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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1718
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR HUDSON.
7366S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 287.030 and 287.128, RSMo, and to enact in lieu thereof two new sections
relating to workers' compensation, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 287.030 and 287.128, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 287.030 and 287.128, to read as follows:3
287.030. 1. The word "employer" as used in this 1
chapter shall be construed to mean: 2
(1) Every person, partnership, association, 3
corporation, limited liability partnership or company, 4
trustee, receiver, the legal representatives of a deceased 5
employer, and every other person, including any person or 6
corporation operating a railroad and any public service 7
corporation, using the service of another for pay; 8
(2) The state, county, municipal corporation, 9
township, school or road, drainage, swamp and levee 10
districts, or school boards, board of education, regents, 11
curators, managers or control commission, board or any other 12
political subdivision, corporation, or quasi-corporation, or 13
cities under special charter, or under the commission form 14
of government; 15
(3) Any of the above-defined employers must have five 16
or more employees to be deemed an employer for the purposes 17
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of this chapter unless election is made to become subject to 18
the provisions of this chapter as provided in subsection 2 19
of section 287.090, [except that] and construction industry 20
employers who erect, demolish, alter or repair improvements 21
shall be deemed an employer for the purposes of this chapter 22
if they have [one] five or more employees. An employee who 23
is a member of the employer's family within the third degree 24
of affinity or consanguinity shall be counted in determining 25
the total number of employees of such employer. 26
2. Any reference to the employer shall also include 27
his or her insurer or group self-insurer. 28
287.128. 1. It shall be unlawful for any person to 1
knowingly present or cause to be presented any false or 2
fraudulent claim for the payment of benefits pursuant to a 3
workers' compensation claim. 4
2. It shall be unlawful for any insurance company or 5
self-insurer in this state to knowingly and intentionally 6
refuse to comply with known and legally indisputable 7
compensation obligations with intent to defraud. 8
3. It shall be unlawful for any person to: 9
(1) Knowingly present multiple claims for the same 10
occurrence with intent to defraud; 11
(2) Knowingly assist, abet, solicit or conspire with: 12
(a) Any person who knowingly presents any false or 13
fraudulent claim for the payment of benefits; 14
(b) Any person who knowingly presents multiple claims 15
for the same occurrence with an intent to defraud; or 16
(c) Any person who purposefully prepares, makes or 17
subscribes to any writing with the intent to present or use 18
the same, or to allow it to be presented in support of any 19
such claim; 20
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(3) Knowingly make or cause to be made any false or 21
fraudulent claim for payment of a health care benefit; 22
(4) Knowingly submit a claim for a health care benefit 23
which was not used by, or on behalf of, the claimant; 24
(5) Knowingly present multiple claims for payment of 25
the same health care benefit with an intent to defraud; 26
(6) Knowingly make or cause to be made any false or 27
fraudulent material statement or material representation for 28
the purpose of obtaining or denying any benefit; 29
(7) Knowingly make or cause to be made any false or 30
fraudulent statements with regard to entitlement to benefits 31
with the intent to discourage an injured worker from making 32
a legitimate claim; 33
(8) Knowingly make or cause to be made a false or 34
fraudulent material statement to an investigator of the 35
division in the course of the investigation of fraud or 36
noncompliance. 37
For the purposes of subdivisions (6), (7), and (8) of this 38
subsection, the term "statement" includes any notice, proof 39
of injury, bill for services, payment for services, hospital 40
or doctor records, X-ray or test results. 41
4. Any person violating any of the provisions of 42
subsection 1 or 2 of this section shall be guilty of a class 43
E felony. In addition, the person shall be liable to the 44
state of Missouri for a fine up to ten thousand dollars or 45
double the value of the fraud whichever is greater. Any 46
person violating any of the provisions of subsection 3 of 47
this section shall be guilty of a class A misdemeanor and 48
the person shall be liable to the state of Missouri for a 49
fine up to ten thousand dollars. Any person who has 50
previously been found guilty of violating any of the 51
