1877. This article shall be known and may be cited as the Workers'
Compensation Insurance Fraud Reporting Act.
1877.1. The following definitions govern the construction of this
article, unless the context requires otherwise:
(a) "Authorized governmental agency" means the district attorney
of any county, any city attorney whose duties include criminal
prosecutions, any law enforcement agency investigating workers'
compensation fraud, the office of the Attorney General, the
Department of Insurance, the Department of Industrial Relations, the
Employment Development Department, the Department of Corrections and
Rehabilitation, the Public Employees' Retirement System, and any
licensing agency governed by the Business and Professions Code.
(b) "Relevant" means having a tendency to make the existence of
any fact that is of consequence to the investigation or determination
of an issue more probable or less probable than it would be without
the information.
(c) "Insurer" means an insurer admitted to transact workers'
compensation insurance in this state, the State Compensation
Insurance Fund, an employer that has secured a certificate of consent
to self-insure pursuant to subdivision (b) or (c) of Section 3700 of
the Labor Code, or a third-party administrator that has secured a
certificate pursuant to Section 3702.1 of the Labor Code.
(d) "Licensed rating organization" means a rating organization
licensed by the Insurance Commissioner pursuant to Section 11750.1.
(e) Information shall be deemed important if, within the sole
discretion of the authorized governmental agency, that information is
requested by that authorized governmental agency.
1877.2. For the purposes of this article, "authorized governmental
agency" includes, in addition to the entities listed in subdivision
(a) of Section 1877.1, any licensing agency governed by the
Chiropractic Initiative Act.
1877.3. (a) Upon written request to an insurer or a licensed rating
organization by an authorized governmental agency, an insurer, an
agent authorized by that insurer, or a licensed rating organization
to act on behalf of the insurer, shall release to the requesting
authorized governmental agency any or all relevant information deemed
important to the authorized governmental agency that the insurer or
licensed rating organization may possess relating to any specific
workers' compensation insurance fraud investigation.
(b) (1) When an insurer or licensed rating organization knows or
reasonably believes it knows the identity of a person or entity whom
it has reason to believe committed a fraudulent act relating to a
workers' compensation insurance claim or a workers' compensation
insurance policy, including any policy application, or has knowledge
of such a fraudulent act that is reasonably believed not to have been
reported to an authorized governmental agency, then, for the purpose
of notification and investigation, the insurer, or agent authorized
by an insurer to act on its behalf, or licensed rating organization
shall notify the local district attorney's office and the Fraud
Division of the Department of Insurance, and may notify any other
authorized governmental agency of that suspected fraud and provide
any additional information in accordance with subdivision (a). The
insurer or licensed rating organization shall state in its notice the
basis of the suspected fraud.
(2) Insurers shall use a form prescribed by the department for the
purposes of reporting suspected fraudulent workers' compensation
acts pursuant to this subdivision.
(3) Nothing in this subdivision shall abrogate or impair the
rights or powers created under subdivision (a).
(c) The authorized governmental agency provided with information
pursuant to subdivision (a), (b), or (e) may release or provide that
information in a confidential manner to any other authorized
governmental agency for purposes of investigation, prosecution, or
prevention of insurance fraud or workers' compensation fraud.
(d) An insurer or licensed rating organization providing
information to an authorized governmental agency pursuant to this
section shall provide the information within a reasonable time, but
not exceeding 60 days from the day on which the duty arose.
(e) Upon written request by an authorized governmental agency, as
specified in subdivision (o) of Section 1095 of the Unemployment
Insurance Code, the Employment Development Department shall release
to the requesting agency any or all relevant information that the
Employment Development Department may possess relating to any
specific workers' compensation insurance fraud investigation.
Relevant information may include, but is not limited to, all of the
following:
(1) Copies of unemployment and disability insurance application
and claim forms and copies of any supporting medical records,
documentation, and records pertaining thereto.
(2) Copies of returns filed by an employer pursuant to Section
1088 of the Unemployment Insurance Code and copies of supporting
documentation.
