Welcome to the
California Department of Insurance
Electronic Suspected Fraudulent Claim (eFD-1) Portal!
Effective October 1, 2020, the California Department of Insurance revised SIU regulations went into effect that instituted changes in how eFD-1 submissions are done. Specifically, revisions were made to CCR Section 2698.38(d)(9) that changed the questions that must be addressed in the eFD-1 summary. The revised summary questions are listed below:
- What facts caused the reporting party to believe insurance fraud occurred or may have occurred?
- What are the suspected misrepresentations and who it was that allegedly made them?
- How is the alleged misrepresentation(s) material, how do they affect the claim or transaction?
- Who are the pertinent witnesses to the alleged misrepresentation and what documentation exists?
- Include a statement as to whether or not the investigation is complete.
Please be informed that our eFD-1 system is undergoing a transition to reflect these revised regulations. There may be instances where the eFD-1 portal summary questions do not match the eFD-1 report questions on the PDF. However, the CDI will consider the revised questions listed above when assessing fraud referrals submitted after October 1, 2020.
Please feel free to contact ElectronicSubmissionFDfirstname.lastname@example.org or 916-854-5777 if you have any questions or concerns. Thank you.
FOR ALL USERS:
- EFD-1 Reports - To print eFD-1 reports, search for the eFD-1 and click "Versions". From there, you can View/Print the eFD-1 in PDF format for viewing and printing. Additionally, eFD-1s being previewed before submission can also be saved and printed.
- Statistical Reports – Until further notice, the EFD-1 Statistics Report and Status Summary Report will provide better data if the criteria involves smaller increments of time. For instance, running the report by month instead of by year will yield better results. Our development team is working to eliminate this time constraint.
- California District Attorney contact list – This is available in the “Help” section (question mark icon on the top banner) for user reference and submission assistance.
- Creation of New Users – If your company/entity has been registered with CDI before the release of the new eFD-1 company portal on October 1, 2018, the system will not allow you to use the same email address twice. This situation occurs when the new user is associated with different companies/entities. Please contact us for assistance.
FOR ISO/NICB USERS:
- Effective 9/6/2019, referrals submitted through ISO/NICB should be available in CDI's eFD-1 system within an hour after receiving the NICB submission confirmation message. If the referral is not available within an hour, please check back the next day. If the NICB submission confirmation message is not received after submitting a referral, please contact NICB. If you are reviewing your NICB submitted referral in the CDI eFD-1 system and there is data missing that was submitted through NICB, please contact CDI at 916-854-5777 or ElectronicSubmissionFDemail@example.com. Please note: a referral transferred from NICB is not complete until several required fields are filled-in in the eFD-1 system.
- If the referral is not available within an hour, please check back the next day.
- If the NICB submission confirmation message is not received after submitting a referral through NICB and the referral is not available in the CDI eFD-1 system, please contact NICB.
- If you are reviewing your NICB submitted referral in the CDI eFD-1 system and have additional questions, please contact CDI at 916-854-5777 or ElectronicSubmissionFDfirstname.lastname@example.org.
- Please note: a referral transferred from NICB is not complete until several required fields are filled-in in the eFD-1 system.
Other Key information regarding the transition to the new company portal:
- With the new system, starting October 1, the Case Number generation process has been changed. A Case Number is no longer generated at the time of the eFD-1 submittal. Once a user submits an eFD-1, the referral may be subject to internal processes before a case number is generated. However, once a user successfully submits a referral, the eFD-1# will act as the receipt/tracking number for both the user and CDI. An email notification will be released once the Case Number is generated.
- On or after October 1, 2018, current eFD-1 company portal users will need to login with their current User ID and password. Once in, the system will ask you to reset your password. Please check your profile and set your security questions.
- After accessing the new portal, please verify/review your company information and report any discrepancies by emailing to ElectronicSubmissionFDemail@example.com.
- Please verify/review the companies that are authorized to submit referrals on your behalf in the new eFD-1 company portal.
- Unregistered companies must register at this time for the new eFD-1 company portal. All referrals must be submitted electronically.
- Referrals by mail will no longer be accepted.
Questions - 916-854-5777 or ElectronicSubmissionFDfirstname.lastname@example.org
This web page allows registered insurance carriers, self-insured companies, and Third Party Administrators (TPA), to submit and amend Electronic Suspected Fraudulent Claims (eFD-1's).
To login and submit eFD-1's, a company must first register with the California Department of Insurance (CDI). To register:
- Click the "Sign In" button.
- Click the "Register your company here" button.
- Review and agree to the Terms and Conditions.
- All required fields identified with an asterisk (*) on the Company Registration page must be completed. When all fields and pages are complete, click the "Register" button.
If you are an admitted insurer with a valid CA number, your registration will be automatically approved. If not, the CDI will review your registration and will notify you of its status.
Registered users of insurance carriers and self-insured companies will be able to login and file Suspected Fraudulent Claim forms electronically.
Registered users of TPA will be able to login and file Suspected Fraudulent Claim forms electronically when authorized by insurance carriers and self-insured companies.
To login, please select the "Sign in" button and enter your "Username" and "Password".
Three Levels of Users Available to a Registered Company
- Company Administrator: This user is considered to be the company administrator and will have the ability to create multiple local managers and general users. A company administrator has the authority to perform all functions. All functions for all users will be described in detail after login.
- Local Managers: Local Managers can create other local managers and general users. They have most of the same rights as a company administrator; however, they are restricted from a few of the higher level functions.
- General Users: General users are typically at the working level. They can create, update, submit and amend eFD-1's. Some functions are limited for this level of user.
- One username per user is used to file Suspected Fraudulent Claim forms electronically for either a single or multiple companies.
- Select "Forgot Your Password?" button.
- Enter a Username.
- Click Submit.