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Home » Submit a Complaint » Insurance Fraud Industry Complaints

Insurance Fraud Industry Complaints

Insurance professionals can use this form to submit a fraud referral to our Insurance Fraud Section. Provide the case details and any supporting documentation so our team can review and investigate suspected fraudulent activity.

Section Resources

Please read the instructions before filling out the form.

Print an industry insurance referral form and send by mail

All printed documents should be sent to the following address:

Office of Attorney General
Insurance Fraud Section
16th Floor, Strawberry Square
Harrisburg PA 17120

"*" indicates required fields

Referred by

Your Name*
Address

Subject Information

Include additional subjects in the Fraud Allegation/Summary Section
(include any known Alias)
Address
Address Type

Sex
This field is hidden when viewing the form

Referral Status

Have you referred this to any other law enforcement agency?
Reason why you are sending this matter to our office

Location Information

City, County, State

Claim Information

(If additional companies are involved please include in Fraud Allegation/Summary Section)
MM slash DD slash YYYY
MM slash DD slash YYYY
Status of claim

Type of Insurance/Fraud Involved
Fraud Summary
Drop files here or
Max. file size: 256 MB, Max. files: 25.
    MM slash DD slash YYYY
    AG Dave Sunday

    Pennsylvania Office of Attorney General

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