captured in the Ifb 1 form. It can be crucial for a thorough investigation.

These forms and documents collectively enhance the reporting process and facilitate a comprehensive investigation into suspected insurance fraud. Each plays a unique role in ensuring that all relevant information is available for review by authorities.

Similar forms

The New York IFB 1 form is a vital document used for reporting insurance fraud. It serves a specific purpose, but there are several other documents that share similarities in terms of function and structure. Here’s a list of ten documents that are comparable to the IFB 1 form:

  • Fraud Report Form: Like the IFB 1, this form is used to report suspected fraudulent activities within insurance claims. It typically includes details about the transaction and the parties involved.
  • Insurance Claim Form: This document is essential for initiating a claim. It requires information about the incident, similar to the IFB 1's request for details about the suspect transaction.
  • Incident Report: Often used in various industries, this report captures details of an event or transaction. It parallels the IFB 1 by documenting essential facts and parties involved.
  • Suspicious Activity Report (SAR): Financial institutions use this form to report unusual transactions. It shares the investigative nature of the IFB 1, focusing on potential fraud.
  • Loss Notification Form: This form notifies an insurance company about a loss. It includes information about the loss type and amount, much like the IFB 1.
  • Witness Statement Form: This document collects information from witnesses of an event. It aligns with the IFB 1 by gathering detailed accounts related to a suspect transaction.
  • Insurance Policy Application: This form is filled out when applying for insurance coverage. It often includes personal information and details about the insured item, similar to the information requested in the IFB 1.
  • Claim Adjustment Form: Used to amend or adjust a claim, this form requires specifics about the claim, paralleling the details sought in the IFB 1.
  • Regulatory Compliance Report: This document ensures that companies comply with legal standards. It often requires detailed information about transactions, akin to the IFB 1’s requirements.
  • Medical Claim Form: This form is used to submit medical expenses for reimbursement. It requires detailed information about the treatment and costs, similar to the IFB 1's focus on loss details.

Each of these documents plays a role in documenting transactions and reporting potential fraud, reflecting the importance of transparency and accountability in the insurance industry.

Dos and Don'ts

When filling out the New York IFB 1 form, it’s important to follow certain guidelines to ensure accuracy and compliance. Below are ten things you should and shouldn’t do during this process.

  • Do print or type your information clearly to avoid confusion.
  • Don’t leave any required fields blank. Fill out every section that applies.
  • Do provide a detailed statement of the suspect transaction, including dates and amounts.
  • Don’t use abbreviations or shorthand that may not be understood.
  • Do ensure that the names and addresses of all parties involved are accurate.
  • Don’t forget to include any relevant policy or claim numbers associated with the transaction.
  • Do indicate if the transaction has been reported to any other law enforcement agency.
  • Don’t provide false information or omit details that could be crucial to the investigation.
  • Do include your contact information for follow-up questions or clarifications.
  • Don’t submit the form without reviewing it for errors or omissions.

Misconceptions

Understanding the New York IFB 1 form is crucial for those involved in reporting insurance fraud. However, several misconceptions often arise. Here are six common misunderstandings about this form:

  • It is only for auto insurance fraud. Many believe that the IFB 1 form is limited to auto-related fraud. In reality, it covers various types of fraud, including medical, workers' compensation, and fraudulent ID cards.
  • Only large insurance companies need to use the form. This is not true. Any entity, regardless of size, that suspects fraudulent activity can and should report it using the IFB 1 form.
  • Submitting the form guarantees an investigation. While submitting the IFB 1 form initiates a review process, it does not guarantee that an investigation will occur. The decision to investigate is based on various factors.
  • All information must be complete before submission. While providing as much information as possible is helpful, individuals can submit the form even if some details are missing. Additional information can be provided later.
  • Confidentiality is not maintained. Many fear that their identity will be revealed when submitting the form. However, the process is designed to protect the identity of the reporting individual to encourage reporting.
  • Once submitted, the form cannot be amended. This misconception is false. If new information arises after submission, individuals can provide updates or additional sheets as necessary.

By addressing these misconceptions, individuals can better navigate the reporting process and contribute to the fight against insurance fraud in New York.

Key takeaways

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

  • Accuracy is crucial. Ensure all information is correct to avoid delays in processing.
  • Complete all sections. Every part of the form must be filled out, including the brief statement of the suspect transaction.
  • Provide detailed descriptions. Be specific about the type of loss and the circumstances surrounding the incident.
  • Include relevant identifiers. If applicable, provide VIN numbers and license plate information to help identify vehicles involved.
  • Designate a contact person. Include the name and contact details of someone who can provide further information if needed.
  • Document any prior reports. If you have reported the incident to another agency, include those details to streamline communication.
  • Keep a copy for your records. Always retain a copy of the submitted form for your own documentation and follow-up.