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Referral Instruction Sheet
Insurance Industry
  1. PPrint and fill out this form, providing all contact information including: your name, your company name, full street address, your e-mail address and a telephone number where you can be reached.
  2. Provide the name of the person or persons you are alleging have committed insurance fraud.
  3. Indicate if you have referred the case to another agency and the name of the agency.
  4. The Philadelphia District Attorney’s Office has jurisdiction to investigate and prosecute a case if at least one of the following occurred in the City and County of Philadelphia: the incident, the claim was received, the false statement was made, the insurance payment was issued and/or the insurance payment was sent. Please indicate if any of these events occurred within the City and County of Philadelphia.
  5. Provide a summary of the essential facts of the case and the specific fraudulent conduct alleged.