Fraud overpayments: Notice, fact-finding and determination

(a) Where the Administrator determines that any individual has, by reason of fraud, wilful misrepresentation or wilful nondisclosure of a material fact by the individual or through the agency of another, received as benefits of any dollar amount while any condition imposed by Chapter 567 of the Connecticut General Statutes was not fulfilled, or has received any amount more than was due him, such individual shall be charged with an overpayment of a sum equal to the amount so overpaid to the individual and shall be liable to repay to the Administrator such sum as well as any other penalties assessed by the Administrator in accordance with the provisions of sections 31-273-6 and 31-273-6a of the Regulations of Connecticut State Agencies. (b) If any individual charged by the Administrator with an overpayment, pursuant to subsection (a), does not make repayment in full of the sum overpaid, the Administrator shall recoup such sum as specified in Section 31-273-7 of the Regulations of Connecticut State Agencies. (c) The Administrator shall, eight years after the payment of any benefits described in this section, cancel any claim for such repayment or recoupment which, in the Administrator’s opinion, is uncollectible. (d) Where the Administrator identifies a question of eligibility pursuant to Chapter 567 of the Connecticut General Statutes with respect to one or more weeks for which an individual was previously paid any sum of benefits or detects that an individual received more benefits than that to which such individual was entitled, and reasonably believes on the basis of available evidence that such receipt of benefits was due to fraud, wilful misrepresentation or wilful nondisclosure of a material fact by the individual or through the agency of another, the Administrator shall notify the individual in writing of the identification of such question and that the individual has a right to a hearing to be held by the Administrator for the purpose of determining whether the individual was eligible for benefits for such week or weeks, and whether any benefits were received fraudulently. The notice shall inform the individual that if such individual does not exercise such right by notifying the Administrator within fourteen days of the date the notice was mailed, a decision will be rendered on the basis of the record available to the Administrator which may be appealed to the Employment Security Appeals Division. In addition, such notice shall advise the individual that an adverse determination will result in the imposition of an administrative penalty pursuant to sections 31-273-6 and 31-273-6a of the Regulations of Connecticut State Agencies and may result in recoupment methods conducted pursuant to the provisions of Section 31-273-7 of the Regulations of Connecticut State Agencies. If the individual exercises such individual’s right to a hearing, the Administrator shall give the individual adequate notice that a hearing will be held. The notice shall include: (1) the time and date of such hearing; (2) notification as to the telephone hearing process if scheduled to be conducted by telephone; (3) information necessary for the claimant to submit evidence or testimony for use at the hearing, if applicable; (4) notification that the hearing will be conducted in accordance with the provisions of Section 31-273-8 of the Regulations of Connecticut State Agencies. (5) identification of the question or questions of eligibility to be addressed at such hearing; (6) notice that a determination of ineligibility or non-entitlement for any week or weeks or part of any week or weeks will result in the charging of an overpayment to the individual; (7) notice that if, following consideration of any question of eligibility or entitlement, there exists the possibility that the individual was overpaid benefits and the individual's receipt of such sum of benefits was due to fraud, wilful misrepresentation or wilful nondisclosure of a material fact by such individual or through the agency of another, the individual shall also have the following issues considered at the same hearing: (A) the exact amount of benefits overpaid to the individual, and (B) whether or not the individual's receipt of such sum was due to fraud, wilful misrepresentation or wilful nondisclosure of a material fact by such individual or through the agency of another for the purpose of obtaining benefits; (8) notice that a finding of fraud, wilful misrepresentation or wilful nondisclosure pursuant to subdivision (5)(A) of this subsection can result in the imposition of an additional administrative penalty in accordance with sections 31-273-6 and 31-273-6a of the Regulations of Connecticut State Agencies; and (9) notice to the individual that if the individual fails to appear at such hearing and a determination of ineligibility or non-entitlement is made, the Administrator will proceed to adjudicate the issues identified in subdivision (7) of this subsection and make a determination with respect to those issues on the basis of the record available to the Administrator. The hearing held by the Administrator shall be conducted in accordance with the provisions of Section 31-273-8 of the Regulations of Connecticut State Agencies. (e) Where the individual is determined to be ineligible for benefits and overpaid as a result of fraud, wilful misrepresentation or wilful nondisclosure of a material fact by the individual or through the agency of another following a hearing described in subsection (d), the Administrator shall issue a determination which contains the following information: (1) the reason the individual was ineligible for or not entitled to benefits; (2) the week or weeks for which the individual was overpaid as the result of such ineligibility or non-entitlement; (3) the total amount of the overpayment; (4) an administrative determination that the individual was overpaid because the individual, by such individual’s own act of commission or omission or through the agency of another knowingly committed fraud, misrepresented a material fact or failed to disclose a material fact for the purpose of obtaining benefits; (5) notice that such overpaid sum shall be repaid in full directly to the Administrator, and that if such sum is not repaid in full, it shall be recouped pursuant to the provisions of Section 31-273-7 of the Regulations of Connecticut State Agencies; (6) the administrative penalty to be imposed, pursuant to sections 31-273-6 and 31-273-6a of the Regulations of Connecticut State Agencies; and (7) the individual's statutory appeal rights. (f) Where an individual is determined to be ineligible for benefits but overpaid benefits for reasons other than fraud, wilful misrepresentation or wilful nondisclosure by such individual or through the agency of another as the result of a hearing described in subsection (d) of this section, the Administrator shall notify the individual that the individual has the right to a hearing in accordance with the provisions of subsection (d) of Section 31-273-2 of the Regulations of Connecticut State Agencies, which may, at the individual's option, be conducted immediately or within five business days.