Greetings, I had a question today about failure to return the Fraud Statement that is sent to a claimant with the initial packet. It is a little used tool, but in the right situation, we can suspend benefits if the claimant fails to return the signed acknowledgement of the Fraud statement (see bold portion of statute):
440.105(7) An injured employee or any other party making a claim under this chapter shall provide his or her personal signature attesting that he or she has reviewed, understands, and acknowledges the following statement: “Any person who, knowingly and with intent to injure, defraud, or deceive any employer or employee, insurance company, or self-insured program, files a statement of claim containing any false or misleading information commits insurance fraud, punishable as provided in s. 817.234.” If the injured employee or other party refuses to sign the document attesting that he or she has reviewed, understands, and acknowledges the statement, benefits, or payments under this chapter shall be suspended until such signature is obtained.
Now in some circumstances this may not make sense and may just cause litigation. It is always a strategic decision on a case-by-case basis.
How quickly do they need to return it is not spelled out, and I would recommend following up with the claimant to remind them first. If they file PFB that has the same statement attached to it, that would probably suffice to satisfy the statute. Under the admin code it says:
Fla. Admin. Code Ann. R. 69L-3.0047 – Fraud Statement
(1) An injured employee or any other party making a claim shall provide his or her personal signature attesting that they have reviewed, understand and acknowledge the fraud statement as specified in section 440.105(7), F.S.
(2) A party who makes claims for services provided to the claim administrator on a recurring basis may make one personally signed attestation to the claim administrator as required by section 440.105(7), F.S., which will satisfy the requirement for all claims submitted to the claim administrator for the calendar year in which the attestation is submitted.
So if they file a PFB with the fraud statement I think you should reinstate benefits. Again, this not for frequent use but in strategic situations.
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Sincerely,
Morgan Indek | Managing Partner