23-934. Fraud; investigations; rules

320 words·~1 min read·/az/title-23/23-934

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

A. The commission shall establish a fraud unit for the purpose of investigating fraudulent activities, statements or representations made in connection with workers' compensation claims. The fraud unit may investigate allegations of fraud either on receiving a complaint or on the fraud unit's own motion. Any allegation involving unfair claim processing practices or bad faith by an employer, self-insured employer, insurance carrier or claims processing representative shall be addressed pursuant to section 23-930.

B. The commission shall adopt rules to establish a process for receiving fraud complaints and conducting fraud investigations pursuant to this section. The rules shall establish:

1. A process by which the fraud unit verifies claimant annual earnings reported pursuant to section 23-1047 with the department of economic security unemployment insurance information for the purpose of investigating workers' compensation fraud.

2. A process of timeliness for receiving and processing fraud complaints.

3. Criteria for determining which allegations of fraud warrant investigation.

4. Duties and authorities of fraud investigators, including issuing and serving subpoenas for witnesses and documentary evidence, taking depositions, administering oaths and examining witnesses under oath relevant to the fraud investigation.

C. If, on investigation, the fraud unit is satisfied that fraudulent activities, statements or representations were made in connection with a workers' compensation benefits or payments claim for the purpose of obtaining compensation benefits or payments, the fraud unit may report violations of law to the claimant or claimant's representative, to the reporting employer, self-insured employer or insurance carrier, to the appropriate licensing agency as defined in section 20-466.04, and to the appropriate county attorney or the attorney general for prosecution.

D. This section does not limit any of the following:

1. The authority of the commission, the department of insurance and financial institutions or any other entity to pursue any remedy pursuant to section 23-970 or 23-1028.

2. The obligation of an insurer to report a fraud claim pursuant to section 20-466, subsection G.