Terminology Relevant To Undertanding Lega/Criminal Matters

  • Terminology relevant to understanding legal/criminal matters.

 

  • Adjudicate:  To make a formal judgement or decision about a problem or disputed matter.

 

  • Adjudicated Guilty:  Means the individual has been found guilty and the court has not withheld “adjudication”.

 

  • Administration of Criminal Justice:  This term refers to the actual act of law enforcement such as detecting, apprehending, detaining, prosecuting or correctional supervision by a government agency.

 

  • Disposition:  Means the details which pertain to the termination of an individual with a criminal justice/regulatory entity.  The information contained within the disposition includes the reason the criminal justice department choose not to refer the matter to a prosecutor, or the matter has already been addressed by the courts (incarcerated, paroled, pardoned, released, etc.

 

  • Record:  Refers to any/all documents, writings, computer memory, microfilm, and any other method of storing information regardless if the information is an official, public, or admissible record (including copies)

 

The investigative division also receives information from consumers, insurers and any other entity with information pertaining potential violations.  Licensed and/or regulated professional medical practitioners having knowledge of “Fraudulent Insurance Acts” are obligated to report and provide information pertaining the violations.  

 

It’s within the best judgement of the division to require further investigation and report alleged violations to the appropriate licensing agency, state attorney and/or other prosecuting agency having jurisdiction over the alleged violation.  

 

  • If the division submits for prosecution to a state attorney or other prosecuting agency and no action is taken the entity must provide to the division a reason for not prosecuting.

 

Florida’s Insurance Marketplace and our Division of Investigative and Forensic Services; when compared with of fraud bureaus and divisions in other states, consistently ranks among the Top 5 safest marketplaces.   

As stated, our Fraud Division is responsible for investigating “suspected” insurance fraud, regardless of who commits the offense (Consumer, Licensee, or Business).  The efforts of the CFO, Office and supporting entities have helped make Florida, one of the safest insurance marketplaces in the USA.

 

In addition to regulatory responsibilities the Division of Investigative and Forensic Services also promotes consumer and professional education and encourages all Floridians to participate and report suspected fraud by utilizing the DFS Fraud Hotline or online resources.  National studies focused on fraud estimate at least $80 BILLION DOLLARS (or more) per year is lost due to insurance fraud alone.  

 

The Coalition Against Insurance Fraud reports these losses are ultimately passed onto the consumer in the form of annual premium increases.

 

  • Online resources to report fraud: MyFloridaCFO.com/fraud

 

  • Consumer Insurance Fraud Hotline: 1.800.378.0445

 

  • Publications: Monthly Newsletter – The PIP Source | Nov 2015 issue 

Q/A interviews and articles with Florida’s State Attorney answering consumer questions such as, 

 

  • Why do you think the State Prosecutors office works so well with the Office of Insurance Regulation?  

 

Katherine Fernandez Rundle responds by praising the diligence of Office Investigators.  She credits detailed investigations and an open working relationship with the State Prosecutors Office success… 

 

“When my prosecution team walks into a courtroom, if the Division of Insurance Fraud has put the case together, they know they have a solid case.  A great deal of credit goes to the CFO for his continued leadership in supporting these efforts”  



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