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Workers’ Compensation and Insurance Fraud Defined
Workers’ Compensation and Insurance Fraud Defined
Workers’ Compensation Insurance Fraud (85A O.S. 6(A)(1)(a))
- WC fraud occurs when the subject makes a material misstatement, misrepresentation, or knowingly conceals material information with respect to any of the following:
- A claim for payment or other benefits from an insurance policy.
- Obtaining Workers’ Compensation coverage under the Administrative Worker’s Compensation Act.
- Failure to report income to an employer, insurance carrier, or Third-Party Administrator while receiving Temporary Total Disability (TTD) benefits.
- Presenting an altered or falsified certificate of Workers’ Compensation Coverage.
- WC fraud occurs when the subject makes a material misstatement, misrepresentation, or knowingly conceals material information with respect to any of the following:
Insurance Fraud (21 O.S. 1662)
- Presenting a false or fraudulent insurance claim or falsifying any supporting documents in an insurance claim for the payment of any loss.
- Preparing or altering certificates, proofs of loss, or other writing with the intent to use it as support for a fraudulent insurance claim.