Report Fraud

Investigative Process

The WCA’s Enforcement Bureau is responsible for investigating allegations of Workers’ Compensation Act violations and allegations of fraudulent activity specifically relating to workers’ compensation.

Upon receipt of the initial report, the Enforcement Bureau acknowledges the report may request additional information through a notice known as a “Notice of Pending Investigation”.

A prosecuting attorney evaluates each report and determines if administrative or criminal charges may be warranted.

Reported violations include (but are not limited to)

• Fraud: (as defined by NMSA 1978, §52-1-28.3)
• Bad faith (as defined by NMSA 1978, §52-1-28.1)
• Unfair claims processing (as defined as NMSA 1978, §52-1-28.1)
• Retaliation (as defined as NMSA 1978, 52-1-28.2)
• Late/non-reporting of required claims data

Other technical violations include (but are not limited to)

• Failure to display the workers’ compensation poster
• Failure to report workplace injuries to the insurer within 72 hours (timely reporting)
• Failure to complete the proof of safety inspection
• Failure to comply with the Risk Reduction program
• Failure to make timely benefits payments
• Any party’s failure to comply with mediation or adjudication rules
• Any health care provider’s billing misconduct

If you are aware of an alleged offense, please download and complete the Report Fraud Form above and submit it to the WCA at WCA.EnforcementReferrals@wca.nm.gov or fill out the form below.

Fraud Form