Minnesota Department of Commerce
Insurance Fraud Division
Suspected Fraud Report
   
This form is only to report insurance fraud.
If you have questions about your insurance policy, your insurance coverage, or about how a claim is being handled, you should contact our Consumer Protection and Education division. You can email consumer.protection@state.mn.us
or call 651-296-2488 or 1-800-657-3602 (MN only).
    

Your Name:
Your Street Address:
City, State, ZIP     
Your Phone: Home: Business:
Give a brief statement of the suspect transaction and the amount of money involved (if known):
Identify the parties to the suspect transaction:
Name and Address if insurance company(s) or HMO(s) (if applicable):
Have you reported this transaction to any other law enforcement agency: Yes

No
If the above answer is YES, please furnish the following information: Name of Agency:

Address of Agency:

Person Contacted:

Phone Number:

Comments or additional information:

Thank you for using our electronic submission form.