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Utah Labor Code | |
Workers' Compensation Act | |
Section 110 | Workers' compensation insurance fraud -- Elements -- Penalties -- Notice. |
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34A-2-110. Workers' compensation insurance fraud -- Elements -- Penalties --
Notice. (1) As used in this section: (a) "Corporation" has the same meaning as in Section 76-2-201. (b) "Intentionally" has the same meaning as in Section 76-2-103. (c) "Knowingly" has the same meaning as in Section 76-2-103. (d) "Person" has the same meaning as in Section 76-1-601. (e) "Recklessly" has the same meaning as in Section 76-2-103. (f) "Thing of value" means one or more of the following obtained under this chapter or Chapter 3, Utah Occupational Disease Act: (i) workers' compensation insurance coverage; (ii) disability compensation; (iii) a medical benefit; (iv) a good; (v) a professional service; (vi) a fee for a professional service; or (vii) anything of value. (2) (a) A person is guilty of workers' compensation insurance fraud if that person intentionally, knowingly, or recklessly: (i) devises a scheme or artifice to do the following by means of a false or fraudulent pretense, representation, promise, or material omission: (A) obtain a thing of value under this chapter or Chapter 3; (B) 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; or (C) deprive an employee of a thing of value under this chapter or Chapter 3; and (ii) 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 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 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: (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 Part 10, Workers' Compensation Coverage Waivers Act, to deprive an employee of workers' compensation coverage under this chapter or Chapter 3; 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 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."
Amended by Chapter 328, 2011 General Session |
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