Program Eligibility Contract

To be eligible for the Insurance Fraud Prevention Intervention Program:

GENERAL CRITERIA
1. Applicants must accept responsibility for their misrepresentation during the associated
insurance claim and be must agree to participate in insurance fraud education.

2. Applicants must comply with the following within 15-days of acceptance into the program:
a. Applicants must complete a Constitutional Rights Questionnaire and waiver of rights.
b. Applicant must complete all education modules.
c. Applicants must complete a demographic questionnaire and Program evaluation.
d. Applicants must pay, in full, the stated administration fee.

INELIGIBLE APPLICANTS
Applicants are ineligible to apply for the Insurance Fraud Intervention Program if any of the following facts are present in the case:
1. If the applicant holds a position of trust.
2. If there was an “actual” financial loss to the Insurer.
3. If the applicant has had a prior charge of Insurance Fraud.
4. If the violation resulted in consumer harm.

ADDITIONAL QUALIFICATIONS REGARDING ELIGIBILITY
In addition to other considerations listed within these guidelines, each case’s eligibility is considered on a case-by-case basis as to the following criteria.

Victim Impact – Consumer Harm
In instances, in which another person has had their liability or bodily injury claim denied due to the applicant’s misrepresentation during the insurance process, the applicant would not be eligible to participate in the program.

Responsibility for the Offense:
To be eligible for the Program, the applicant must acknowledge that the evidence available could likely result in conviction upon prosecution. An applicant’s initial or subsequent plea in court is not to be considered for eligibility.
The applicant must accept responsibility for the offense to the extent that they agree to comply with all the Program’s terms and conditions. An applicant may plead not guilty and reserve the right to a trial if not accepted into the Program or if later dropped from the Program.

Positions of Trust:
Offenses that constitute violations of a position of trust whether public or private may not be eligible for the program. This includes any of the following, but is not limited to:
1. Any person who stands in a fiduciary relationship to the victim, including a trustee, an attorney, or a certified public accountant.
2. Offenses that constitute a violation of a professional duty or licensing rule, regulation, including insurance producers, or those working with in the insurance industry.

PROGRAM TERMS & CONDITIONS
Applicants that are otherwise eligible who believe the facts of the case are inaccurate should request a review of their case within 15 days of receiving notice. All supporting evidence will be reviewed and considered.

CONFIDENTIALITY
Any information which pertains to anyone who is being screened or has been accepted into the Program or who has been in the program at any time in the past, will remain available to STR Intervention Specialists and the Assigning Agency. This includes the following information:

1. Name of Applicant
2. Date of Offense
3. Nature of the Offense
4. Constitutional Rights Questionnaire
5. Acceptance & Rejection Report
6. Program Outcome Status

Any person who participates in the Program waives any right to confidentiality with respect to the Program Agreement which sets forth the conditions of the Program. Information pertaining to the successful completion of the Program can be used in criminal court proceedings, upon any future charges of insurance fraud violation.

UNSUCCESSFUL TERMINATION FROM A PROBLEM-SOLVING PROGRAM
Participants may be terminated from the Program for noncompliance with the conditions of their program agreement. Participants are expected to fulfill all contract terms to constitute a successful completion. Specific conditions of the program agreement may not be modified without prior approval by the Assigning Agency.
If a participant is terminated from the Program the Assigning Agency will be notified by STR administration.