Wisconsin Fraud Reporting

Definition of “Fraudulent Insurance Act”

Wis. Stat. s. 895.486 defines “insurance fraud”:

(1) In this section, "insurance fraud" means the presentation of any statement, document or claim, or the preparation of a statement, document or claim with the knowledge that the statement, document or claim will be presented, that the person knew or should have known contained materially false, incomplete or misleading information concerning any of the following:

(a) An application for the issuance of an insurance policy. (b) A claim for payment, reimbursement or benefits payable under an insurance policy.
(c) A payment made in accordance with the terms of an insurance policy.
(d) A premium on an insurance policy.
(e) The rating of an insurance policy.
. . .

Mandatory Fraud Reporting Statute(s) - None, unrelated to agent fraud.

No mandatory reporting requirement if unrelated to agent fraud.
Agent has duty to report his own change in status per Wis. Stat. s. 628.08:

Every change in the members of a partnership or a limited liability company or the principal officers of a corporation licensed as an intermediary, every significant change in management powers in the entity, and so far as it relates to competency or trustworthiness as an intermediary, every change in the status and relationships of a natural person licensed as an intermediary, shall be reported to the commissioner promptly by the intermediary, in such detail and form as the commissioner by rule prescribes.

*“An Intermediary’s Guide to Wisconsin Law,” references Wis. Stat. 628.08 (recited above), and provides the following examples of “changes in status [which] must be reported to the commissioner within 30 days:”
. . .
• Lawsuit filed alleging misrepresentation, fraud, theft, or embezzlement (individual or business). (emphasis added)
. . .
*Please carefully review pages 21-22 of “An Intermediary’s Guide to Wisconsin Law,” because in addition to the above, there are other examples provided of when an agent must report himself.

How to Report Fraud - Not provided by Regulator if unrelated to agent fraud

For agent fraud, contact the Office of the Commissioner’s Agent Licensing Section, Melody Esquivel, Insurance Supervisor, ph. 608-264-8132, melody.esquivel@wisconsin.gov.