(3) Copies of benefit payment checks issued to claimants.
(4) Copies of any documentation that specifically identifies the
claimant by social security number, residence address, or telephone
number.
1877.35. (a) The Public Employees' Retirement System may request
information from an insurer for any specific investigation of
eligibility for, and unlawful application or receipt of, benefits
provided under Part 3 (commencing with Section 20000) of Division 5
of Title 2 of the Government Code.
(b) Information received by the Public Employees' Retirement
System pursuant to this article may be used for purposes of
determining eligibility for, and unlawful application or receipt of,
benefits provided under Part 3 (commencing with Section 20000) of
Division 5 of Title 2 of the Government Code.
1877.4. (a) Any information acquired pursuant to this article shall
not be a part of the public record. Except as otherwise provided by
law, any authorized governmental agency, an insurer, or an agent
authorized to act on its behalf, which receives any information
furnished pursuant to this article shall not release that information
to any person not authorized to receive the information under this
article. Any person who violates the prohibition of this subdivision
is guilty of a misdemeanor.
(b) The evidence or information described in this section shall be
privileged and shall not be subject to subpoena or subpoena duces
tecum in a civil or criminal proceeding, unless, after reasonable
notice to any insurer, an agent authorized by an insurer to act on
its behalf, licensed rating organization, or authorized governmental
agency which has an interest in the information, and a hearing, the
court determines that the public interest and any ongoing
investigation by the authorized governmental agency, insurer, or an
agent authorized by the insurer to act on its behalf, or licensed
rating organization will not be jeopardized by its disclosure, or by
the issuance of and compliance with a subpoena or subpoena duces
tecum.
1877.5. No insurer, agent authorized by an insurer to act on its
behalf, or licensed rating organization who furnishes information,
written or oral, pursuant to this article, and no authorized
governmental agency or its employees who (a) furnishes or receives
information, written or oral, pursuant to this article, or (b)
assists in any investigation of a suspected violation of Section
1871.1, 1871.4, 11760, or 11880, or of Section 549 of the Penal Code,
or of Section 3215 or 3219 of the Labor Code conducted by an
authorized governmental agency, shall be subject to any civil
liability in a cause or action of any kind where the insurer,
authorized agent, licensed rating organization, or authorized
governmental agency acts in good faith, without malice, and
reasonably believes that the action taken was warranted by the then
known facts, obtained by reasonable efforts. Nothing in this chapter
is intended to, nor does in any way or manner, abrogate or lessen the
existing common law or statutory privileges and immunities of an
insurer, agent authorized by that insurer to act on its behalf,
licensed rating organization, or any authorized governmental agency
or its employees.
1877. This article shall be known and may be cited as the Workers'
Compensation Insurance Fraud Reporting Act.
1877.1. The following definitions govern the construction of this
article, unless the context requires otherwise:
(a) "Authorized governmental agency" means the district attorney
of any county, any city attorney whose duties include criminal
prosecutions, any law enforcement agency investigating workers'
compensation fraud, the office of the Attorney General, the
Department of Insurance, the Department of Industrial Relations, the
Employment Development Department, the Department of Corrections and
Rehabilitation, the Public Employees' Retirement System, and any
licensing agency governed by the Business and Professions Code.
(b) "Relevant" means having a tendency to make the existence of
any fact that is of consequence to the investigation or determination
of an issue more probable or less probable than it would be without
the information.
(c) "Insurer" means an insurer admitted to transact workers'
compensation insurance in this state, the State Compensation
Insurance Fund, an employer that has secured a certificate of consent
to self-insure pursuant to subdivision (b) or (c) of Section 3700 of
the Labor Code, or a third-party administrator that has secured a
certificate pursuant to Section 3702.1 of the Labor Code.
(d) "Licensed rating organization" means a rating organization
licensed by the Insurance Commissioner pursuant to Section 11750.1.
(e) Information shall be deemed important if, within the sole
discretion of the authorized governmental agency, that information is
requested by that authorized governmental agency.