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provisions of subsection 1, 2 or 3 of this section and who 52
subsequently violates any of the provisions of subsection 1, 53
2 or 3 of this section shall be guilty of a class D felony. 54
5. It shall be unlawful for any person, company, or 55
other entity to prepare or provide an invalid certificate of 56
insurance as proof of workers' compensation insurance. Any 57
person violating any of the provisions of this subsection 58
shall be guilty of a class E felony and, in addition, shall 59
be liable to the state of Missouri for a fine up to ten 60
thousand dollars or double the value of the fraud, whichever 61
is greater. 62
6. Any person who knowingly misrepresents any fact in 63
order to obtain workers' compensation insurance at less than 64
the proper rate for that insurance shall be guilty of a 65
class A misdemeanor. Any person who has previously been 66
found guilty of violating any of the provisions of this 67
section and who subsequently violates any of the provisions 68
of this section shall be guilty of a class E felony. 69
7. Any employer who knowingly fails to insure his or 70
her liability pursuant to this chapter shall result in a 71
written warning for the first violation and upon a second 72
violation or any additional subsequent violations thereafter 73
shall be guilty of a class A misdemeanor and, in addition, 74
shall be liable to the state of Missouri for a penalty in an 75
amount up to three times the annual premium the employer 76
would have paid had such employer been insured or up to 77
fifty thousand dollars, whichever amount is greater. [Any 78
person who has previously been found guilty of violating any 79
of the provisions of this section and who subsequently 80
violates any of the provisions of this section shall be 81
guilty of a class E felony.] 82
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8. Any person may file a complaint alleging fraud or 83
noncompliance with this chapter with a legal advisor in the 84
division of workers' compensation. The legal advisor shall 85
refer the complaint to the fraud and noncompliance unit 86
within the division. The unit shall investigate all 87
complaints and present any finding of fraud or noncompliance 88
to the director, who may refer the file to the attorney 89
general. The attorney general may prosecute any fraud or 90
noncompliance associated with this chapter. All costs 91
incurred by the attorney general associated with any 92
investigation and prosecution pursuant to this subsection 93
shall be paid out of the workers' compensation fund. Any 94
fines or penalties levied and received as a result of any 95
prosecution under this section shall be paid to the workers' 96
compensation fund. Any restitution ordered as a part of the 97
judgment shall be paid to the person or persons who were 98
defrauded. 99
9. Any and all reports, records, tapes, photographs, 100
and similar materials or documentation submitted by any 101
person, including the department of commerce and insurance, 102
to the fraud and noncompliance unit or otherwise obtained by 103
the unit pursuant to this section, used to conduct an 104
investigation for any violation under this chapter, shall be 105
considered confidential and not subject to the requirements 106
of chapter 610. Nothing in this subsection prohibits the 107
fraud and noncompliance unit from releasing records used to 108
conduct an investigation to the local, state, or federal law 109
enforcement authority or federal or state agency conducting 110
an investigation, upon written request. 111
10. There is hereby established in the division of 112
workers' compensation a fraud and noncompliance 113
administrative unit responsible for investigating incidences 114
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of fraud and failure to comply with the provisions of this 115
chapter. 116
11. Any prosecution for a violation of the provisions 117
of this section or section 287.129 shall be commenced within 118
three years after discovery of the offense by an aggrieved 119
party or by a person who has a legal duty to represent an 120
aggrieved party and who is not a party to the offense. As 121
used in this subsection, the term "person who has a legal 122
duty to represent an aggrieved party" shall mean the 123
attorney general or the prosecuting attorney having 124
jurisdiction to prosecute the action. 125
12. By January 1, 2006, the attorney general shall 126
forward to the division and the members of the general 127
assembly the first edition of an annual report of the costs 128
of prosecuting fraud and noncompliance under this chapter. 129
The report shall include the number of cases filed with the 130
attorney general by county by the fraud and noncompliance 131
unit, the number of cases prosecuted by county by the 132
attorney general, fines and penalties levied and received, 133
and all incidental costs. 134
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