WILLFUL MISREPRESENTATION (FRAUD)
The following documentation is required for the department to make a determination regarding willful misrepresentation or fraud. If any of these elements are missing, it may significantly delay the decision-making process.
Upon review of the these elements, the Fraud Adjudicator and the Fraud Assistant Attorney General will make a decision as to whether or not fraud can be proven. They may determine to issue an overpayment instead.
Before submission to the department, please mark all documents related to fraud or willful misrepresentation “DO NOT FILM.” The documents should not be placed in the file as investigation information is not released to the claimant or their attorney while the investigation is still pending.
- An investigation report, including
- Summary
- Date of Discovery
- Copies of time loss checks
- Certified copies of Warrants
- Statements from witnesses or employers (Names, addresses and phone numbers of any witnesses)
- Interview with claimant (or documentation of attempt to interview)
- Specific dates fraud occurred
- Amount of money involved
- For medical, prescription or vocational services fraud, documentation regarding the specific medical/prescriptions is needed along with the specific dates and amounts.
- If you have video of the worker, please send a description of what the video contains. The department does NOT require original or copies of videotapes. However, please retain the video - if the order goes to hearing the videos will be needed at that time.
- A draft order describing exactly what you are contending will help in making a determination regarding fraud, though it is not required.
If you have any questions regarding fraud orders, please call the Self Insurance Pension Desk at 360-902-6917.
