AB 1697: Workers’ compensation.

Existing law establishes a workers compensation system, administered by the Administrative Director of the Division of Workers Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of his or her employment. Existing law makes it a crime to commit various acts of fraud relating to workers compensation, including to knowingly make or cause to be made a false or fraudulent claim for payment of workers compensation health benefits.

Existing law creates the Fraud Division, within the Department of Insurance, to administer provisions related to insurance fraud. Existing law requires the Insurance Commissioner to ensure that the Fraud Division aggressively pursues all reported incidents of probable workers compensation fraud.

This bill would require the administrative director to establish an antifraud support unit within the Division of Workers Compensation. The bill would set forth the duties of the unit, including coordinating and advancing antifraud activities for the division and serving as the point of contact between the division and other agencies and entities engaged in antifraud activities. The bill would require the unit to develop and implement by July 1, 2019, data analytics processes to identify the sources of previously unknown fraud and the magnitude of known or suspected fraud, as specified. The bill would require state entities to submit the data to the unit for analysis, as specified. The bill would also require the unit to report to the Legislature, not less frequently than every 3 years, on the effectiveness of its data analytics efforts and to revise the data analytics processes if it identifies improved methods of detecting fraud.