31 Pa. Code § 119.11 - Insurance claims fraud reporting, investigation and prosecution

Insurers, as defined in section 1101 of the act (77 P. S. § 1039.1) should report an incidence of workers' compensation insurance fraud to State and local criminal law enforcement agencies.

(1) Sections 1106 and 1107 of the act (77 P. S. §§ 1039.6 and 1039.7) provide incentives for active reporting of fraud by an express grant of civil and criminal immunity to insurers and their representatives and the opportunity to pursue restitution through judicial proceedings.

(2) Section 1109 of the act (77 P. S. § 1039.9) expressly authorizes district attorneys or the Attorney General, or both, to investigate and prosecute instances of fraud as identified in Article XI of the act (77 P. S. §§ 1039.1-1039.12).

(3) The Department will look to insurers to report an incidence of fraud directly to district attorneys or the Attorney General, or both, and, when practical, seek court ordered restitution to compensate for fraud-related losses.

Notes

31 Pa. Code § 119.11