Workers’ compensation insurance fraud reporting.

Senator Archuleta's workers' compensation fraud detection measure expands California's reporting requirements by mandating that insurers and licensed rating organizations notify the Employment Development Department (EDD) when discovering suspected premium fraud. The legislation builds upon existing requirements to report fraud to local district attorneys and the Department of Insurance's Fraud Division.

The bill establishes a framework for insurers and rating organizations to obtain detailed payroll information from the EDD, allowing verification against employer-provided data in workers' compensation claims. To access this information, requesters must specify their needs in writing, and the EDD must determine the request aligns with a legitimate workers' compensation fraud investigation. The law places strict limits on information sharing - data cannot be disclosed to law enforcement except through formal fraud referrals or as part of authorized investigative processes.

To balance fraud detection capabilities with privacy protections, the measure includes confidentiality requirements for handling worker information. The EDD must provide requested data within 60 days while ensuring compliance with federal law and avoiding interference with ongoing investigations. The bill's findings emphasize the need to protect worker privacy while enabling effective fraud investigations through controlled information sharing between authorized entities.