1877.2. For the purposes of this article, "authorized governmental
agency" includes, in addition to the entities listed in subdivision
(a) of Section 1877.1, any licensing agency governed by the
Chiropractic Initiative Act.
1877.3. (a) Upon written request to an insurer or a licensed rating
organization by an authorized governmental agency, an insurer, an
agent authorized by that insurer, or a licensed rating organization
to act on behalf of the insurer, shall release to the requesting
authorized governmental agency any or all relevant information deemed
important to the authorized governmental agency that the insurer or
licensed rating organization may possess relating to any specific
workers' compensation insurance fraud investigation.
(b) (1) When an insurer or licensed rating organization knows or
reasonably believes it knows the identity of a person or entity whom
it has reason to believe committed a fraudulent act relating to a
workers' compensation insurance claim or a workers' compensation
insurance policy, including any policy application, or has knowledge
of such a fraudulent act that is reasonably believed not to have been
reported to an authorized governmental agency, then, for the purpose
of notification and investigation, the insurer, or agent authorized
by an insurer to act on its behalf, or licensed rating organization
shall notify the local district attorney's office and the Fraud
Division of the Department of Insurance, and may notify any other
authorized governmental agency of that suspected fraud and provide
any additional information in accordance with subdivision (a). The
insurer or licensed rating organization shall state in its notice the
basis of the suspected fraud.
(2) Insurers shall use a form prescribed by the department for the
purposes of reporting suspected fraudulent workers' compensation
acts pursuant to this subdivision.
(3) Nothing in this subdivision shall abrogate or impair the
rights or powers created under subdivision (a).
(c) The authorized governmental agency provided with information
pursuant to subdivision (a), (b), or (e) may release or provide that
information in a confidential manner to any other authorized
governmental agency for purposes of investigation, prosecution, or
prevention of insurance fraud or workers' compensation fraud.
(d) An insurer or licensed rating organization providing
information to an authorized governmental agency pursuant to this
section shall provide the information within a reasonable time, but
not exceeding 60 days from the day on which the duty arose.
(e) Upon written request by an authorized governmental agency, as
specified in subdivision (o) of Section 1095 of the Unemployment
Insurance Code, the Employment Development Department shall release
to the requesting agency any or all relevant information that the
Employment Development Department may possess relating to any
specific workers' compensation insurance fraud investigation.
Relevant information may include, but is not limited to, all of the
following:
(1) Copies of unemployment and disability insurance application
and claim forms and copies of any supporting medical records,
documentation, and records pertaining thereto.
(2) Copies of returns filed by an employer pursuant to Section
1088 of the Unemployment Insurance Code and copies of supporting
documentation.
(3) Copies of benefit payment checks issued to claimants.
(4) Copies of any documentation that specifically identifies the
claimant by social security number, residence address, or telephone
number.
1877.35. (a) The Public Employees' Retirement System may request
information from an insurer for any specific investigation of
eligibility for, and unlawful application or receipt of, benefits
provided under Part 3 (commencing with Section 20000) of Division 5
of Title 2 of the Government Code.
(b) Information received by the Public Employees' Retirement
System pursuant to this article may be used for purposes of
determining eligibility for, and unlawful application or receipt of,
benefits provided under Part 3 (commencing with Section 20000) of
Division 5 of Title 2 of the Government Code.
1877.4. (a) Any information acquired pursuant to this article shall
not be a part of the public record. Except as otherwise provided by
law, any authorized governmental agency, an insurer, or an agent
authorized to act on its behalf, which receives any information
furnished pursuant to this article shall not release that information
to any person not authorized to receive the information under this
article. Any person who violates the prohibition of this subdivision
is guilty of a misdemeanor.
