Report Suspected Insurance Fraud - Commissioner Of Securities & Insurance Montana State Auditor

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Matt M. Rosendale
Phone: 406.444.2040
Commissioner of Securities & Insurance
800.332.6148
Montana State Auditor
Fax: 406.444.3497
840 Helena Ave
Helena, MT 59601
Report Suspected
Insurance Fraud
Your Information:
Last
First
Phone #
E-mail Address
Street/Apartment #
City
State
ZIP Code
Suspect Information:
Last
First
M.I.
Date of Birth
Street/Apartment #
City
State
ZIP Code
Nature of Suspected Fraud:
Faked Property Damage
Billed for Services Not Provided
Inflated Financial Loss
Billed for Excessive or Extended Treatments
Faked/Exaggerated Injury
Fabricated Services
Staged Accident/Injury
Charged Inconsistent with Services Provided
History of Filing Suspect Claims
Other:
Provided an Inaccurate History
Describe the nature of the suspected fraud. Please include as much information as you can about the type
of insurance involved, the dates the suspected fraud occurred and a description of the suspected fraud:
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