Referral Instruction Sheet
- 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.
- Provide the name of the person or persons you are alleging have committed insurance fraud.
- Indicate if you have referred the case to another agency and the name of the agency.
- 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.
- Provide a summary of the essential facts of the case and the specific fraudulent conduct alleged.