Arizona Laws 23-934. Fraud; investigations; rules
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.
Terms Used In Arizona Laws 23-934
- Allegation: something that someone says happened.
- Commission: means the industrial commission of Arizona. See Arizona Laws 23-901
- Compensation: means the compensation and benefits provided by this chapter. See Arizona Laws 23-901
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Fraud: Intentional deception resulting in injury to another.
- including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
- Insurance carrier: means every insurance carrier duly authorized by the director of the department of insurance and financial institutions to write workers' compensation or occupational disease compensation insurance in this state. See Arizona Laws 23-901
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
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.