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House Engrossed Senate Bill
workers' compensation; fraud investigations; adjudications |
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State of Arizona Senate Fifty-sixth Legislature First Regular Session 2023
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SENATE BILL 1164 |
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An Act
amending title 23, chapter 6, article 2, Arizona Revised Statutes, by adding section 23-934; amending section 1, as added by house bill 2431, fifty-sixth legislature, first regular session, as transmitted to the governor; relating to workers' compensation.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 23, chapter 6, article 2, Arizona Revised Statutes, is amended by adding section 23-934, to read:
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.
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.
Sec. 2. Section 1, as added by House Bill 2431, fifty-sixth legislature, first regular session, as transmitted to the governor, is amended to read:
Section 1. Commercial workers' compensation; firefighters; rate deviations; experience modifications; Covid-19; intent; delayed repeal
A. notwithstanding section 20-344, arizona revised statutes, commercial workers' compensation insurers that cover firefighters and fire investigators may charge and collect additional premiums from fire districts to offset and recover Covid-19-related claims costs paid by the insurer before July 1, 2023 to the extent the fire district is able to obtain reimbursement for such additional premium charges from the American Rescue Plan Act of 2021. This additional premium is in addition to the rate deviations prescribed in section 20-359, Arizona Revised Statutes, and any experience modifications prescribed in section 23-963.01, Arizona Revised Statutes. A commercial workers' compensation insurer may charge a premium only if the insurance policy includes a provision that would allow the insurer to charge an additional premium.
B. The total aggregate maximum amount of the additional premium each commercial workers’ compensation insurer may charge and collect from all fire district insureds pursuant to subsection A of this section is $800,000. Notwithstanding subsection A of this section, a commercial workers’ compensation insurer may not include any Covid-19-related claims costs for which the insurer charges and collects additional premiums pursuant to subsection A of this section in any experience modification charged to the fire district.
C. The legislature intends that this section not delay payment of fire districts’ eligible COVID-19-related expenses by the industrial commission of Arizona using American Rescue Plan Act monies allocated as part of the fiscal year 2022-2023 budget.
D. This section is repealed from and after December 31, 2024.
Sec. 3. Conditional enactment
Section 2 of this act does not become effective unless House Bill 2431, fifty-sixth legislature, first regular session, relating to commercial workers' compensation for firefighters, becomes law.