Revisión de Planes Antifraude por el Comisionado

Explicación Simple

Los seguros deben presentar un plan para evitar el fraude. Si el plan no es bueno, el comisionado lo rechaza y debe volver a enviarlo en 60 días.

Es como cuando un profesor revisa un proyecto. Si no le gusta, te dice por qué y te da tiempo para mejorar y entregarlo de nuevo.

Ejemplo Práctico

Imagina que la compañía de seguros 'Seguros Felices' presenta un plan antifraude al comisionado. Si el comisionado encuentra fallas, le dice a 'Seguros Felices' qué corregir y les da 60 días para volver a enviarlo. Si lo hacen bien, pueden seguir trabajando.

Texto Original del Estatuto (Inglés)

75 Pa.C.S. 1813 - Review By Commissioner Antifraud plans shall be filed with the department. If, after review, the commissioner finds that the antifraud plan does not comply with section 1812 (relating to content of plans), the antifraud plan may be disapproved. Notice of disapproval shall include a statement of the specific reasons for such disapproval. Any plan disapproved by the commissioner must be refiled within 60 days of the date of the notice of disapproval. The commissioner may audit insurers to ensure compliance with antifraud plans as a part of the examinations performed under sections 213, 214 and 216 of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of one thousand nine hundred and twenty-one. References in Text.Sections 213, 214 and 216 of the act of May 17, 1921 (P.L.789, No.285), known as The Insurance Department Act of 1921, referred to in this section, were repealed by the act of February 17, 1994 (P.L.79, No.8). Cross References.Section 1813 is referred to in section 1815 of this title. 75 Pa.C.S. 1814 - Report On Antifraud Activities All insurers shall annually provide to the department a summary report on actions taken under the plan to prevent and combat insurance fraud, including, but not limited to, measures taken to protect and ensure the integrity of electronic data-processing-generated data and manually compiled data, statistical data on the amount of resources committed to combating fraud, and the amount of fraud identified and recovered during the reporting period.