Fraud Investigation
Insurance DivisionInformation
Financial Services Investigation Unit (FSIU) -This Section investigates allegations of abuse, fraud, waste, and other violation of state or federal law.
This section is responsible for investigating fraud committed by licensed entities offering insurance products in the state of Tennessee. Licensed entities include but are not limited to insurance producers, agents, agencies and companies. This section does not investigate fraud committed by a consumer against an insurance company. That kind of fraud is handled by local law enforcement. Any complaint of wrongdoing by any licensed entity relating to insurance is appropriately referred to the fraud section.
The section ensures that allegations of fraud as related to the Department of Commerce and Insurance are investigated in a manner that best serves the Insurers and policyholders of the state of Tennessee. The Section functions both on a proactive and referral basis.
The Process: Complaint Form (PDF) | Online Complaint Form
Complete and sign the above complaint and forward it to the Financial Services Investigation Unit:
TDCI Financial Services Investigation Unit, 500 James Robertson Parkway 11th Floor, Nashville, Tennessee 37243-0600
Include copies of any relevant documents, such as: certificates of insurance, policy documents, sales literature, account statements, cancelled checks, confirmations, correspondence, or any other relevant materials.
Upon receipt, an investigator will be assigned to your case and you will be mailed a letter acknowledging the receipt of your complaint.
Your complaint will be reviewed by an investigator to determine whether the complaint provides reasonable suspicion to believe that there has been a violation of Tennessee Insurance Law. If so, an official investigation will be opened.
You will be contacted by the investigator if your complaint requires further investigation or further action.
If necessary, you may be asked to provide statements and/or testimony concerning the allegations in your complaint.
You will be notified when your complaint is closed and given the reason for the closure.
What does the Fraud Investigations Section (“FIS”) do? FIS investigates allegations of fraud, abuse, waste, and other violations of state insurance laws committed by insurance companies, insurance producers, agents, and other industry professionals doing business in the State of Tennessee.
What is the most common type of fraud investigated by FIS? Although our investigations vary greatly, the most common type of complaint involves premium fraud. In this type of fraud, dishonest agents collect premiums from policyholders but intentionally fail to remit the payments to the insurance carriers, leaving the victim both out-of-pocket for the loss of premiums and without insurance coverage. In some cases, the dishonest agent will produce a false certificate of insurance so that the victim believes he or she has a valid insurance policy.
Does FIS investigate fraud committed by policyholders? No. FIS regulates the insurance industry and insurance professionals. Its statutory authority does not extend to investigations involving fraud committed by policyholders or third parties. Such investigations are generally handled by insurance companies or law enforcement.
How do I file a complaint? You can file a complaint online, over the phone, or in person. The most convenient way to file a complaint is to fill out a complaint form, which is located on our website at http://www.tn.gov/insurance/fraudinvestigations/index.shtml. You can also call our hotline at (615) 253-8841 or our toll-free number at (800) 792- 7573. You are also welcome to file a complaint in person with one of our investigators at the Davy Crockett Building, 500 James Robertson Parkway, 10th Floor, Nashville, Tennessee 37243.
Can I file a complaint anonymously? Yes. You may call our hotline at (615) 253-8841 and leave as much information as you would like. However, without knowing the source of the complaint, it is often difficult to effectively investigate the allegations. What documentation do I need to file a complaint? Generally, the more relevant documentation you supply, the easier it is to investigate your complaint. Examples of relevant documentation are: insurance policies, certificates of insurance, sales literature, account statements, cancelled checks, confirmations, correspondence, or anything else that might be pertinent to proving or disproving allegations.
I have filed a complaint. What happens next? After your complaint has been received, it will be reviewed and assigned to an investigator for further evaluation. The investigator will review your complaint and decide whether to recommend that we open an official investigation. You will be contacted by the investigator who will be looking to gather more facts and information, and you may be asked to give a formal interview or statement. If necessary, you may be asked to testify at an administrative hearing.
What happens if FIS determines that fraud has occurred? If the investigation concludes that fraud has occurred, FIS will recommend that the appropriate administrative action be taken by our legal division. Such action could include fines, suspension, or revocation of the license. If legal action is initiated, the outcome will be determined in a hearing before an administrative law judge. In certain situations, FIS will refer the investigation to the appropriate law enforcement authorities for possible criminal prosecution.