Report Insurance Fraud

*Indicates required field

Information About the Fraud

Type of Fraud

City

State

Date

Time

Name(s), address(es), phone number(s) and other information about individuals involved

How did you learn about the suspected fraud? Please describe the incident in detail.

Additional information pertaining to the suspected fraud

We can assure you that your identity will remain anonymous should you choose to share it.

May we please contact you?

Yes

Please provide at least your first name and either your phone number or your email address.

First Name

Last Name

Phone Number

Email Address