INSURANCE ADJUSTER FRAUD REPORT FORM

Note: The information on this form will be kept confidential and will not be released to any enforcement bureau or 3rd party unless you specifically request we do so. The American Policyholder Association & United Policyholders will use your report to compile statistics of insurer misconduct. At the end of this form you will be given the choice to have us submit it for you to the appropriate Enforcement/Regulatory Agency or to use your incident only for statistical purposes and your report will be kept strictly confidential. In either case, the APA does not share your personal information except at your request.

Full Name*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Phone
Cell*
Insurance Adjuster Company Suspected of Fraud
Insurance Adjuster Suspected of Fraud
State Loss Occurred In?*
Your Insurance Company Name
Policy No.
Briefly Describe Loss
Briefly Describe Insurance Adjuster's response?
Briefly Describe why you Think Fraud Occurred
Elements of Fraud Present in This Case
Check all that apply
- Forged Signature
- False Expert Testimony
- Changed Engineering Report
- Fraudulent Report
Will my insurance company or adjustor get mad and treat me unfairly for reporting them?
This is a question that we hear all the time. It is natural human instinct to think that if we treat others nicely, they will return the courtesy. Unfortunately, that is not always the case with insurance companies or the professionals they hire. The very fact that you are reading this reveals that you most likely have not been treated fairly. Our experience has shown the opposite: It’s easier to take advantage of a ‘quiet’ victim who keeps things to themselves. Insurance companies & the experts they hire are less likely to misbehave when they know the regulators are watching. As with all business, being an educated consumer who stands up for his or her rights is the best defense against misconduct. The American Policyholder Association strongly encourages all policyholders who feel they have been cheated by their insurance company or anyone else to pursue their rights to the fullest extent of the law. It is only by fighting back that we ensure that our friends, family, and neighbors will be treated with fairness and integrity.
Please select a reporting option*
- Yes I want to report this fraud to the appropriate enforcement or regulatory agency
- Use my information for statistics only, I will report the Fraud myself
Click here for State Fraud Reporting Info
Terms of Use Agreement
- By submitting this form I accept the terms of use of the APA and I certify that the information contained herein is accurate and truthful.

BECOME AN ASSOCIATE MEMBER

Become an associate member of the APA by filling out your details here.
Please note associate membership is just for Policyholders, Non-profits, Consumer Groups, Regulatory and Law-enforcement agencies.
If you are an Attorney, Public Insurance Adjustor or Restoration Contractor – please sign up for a Professional Membership or apply to be a Board Advisor.

Name*
E-Mail*
Phone
State*
*
- I am NOT an industry professional (Attorney, Contractor, Public Adjustor etc) and I agree to the Terms of Use*
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INSURANCE ADJUSTER FRAUD REPORT FORM

Will my insurance company or adjustor get mad and treat me unfairly for reporting them?

BECOME AN ASSOCIATE MEMBER