Fraud is the intentional misrepresentation of a material existing fact made by one person to another for the purpose of inducing the other person to act with resulting injury or damage. In other words, someone misrepresents a fact that causes you to act on that misrepresentation and you were damaged somehow. Fraud is when a worker lies about an accident occurring at work and you rely on that and fact to report the accident and the worker receives benefits. Fraud includes but is not limited to:
- Staging an accident,
- Falsely claiming an injury was work related,
- Misrepresenting medical or work status,
- Intentional mis-classification of class code or payroll
The price for fraud is seen in higher claim costs and in turn higher premiums. This can lead to lost jobs, and profits, lower wages, reductions in benefits and a higher cost for goods and services.
New Mexico Mutual has a “Zero Tolerance” policy for fraud, and aggressively pursues allegations of fraudulent activities by injured workers, medical providers, or employers. Any agent, customer, employee may anonymously communicate or report any Code of Conduct matter through the Global Compliance Alert Line or call 1-877-874-8416.