102.125 Fraud reporting, investigation, and prosecution.

371 words·~2 min read·/wi/chapter-102/102-125-7

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

(1)Fraudulent claims reporting and investigation. If an insurer or self-insured employer has evidence that a claim is false or fraudulent in violation of s. 943.395 and if the insurer or self-insured employer is satisfied that reporting the claim to the department will not impede its ability to defend the claim, the insurer or self-insured employer shall report the claim to the department. The department may require an insurer or self-insured employer to investigate an allegedly false or fraudulent claim and may provide the insurer or self-insured employer with any records of the department relating to that claim. An insurer or self-insured employer that investigates a claim under this subsection shall report on the results of that investigation to the department.

(1m)Application and premium fraud. If an insurer has evidence that an application for worker’s compensation insurance coverage is fraudulent or that an employer has committed fraud by misclassifying employees to lower the employer’s worker’s compensation insurance premiums in violation of s. 943.395 , the insurer shall report the claim to the department. The department may require an insurer to investigate an allegedly fraudulent application or alleged fraud by misclassification of employees and may provide the insurer with any records of the department relating to that alleged fraud. An insurer that investigates alleged fraud under this subsection shall report the results of that investigation to the department.

(2)Assistance by department of justice. The department of workforce development may request the department of justice to assist the department of workforce development in an investigation under sub.

(1)or

(1m)or in the investigation of any other suspected fraudulent activity on the part of an employer, employee, insurer, health care provider, or other person related to worker’s compensation.

(3)Prosecution. If based on an investigation under sub.

(1),

(1m), or

(2)the department has a reasonable basis to believe that a violation of s. 943.20 , 943.38 , 943.39 , 943.392 , 943.395 , 943.40 , or any other criminal law has occurred, the department shall refer the results of the investigation to the department of justice or to the district attorney of the county in which the alleged violation occurred for prosecution.