(b) The evidence or information described in this section shall be
privileged and shall not be subject to subpoena or subpoena duces
tecum in a civil or criminal proceeding, unless, after reasonable
notice to any insurer, an agent authorized by an insurer to act on
its behalf, licensed rating organization, or authorized governmental
agency which has an interest in the information, and a hearing, the
court determines that the public interest and any ongoing
investigation by the authorized governmental agency, insurer, or an
agent authorized by the insurer to act on its behalf, or licensed
rating organization will not be jeopardized by its disclosure, or by
the issuance of and compliance with a subpoena or subpoena duces
tecum.
1877.5. No insurer, agent authorized by an insurer to act on its
behalf, or licensed rating organization who furnishes information,
written or oral, pursuant to this article, and no authorized
governmental agency or its employees who (a) furnishes or receives
information, written or oral, pursuant to this article, or (b)
assists in any investigation of a suspected violation of Section
1871.1, 1871.4, 11760, or 11880, or of Section 549 of the Penal Code,
or of Section 3215 or 3219 of the Labor Code conducted by an
authorized governmental agency, shall be subject to any civil
liability in a cause or action of any kind where the insurer,
authorized agent, licensed rating organization, or authorized
governmental agency acts in good faith, without malice, and
reasonably believes that the action taken was warranted by the then
known facts, obtained by reasonable efforts. Nothing in this chapter
is intended to, nor does in any way or manner, abrogate or lessen the
existing common law or statutory privileges and immunities of an
insurer, agent authorized by that insurer to act on its behalf,
licensed rating organization, or any authorized governmental agency
or its employees.
1877. This article shall be known and may be cited as the Workers'
Compensation Insurance Fraud Reporting Act.
1877.1. The following definitions govern the construction of this
article, unless the context requires otherwise:
(a) "Authorized governmental agency" means the district attorney
of any county, any city attorney whose duties include criminal
prosecutions, any law enforcement agency investigating workers'
compensation fraud, the office of the Attorney General, the
Department of Insurance, the Department of Industrial Relations, the
Employment Development Department, the Department of Corrections and
Rehabilitation, the Public Employees' Retirement System, and any
licensing agency governed by the Business and Professions Code.
(b) "Relevant" means having a tendency to make the existence of
any fact that is of consequence to the investigation or determination
of an issue more probable or less probable than it would be without
the information.
(c) "Insurer" means an insurer admitted to transact workers'
compensation insurance in this state, the State Compensation
Insurance Fund, an employer that has secured a certificate of consent
to self-insure pursuant to subdivision (b) or (c) of Section 3700 of
the Labor Code, or a third-party administrator that has secured a
certificate pursuant to Section 3702.1 of the Labor Code.
(d) "Licensed rating organization" means a rating organization
licensed by the Insurance Commissioner pursuant to Section 11750.1.
(e) Information shall be deemed important if, within the sole
discretion of the authorized governmental agency, that information is
requested by that authorized governmental agency.
1877.2. For the purposes of this article, "authorized governmental
agency" includes, in addition to the entities listed in subdivision
(a) of Section 1877.1, any licensing agency governed by the
Chiropractic Initiative Act.
1877.3. (a) Upon written request to an insurer or a licensed rating
organization by an authorized governmental agency, an insurer, an
agent authorized by that insurer, or a licensed rating organization
to act on behalf of the insurer, shall release to the requesting
authorized governmental agency any or all relevant information deemed
important to the authorized governmental agency that the insurer or
licensed rating organization may possess relating to any specific
workers' compensation insurance fraud investigation.
(b) (1) When an insurer or licensed rating organization knows or
reasonably believes it knows the identity of a person or entity whom
it has reason to believe committed a fraudulent act relating to a
workers' compensation insurance claim or a workers' compensation
insurance policy, including any policy application, or has knowledge
of such a fraudulent act that is reasonably believed not to have been
reported to an authorized governmental agency, then, for the purpose
of notification and investigation, the insurer, or agent authorized
by an insurer to act on its behalf, or licensed rating organization
shall notify the local district attorney's office and the Fraud
Division of the Department of Insurance, and may notify any other
authorized governmental agency of that suspected fraud and provide
any additional information in accordance with subdivision (a). The
insurer or licensed rating organization shall state in its notice the
basis of the suspected fraud.
