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Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
Disability: means an administrative determination that may result in an entitlement to compensation as a consequence of becoming medically impaired as to function. See Utah Code 34A-2-102
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.
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.
State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(a)
“Corporation” means the same as that term is defined in Section 76-2-201.
(b)
“Intentionally” means the same as that term is defined in Section 76-2-103.
(c)
“Knowingly” means the same as that term is defined in Section 76-2-103.
(d)
“Person” means the same as that term is defined in Section 76-1-101.5.
(e)
“Recklessly” means the same as that term is defined in Section 76-2-103.
avoid paying the premium that an insurer charges, for an employee on the basis of the underwriting criteria applicable to that employee, to obtain a thing of value under this chapter or Chapter 3, Utah Occupational Disease Act; or
communicates or causes a communication with another in furtherance of the scheme or artifice.
(b)
A violation of this Subsection (2) includes a scheme or artifice to:
(i)
make or cause to be made a false written or oral statement with the intent to obtain insurance coverage as mandated by this chapter or Chapter 3, Utah Occupational Disease Act, at a rate that does not reflect the risk, industry, employer, or class code actually covered by the insurance coverage;
(ii)
form a business, reorganize a business, or change ownership in a business with the intent to:
(A)
obtain insurance coverage as mandated by this chapter or Chapter 3, Utah Occupational Disease Act, at a rate that does not reflect the risk, industry, employer, or class code actually covered by the insurance coverage;
(B)
misclassify an employee as described in Subsection (2)(b)(iii); or
(C)
deprive an employee of workers’ compensation coverage as required by Subsection 34A-2-103(8);
(iii)
misclassify an employee as one of the following so as to avoid the obligation to obtain insurance coverage as mandated by this chapter or Chapter 3, Utah Occupational Disease Act:
(A)
an independent contractor;
(B)
a sole proprietor;
(C)
an owner;
(D)
a partner;
(E)
an officer; or
(F)
a member in a limited liability company;
(iv)
use a workers’ compensation coverage waiver issued under 10, to deprive an employee of workers’ compensation coverage under this chapter or Chapter 3, Utah Occupational Disease Act; or
(v)
collect or make a claim for temporary disability compensation as provided in Section 34A-2-410 while working for gain.
(3)
(a)
Workers’ compensation insurance fraud under Subsection (2) is punishable in the manner prescribed in Subsection (3)(c).
(b)
A corporation or association is guilty of the offense of workers’ compensation insurance fraud under the same conditions as those set forth in Section 76-2-204.
(c)
(i)
In accordance with Subsection (3)(c)(ii), the determination of the degree of an offense under Subsection (2) shall be measured by the following on the basis of which creates the greatest penalty:
(A)
the total value of all property, money, or other things obtained or sought to be obtained by the scheme or artifice described in Subsection (2); or
(B)
the number of individuals not covered under this chapter or Chapter 3, Utah Occupational Disease Act, because of the scheme or artifice described in Subsection (2).
(ii)
A person is guilty of:
(A)
a class A misdemeanor:
(I)
if the value of the property, money, or other thing of value described in Subsection (3)(c)(i)(A) is less than $1,000; or
(II)
for each individual described in Subsection (3)(c)(i)(B), if the number of individuals described in Subsection (3)(c)(i)(B) is less than five;
(B)
a third degree felony:
(I)
if the value of the property, money, or other thing of value described in Subsection (3)(c)(i)(A) is equal to or greater than $1,000, but is less than $5,000; or
(II)
for each individual described in Subsection (3)(c)(i)(B), if the number of individuals described in Subsection (3)(c)(i)(B) is equal to or greater than five, but is less than 50; and
(C)
a second degree felony:
(I)
if the value of the property, money, or other thing of value described in Subsection (3)(c)(i)(A) is equal to or greater than $5,000; or
(II)
for each individual described in Subsection (3)(c)(i)(B), if the number of individuals described in Subsection (3)(c)(i)(B) is equal to or greater than 50.
(4)
The following are not a necessary element of an offense described in Subsection (2):
(a)
reliance on the part of a person;
(b)
the intent on the part of the perpetrator of an offense described in Subsection (2) to permanently deprive a person of property, money, or anything of value; or
(c)
an insurer or self-insured employer giving written notice in accordance with Subsection (5) that workers’ compensation insurance fraud is a crime.
(5)
(a)
An insurer or self-insured employer who, in connection with this chapter or Chapter 3, Utah Occupational Disease Act, prints, reproduces, or furnishes a form described in Subsection (5)(b) shall cause to be printed or displayed in comparative prominence with other content on the form the statement: “Any person who knowingly presents false or fraudulent underwriting information, files or causes to be filed a false or fraudulent claim for disability compensation or medical benefits, or submits a false or fraudulent report or billing for health care fees or other professional services is guilty of a crime and may be subject to fines and confinement in state prison.”
(b)
Subsection (5)(a) applies to a form upon which a person:
(i)
applies for insurance coverage;
(ii)
applies for a workers’ compensation coverage waiver issued under 10;
(iii)
reports payroll;
(iv)
makes a claim by reason of accident, injury, death, disease, or other claimed loss; or
(v)
makes a report or gives notice to an insurer or self-insured employer.
(c)
An insurer or self-insured employer who issues a check, warrant, or other financial instrument in payment of compensation issued under this chapter or Chapter 3, Utah Occupational Disease Act, shall cause to be printed or displayed in comparative prominence above the area for endorsement a statement substantially similar to the following: “Workers’ compensation insurance fraud is a crime punishable by Utah law.”
(d)
This Subsection (5) applies only to the legal obligations of an insurer or a self-insured employer.
(e)
A person who violates Subsection (2) is guilty of workers’ compensation insurance fraud, and the failure of an insurer or a self-insured employer to fully comply with this Subsection (5) is not:
(i)
a defense to violating Subsection (2); or
(ii)
grounds for suppressing evidence.
(6)
In the absence of malice, a person, employer, insurer, or governmental entity that reports a suspected fraudulent act relating to a workers’ compensation insurance policy or claim is not subject to civil liability for libel, slander, or another relevant cause of action.
Nothing in this section prohibits the Insurance Department from investigating violations of this section or from pursuing civil or criminal penalties for violations of this section in accordance with Section 31A-31-109 and this title.
