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 Insurance Fraud Bureau.  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. 
If you DO NOT work for an insurance company, Click Here.

To upload fraud evidence, Click Here.

Fraud Tip Line: 1-800-654-0775

	*  Required
*  COUNTY where the crime occurred:	Select County
*  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)
Other State Involved:	Select State
Reporting Agency
* Company Submitting Report:
* Company Address:
* City, State, Zip:	Select State
* Contact's First Name:
MI:	MI A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
* Contact's Last Name:
* Contact's Title:
* Contact's Telephone:
* Contact's Email Address:
Primary Suspect
* First Name:
MI:	MI A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
* Last Name:
Date of Birth:	(MM/DD/YYYY)
Telephone:
* Known Address:
* City, State, Zip:	Select State
* Claim No:
* Policy No:
Secondary Suspect
First Name:
MI:	MI A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Last Name:
Date of Birth:	(MM/DD/YYYY)
Telephone:
Known Address:	Same as Primary Address
City, State, Zip:	Select State
Claim No:
Policy No:
* Status of the Claim:	Select Status Open Closed Inactive Pending
* Total payments made, to date:	(Ex. 5000)
* Total financial exposure:	(Ex. 5000)
* Has the person retained legal representation?	YesNo
Evidence available:	Statements/Transcripts
	SIU Reports
	Photos
	Witness Information
	Other
If other, give description:
* Short summary as to why this is fraud:
	For additional security, please check the checkbox below (and complete any puzzle prompts you may receive).