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	<ns0:Description>
		<ns0:Id>20250SB__053697AMD</ns0:Id>
		<ns0:VersionNum>97</ns0:VersionNum>
		<ns0:History>
			<ns0:Action>
				<ns0:ActionText>INTRODUCED</ns0:ActionText>
				<ns0:ActionDate>2025-02-20</ns0:ActionDate>
			</ns0:Action>
			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-04-30</ns0:ActionDate>
			</ns0:Action>
			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-05-23</ns0:ActionDate>
			</ns0:Action>
		</ns0:History>
		<ns0:LegislativeInfo>
			<ns0:SessionYear>2025</ns0:SessionYear>
			<ns0:SessionNum>0</ns0:SessionNum>
			<ns0:MeasureType>SB</ns0:MeasureType>
			<ns0:MeasureNum>536</ns0:MeasureNum>
			<ns0:MeasureState>AMD</ns0:MeasureState>
		</ns0:LegislativeInfo>
		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Archuleta</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>SENATE</ns0:House>
				<ns0:Name>Archuleta</ns0:Name>
			</ns0:Legislator>
		</ns0:Authors>
		<ns0:Title>An act to amend Section 1877.3 of the Insurance Code, relating to insurance. </ns0:Title>
		<ns0:RelatingClause>insurance</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>Workers’ compensation insurance fraud reporting.</ns0:Subject>
		</ns0:GeneralSubject>
		<ns0:DigestText>
			<html:p>Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers’ compensation, as specified. Existing law, the Workers’ Compensation Insurance Fraud Reporting Act (the act), requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, relevant information deemed important to the authorized governmental agency that the insurer or licensed rating organization may possess relating to any specific workers’ compensation insurance fraud investigation. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorney’s office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other
			 authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department to release, upon written request, to an authorized governmental agency relevant information that the Employment Development Department may possess relating to any specific workers’ compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to release or provide that information in a confidential manner to any other authorized governmental agency for purposes of investigation, prosecution, or prevention of insurance fraud or workers’ compensation fraud. </html:p>
			<html:p>This bill would require an insurer or licensed rating organization to notify the Employment Development Department, in addition to the local district attorney’s office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent
			 act relates to premium fraud. The bill would also require, upon written request by an insurer, agent, or licensed rating organization, the Employment Development Department to release or provide detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers’ compensation claims or pursuant to workers’ compensation policies, unless doing so would violate existing law or compromise an ongoing investigation. The bill would require the Employment Development Department to only provide the information if specified requirements are
			 met, and the requesting insurer, agent, or licensed rating organization to reimburse the department’s actual, direct costs of releasing or providing this information. The bill would prohibit the provided documents from being used for specified purposes. </html:p>
			<html:p>Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.</html:p>
			<html:p>This bill would make legislative findings to that effect.</html:p>
		</ns0:DigestText>
		<ns0:DigestKey>
			<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
			<ns0:Appropriation>NO</ns0:Appropriation>
			<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
			<ns0:LocalProgram>NO</ns0:LocalProgram>
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		<ns0:MeasureIndicators>
			<ns0:ImmediateEffect>NO</ns0:ImmediateEffect>
			<ns0:ImmediateEffectFlags>
				<ns0:Urgency>NO</ns0:Urgency>
				<ns0:TaxLevy>NO</ns0:TaxLevy>
				<ns0:Election>NO</ns0:Election>
				<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
				<ns0:BudgetBill>NO</ns0:BudgetBill>
				<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
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	</ns0:Description>
	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_AEAC5CFE-B28B-400A-B9EC-768FD1CD881E">
			<ns0:Num>SECTION 1.</ns0:Num>
			<ns0:ActionLine action="IS_AMENDED" ns3:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'PART'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'12.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'7.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'1877.3.'%5D)" ns3:label="fractionType: LAW_SECTION" ns3:type="locator">
				Section 1877.3 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
			</ns0:ActionLine>
			<ns0:Fragment>
				<ns0:LawSection id="id_2E717AB6-5517-474A-AC07-A2D7C444E134">
					<ns0:Num>1877.3.</ns0:Num>
					<ns0:LawSectionVersion id="id_C696DF98-62E0-42E4-9F09-62D35BC4A779">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								Upon written request to an insurer or a licensed rating organization by an authorized governmental agency, an insurer, an agent authorized by that insurer, or a licensed rating organization to act on behalf of the insurer, shall release to the requesting authorized governmental agency any or all relevant information deemed important to the authorized governmental agency that the insurer or licensed rating organization may possess relating to any specific workers’ compensation insurance fraud investigation.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								When an insurer or licensed rating organization knows or reasonably believes it knows the identity of a person or entity whom it has reason to
						believe committed a fraudulent act relating to a workers’ compensation insurance claim or a workers’ compensation insurance policy, including any policy application, or has knowledge of such a fraudulent act, then, for the purpose of notification and investigation, the insurer, or agent authorized by an insurer to act on its behalf, or licensed rating organization shall notify the local district attorney’s office, the Fraud Division of the Department of Insurance, and, when the fraudulent act relates to premium fraud, the Employment Development Department, and may notify any other authorized governmental agency of that suspected fraud and provide any additional information in accordance with subdivision (a). The insurer or licensed rating organization shall state in its notice the basis of the suspected fraud.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Insurers shall use a form
						prescribed by the department for the purposes of reporting suspected fraudulent workers’ compensation acts pursuant to this subdivision.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								This section does not abrogate or impair the rights or powers created under subdivision (a).
