Workers' COmpensation Fraud

WORKERS’ COMPENSATION FRAUD

Workers’ Compensation fraud is a big problem in the State of California and in Solano County. Fraudulent claims cost jobs forcing companies to other states where they can avoid paying the accelerated costs of workers’ compensation insurance.  Fraudulent claims have also undermined the integrity of the system, causing unnecessary delays in treating real injuries and casting a shadow over the thousands of legitimate claims that are filed each year.

The Solano County District Attorney’s WORKERS’ COMPENSATION FRAUD DIVISION has pursued and will continue to pursue a campaign to identify, investigate and prosecute workers’ compensation fraud. This crime is committed by doctors, lawyers, employers, insurance company employees and claimants and it occurs in both the private and public sectors.

Everyone suffers because of worker’s compensation fraud. Tax dollars are wasted, the price of consumer goods increases and employers and legitimately injured workers lose money. If you think someone is committing workers’ compensation fraud, report it to your workers compensation insurer or your employer. You may also report it to the District Attorney’s Officer by calling (707) 784-6800 and ask to speak with a Workers’ Compensation Fraud Investigator.

 MOST COMMON TYPES OF WORKERS’ COMPENSATION FRAUD

CLAIM MILLS

Organized workers’ compensation fraud involving doctors and lawyers are also a problem.  Fraud rings have made a practice of recruiting people to file phony work injury claims. The workers are sent to medical clinics or legal referral centers (commonly known as “claim mills”), which in turn refer them to a doctor or lawyer who is in on the scheme.

PROVIDER FRAUD

Regardless of the legitimacy of the original claim, many medical or other health practitioners fraudulently maximize the number of medical reports and referrals in each case to increase the number of billings. They may also over the bill or render unnecessary treatment.

PREMIUM FRAUD/UNINSURED EMPLOYER FRAUD

Premium fraud occurs when employers try to lower their workers’ compensation insurance premium by fraudulently misstating the number of employees they employ or the nature of their work. For example, an employer may report a roofer, a high risk position, as an office worker. Other businesses are part of the “underground economy” and carry no workers’ compensation insurance.

Premium fraud puts workers at risk of not being covered in the event of an on-the-job injury. It also gives fraudulent employers an unfair advantage. With lower insurance costs-and, thus, lower overhead they can offer customers lower prices than their law-abiding competitors.

Premium fraud is a serious offense and under California law, the Workers’ Compensation Fraud Division can prosecute the uninsured employer.

EMPLOYER AND INSURANCE CARRIER FRAUD

In this type of fraud, employers or employees of an insurance carrier will make a false statement regarding a workers entitlement to benefits. The statement is designed to discourage the worker form pursuing a legitimate claim.

APPLICANT FRAUD

These cases involve workers who fake an injury, lie about the extent of their injury, lie by denying filing previous claims, fail to disclose a prior injury to the same body part, claim a non-work injury is work related, or illegally work while obtaining benefits.

PUBLIC SECTOR FRAUD

Fraud perpetrated upon government entities has a direct negative impact on all taxpayers.

Download an informational brochure on workers' compensation insurance fraud.