1. A. The Fraud Unit shall have jurisdiction to investigate allegations of:

   1. 1. Claimant fraud related to workers’ compensation claims receiving indemnity or medical benefits.
   2. 2. Employer or Carrier fraud related to workers’ compensation insurance coverage, payment of premiums, or payment of workers’ compensation benefits.
   3. 3. Medical Provider fraud related to workers’ compensation claims.
2. B. For purposes of this Section, “Fraud” means knowingly making a false statement or representation or concealing information in order to obtain any compensation, benefit or payment for themself or another.
3. C. The Fraud Unit does not have jurisdiction over allegations of unfair claims processing practices and bad faith claims.

Historical Note

Adopted effective September 9, 1998 (Supp. 98-3). Section repealed by final rulemaking at 28 A.A.R. 3435 (October 28, 2022), with an immediate effective date of October 5, 2022 (Supp. 22-4). New Section R20-5-703 made by final rulemaking at 31 A.A.R. 4199 (October 31, 2025), effective December 6, 2025 (Supp. 25-4).