What must an insurer do when fraud is suspected in a claim?

When an insurer suspects fraud in a workers’ compensation claim, the correct course of action is to report findings to the Department of Commerce. This is a critical step in maintaining integrity within the workers’ compensation system and ensuring that fraudulent activities are properly investigated.

By reporting to the Department of Commerce, the insurer contributes to a centralized effort to combat fraud, allowing regulatory authorities to take appropriate actions and enforcing compliance with the law. This is part of the insurer's responsibility to promote accountability and transparency in the claims process.

In contrast, ignoring the claim would not address the potential fraudulent activity and could perpetuate loss in the system. Making findings public could violate confidentiality laws and protocols surrounding sensitive claims information. Refusing all further claims from the claimant would be inappropriate and could expose the insurer to legal challenges, as each claim should be evaluated on its own merits regardless of prior suspicions. Thus, the most responsible action is to report the findings to the appropriate regulatory body.