| 1 | 1 | | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 536Introduced by Senator ArchuletaFebruary 20, 2025 An act to amend Section 1877.3 of the Insurance Code, relating to insurance. LEGISLATIVE COUNSEL'S DIGESTSB 536, as introduced, Archuleta. Workers compensation insurance fraud reporting.Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers compensation, as specified. Existing law, the Workers Compensation Insurance Fraud Reporting Act (the act), requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, 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. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorneys office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department to release, upon written request, to an authorized governmental agency relevant information that the Employment Development Department may possess relating to any specific workers compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to 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. This bill would require an insurer or licensed rating organization to notify the Employment Development Department, in addition to the local district attorneys office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent act relates to premium fraud. The bill would also require, upon written request by an insurer or specified others, the Employment Development Department to release detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The bill would prohibit the provided documents from being used for specified purposes. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1877.3 of the Insurance Code is amended to read: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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 3 | 3 | | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Senate Bill No. 536Introduced by Senator ArchuletaFebruary 20, 2025 An act to amend Section 1877.3 of the Insurance Code, relating to insurance. LEGISLATIVE COUNSEL'S DIGESTSB 536, as introduced, Archuleta. Workers compensation insurance fraud reporting.Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers compensation, as specified. Existing law, the Workers Compensation Insurance Fraud Reporting Act (the act), requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, 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. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorneys office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department to release, upon written request, to an authorized governmental agency relevant information that the Employment Development Department may possess relating to any specific workers compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to 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. This bill would require an insurer or licensed rating organization to notify the Employment Development Department, in addition to the local district attorneys office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent act relates to premium fraud. The bill would also require, upon written request by an insurer or specified others, the Employment Development Department to release detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The bill would prohibit the provided documents from being used for specified purposes. Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO |
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| 9 | 9 | | CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION |
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| 11 | 11 | | Senate Bill |
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| 13 | 13 | | No. 536 |
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| 15 | 15 | | Introduced by Senator ArchuletaFebruary 20, 2025 |
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| 17 | 17 | | Introduced by Senator Archuleta |
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| 18 | 18 | | February 20, 2025 |
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| 19 | 19 | | |
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| 20 | 20 | | An act to amend Section 1877.3 of the Insurance Code, relating to insurance. |
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| 21 | 21 | | |
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| 22 | 22 | | LEGISLATIVE COUNSEL'S DIGEST |
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| 23 | 23 | | |
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| 24 | 24 | | ## LEGISLATIVE COUNSEL'S DIGEST |
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| 25 | 25 | | |
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| 26 | 26 | | SB 536, as introduced, Archuleta. Workers compensation insurance fraud reporting. |
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| 27 | 27 | | |
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| 28 | 28 | | Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers compensation, as specified. Existing law, the Workers Compensation Insurance Fraud Reporting Act (the act), requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, 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. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorneys office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department to release, upon written request, to an authorized governmental agency relevant information that the Employment Development Department may possess relating to any specific workers compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to 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. This bill would require an insurer or licensed rating organization to notify the Employment Development Department, in addition to the local district attorneys office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent act relates to premium fraud. The bill would also require, upon written request by an insurer or specified others, the Employment Development Department to release detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The bill would prohibit the provided documents from being used for specified purposes. |
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| 30 | 30 | | Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers compensation, as specified. Existing law, the Workers Compensation Insurance Fraud Reporting Act (the act), requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, 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. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorneys office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department to release, upon written request, to an authorized governmental agency relevant information that the Employment Development Department may possess relating to any specific workers compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to 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. |
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| 32 | 32 | | This bill would require an insurer or licensed rating organization to notify the Employment Development Department, in addition to the local district attorneys office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent act relates to premium fraud. The bill would also require, upon written request by an insurer or specified others, the Employment Development Department to release detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The bill would prohibit the provided documents from being used for specified purposes. |
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| 33 | 33 | | |
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| 34 | 34 | | ## Digest Key |
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| 35 | 35 | | |
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| 36 | 36 | | ## Bill Text |
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| 37 | 37 | | |
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| 38 | 38 | | The people of the State of California do enact as follows:SECTION 1. Section 1877.3 of the Insurance Code is amended to read: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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 40 | 40 | | The people of the State of California do enact as follows: |
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| 41 | 41 | | |
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| 42 | 42 | | ## The people of the State of California do enact as follows: |
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| 44 | 44 | | SECTION 1. Section 1877.3 of the Insurance Code is amended to read: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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 46 | 46 | | SECTION 1. Section 1877.3 of the Insurance Code is amended to read: |
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| 48 | 48 | | ### SECTION 1. |
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| 49 | 49 | | |
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| 50 | 50 | | 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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 52 | 52 | | 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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 54 | 54 | | 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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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) This section does not 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) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. 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.(f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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| 58 | 58 | | 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. |
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| 60 | 60 | | (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, 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 attorneys office and office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, 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. |
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| 62 | 62 | | (2) Insurers shall use a form prescribed by the department for the purposes of reporting suspected fraudulent workers compensation acts pursuant to this subdivision. |
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| 63 | 63 | | |
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| 64 | 64 | | (3) This section does not abrogate or impair the rights or powers created under subdivision (a). |
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| 65 | 65 | | |
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| 66 | 66 | | (c) The authorized governmental agency provided with information pursuant to subdivision (a), (b), or (e) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, 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. |
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| 67 | 67 | | |
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| 68 | 68 | | (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. |
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| 69 | 69 | | |
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| 70 | 70 | | (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. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. Relevant information may include, but is not limited to, all of the following: |
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| 71 | 71 | | |
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| 72 | 72 | | (1) Copies of unemployment and disability insurance application and claim forms and copies of any supporting medical records, documentation, and records pertaining thereto. |
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| 73 | 73 | | |
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| 74 | 74 | | (2) Copies of returns filed by an employer pursuant to Section 1088 of the Unemployment Insurance Code and copies of supporting documentation. |
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| 75 | 75 | | |
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| 76 | 76 | | (3) Copies of benefit payment checks issued to claimants. |
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| 77 | 77 | | |
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| 78 | 78 | | (4) Copies of any documentation that specifically identifies the claimant by social security number, residence address, or telephone number. |
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| 79 | 79 | | |
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| 80 | 80 | | (f) Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers compensation claims or pursuant to workers compensation policies. The documents provided under this subdivision shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1). |
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