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								The authorized governmental agency provided with information pursuant to subdivision (a), (b), or (e) shall, upon request, unless it would violate federal law or otherwise compromise an investigation, release or provide that information in a confidential manner to any other authorized governmental agency for purposes of investigation, prosecution, or prevention of insurance fraud or workers’ compensation fraud.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								An insurer or licensed rating organization providing information to
						an authorized governmental agency pursuant to this section shall provide the information within a reasonable time, but not exceeding 60 days from the day on which the duty arose.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								Upon written request by an authorized governmental agency, as specified in subdivision (o) of Section 1095 of the Unemployment Insurance Code, the Employment Development Department shall release to the requesting agency any or all relevant information that the Employment Development Department may possess relating to any specific workers’ compensation insurance fraud investigation. If an authorized governmental agency seeks to disclose this information to any other governmental agency that is not authorized to receive that information pursuant to subdivision (o) of Section 1095 of the Unemployment Insurance Code or subdivision (c) of Section 603.9 of
						Title 20 of the Code of Federal Regulations, that agency shall submit a request to the Employment Development Department for approval prior to disclosure. Relevant information may include, but is not limited to, all of the following:
							</html:p>
							<html:p>
								(1)
								<html:span class="EnSpace"/>
								Copies of unemployment and disability insurance application and claim forms and copies of any supporting medical records, documentation, and records pertaining thereto.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								Copies of returns filed by an employer pursuant to Section 1088 of the Unemployment Insurance Code and copies of supporting documentation.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								Copies of benefit payment checks issued to claimants.
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								Copies of any documentation that specifically identifies the claimant
						by social security number, residence address, or telephone number.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								Upon written request by an insurer, an agent authorized by that insurer, or a licensed rating organization, the Employment Development Department shall release or provide to the requesting insurer, agent, or licensed rating organization detailed payroll information, including payroll summary totals, that would allow the insurer, agent, or licensed rating organization to compare the records with the information they are otherwise entitled to receive from employers in workers’ compensation claims or pursuant to workers’ compensation policies, unless it would violate federal law or otherwise compromise an ongoing investigation. The information shall only be provided or released if both of the following requirements are met:
							</html:p>
							<html:p>
								(A)
								<html:span class="EnSpace"/>
								The insurer, agent, or licensed rating organization specifies in the written request what information is necessary.
							</html:p>
							<html:p>
								(B)
								<html:span class="EnSpace"/>
								The Employment Development Department determines the information requested is consistent with a workers’ compensation investigation by an insurer, agent, or licensed rating organization and could be used in the investigation of potential workers’ compensation insurance fraud.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								The information provided under this subdivision shall be provided in a confidential manner and shall not be used for the purposes described in subdivision (k) of Section 791.13 of the Insurance Information and Privacy Protection Act (Article 6.6 (commencing with Section 791) of Chapter 1).
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								The information released or provided cannot be shared with law enforcement unless released or provided as part of a fraud referral pursuant to special investigative unit compliance requirements as authorized by Section 1872.4 or as part of the information provided or released pursuant to subdivision (a) or (b) of this section. 
							</html:p>
							<html:p>
								(4)
								<html:span class="EnSpace"/>
								An insurer, agent, or licensed rating organization requesting information pursuant to this subdivision shall quarterly reimburse the Employment Development Department for the department’s actual, direct costs of releasing or providing information from its records to the requesting insurer, agent, or licensed rating organization.
							</html:p>
						</ns0:Content>
					</ns0:LawSectionVersion>
				</ns0:LawSection>
			</ns0:Fragment>
		</ns0:BillSection>
		<ns0:BillSection id="id_81AD6C5D-9CC3-4ABA-ACBA-E54104AB0D89">
			<ns0:Num>SEC. 2.</ns0:Num>
			<ns0:Content>
				<html:p>The Legislature finds and declares that Section 1 of this act, which amends Section 1877.3 of the Insurance Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:</html:p>
				<html:p>In order to protect the privacy of California workers, while also gathering useful information related to a workers’ compensation investigation,
				it is necessary that personal identifying information remain confidential. </html:p>
			</ns0:Content>
		</ns0:BillSection>
	</ns0:Bill>
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