(2) Insurers shall use a form prescribed by the department for the
purposes of reporting suspected fraudulent workers' compensation
acts pursuant to this subdivision.
(3) Nothing in this subdivision shall abrogate or impair the
rights or powers created under subdivision (a).
(c) The authorized governmental agency provided with information
pursuant to subdivision (a), (b), or (e) may release or provide that
information in a confidential manner to any other authorized
governmental agency for purposes of investigation, prosecution, or
prevention of insurance fraud or workers' compensation fraud.
(d) An insurer or licensed rating organization providing
information to an authorized governmental agency pursuant to this
section shall provide the information within a reasonable time, but
not exceeding 60 days from the day on which the duty arose.
(e) Upon written request by an authorized governmental agency, as
specified in subdivision (o) of Section 1095 of the Unemployment
Insurance Code, the Employment Development Department shall release
to the requesting agency any or all relevant information that the
Employment Development Department may possess relating to any
specific workers' compensation insurance fraud investigation.
Relevant information may include, but is not limited to, all of the
following:
(1) Copies of unemployment and disability insurance application
and claim forms and copies of any supporting medical records,
documentation, and records pertaining thereto.
(2) Copies of returns filed by an employer pursuant to Section
1088 of the Unemployment Insurance Code and copies of supporting
documentation.
(3) Copies of benefit payment checks issued to claimants.
(4) Copies of any documentation that specifically identifies the
claimant by social security number, residence address, or telephone
number.
1877.35. (a) The Public Employees' Retirement System may request
information from an insurer for any specific investigation of
eligibility for, and unlawful application or receipt of, benefits
provided under Part 3 (commencing with Section 20000) of Division 5
of Title 2 of the Government Code.
(b) Information received by the Public Employees' Retirement
System pursuant to this article may be used for purposes of
determining eligibility for, and unlawful application or receipt of,
benefits provided under Part 3 (commencing with Section 20000) of
Division 5 of Title 2 of the Government Code.
1877.4. (a) Any information acquired pursuant to this article shall
not be a part of the public record. Except as otherwise provided by
law, any authorized governmental agency, an insurer, or an agent
authorized to act on its behalf, which receives any information
furnished pursuant to this article shall not release that information
to any person not authorized to receive the information under this
article. Any person who violates the prohibition of this subdivision
is guilty of a misdemeanor.
(b) The evidence or information described in this section shall be
privileged and shall not be subject to subpoena or subpoena duces
tecum in a civil or criminal proceeding, unless, after reasonable
notice to any insurer, an agent authorized by an insurer to act on
its behalf, licensed rating organization, or authorized governmental
agency which has an interest in the information, and a hearing, the
court determines that the public interest and any ongoing
investigation by the authorized governmental agency, insurer, or an
agent authorized by the insurer to act on its behalf, or licensed
rating organization will not be jeopardized by its disclosure, or by
the issuance of and compliance with a subpoena or subpoena duces
tecum.
1877.5. No insurer, agent authorized by an insurer to act on its
behalf, or licensed rating organization who furnishes information,
written or oral, pursuant to this article, and no authorized
governmental agency or its employees who (a) furnishes or receives
information, written or oral, pursuant to this article, or (b)
assists in any investigation of a suspected violation of Section
1871.1, 1871.4, 11760, or 11880, or of Section 549 of the Penal Code,
or of Section 3215 or 3219 of the Labor Code conducted by an
authorized governmental agency, shall be subject to any civil
liability in a cause or action of any kind where the insurer,
authorized agent, licensed rating organization, or authorized
governmental agency acts in good faith, without malice, and
reasonably believes that the action taken was warranted by the then
known facts, obtained by reasonable efforts. Nothing in this chapter
is intended to, nor does in any way or manner, abrogate or lessen the
existing common law or statutory privileges and immunities of an
insurer, agent authorized by that insurer to act on its behalf,
licensed rating organization, or any authorized governmental agency
or its employees.
