Workers Compensation Fraud
In California, workers’ compensation is a form of insurance that pays for medical expenses related to the injury obtained at the work and partial wage replacement while you’re away from work and recovering.
In some cases, there is an investigation to confirm that the injuries being claimed are legitimate. If there is suspicion that there was lying or fraud involved in the claim, you can be charged criminally for Worker’s Compensation Fraud as well as under separate but related charges. Workers Fraud case can also be filed against an Employer
1. In California, Activities that are considered worker’s compensation fraud under IC 1871.4 include;
- Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any compensation
- Present or cause to be presented a knowingly false or fraudulent written or oral material statement in support of, or in opposition to, a claim for compensation for the purpose of obtaining or denying any compensation
- Knowingly assist, abet, conspire with, or solicit a person in an unlawful act under section IC 1871.4 (ie. this section)
- Make or cause to be made a knowingly false or fraudulent statement with regard to entitlement to benefits with the intent to discourage an injured worker from claiming benefits or pursuing a claim.
- Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any of the benefits or reimbursement provided in the Return-to-Work Program
- Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of discouraging an employer from claiming any of the benefits or reimbursement provided in the Return-to-Work Program
2. Some Examples of people who could be charged with Worker’s Compensation fraud in California includes:
- A person falls at the workplace and injures their shoulder. They claim the injury as serious and collects for workers’ comp payments. At the same time, that person is working at another job under the table, using their alleged injured shoulder (which was not seriously injured) in full capacity.
- An employer lies about the details and circumstances involving an employee’s accident at work in order to stop that employee from getting workers’ compensation benefits.
- A doctor regularly submits bills to workers’ comp insurance for treatments that the patients did not actually receive or need.
3. Penalties under IC 1871.4
Many charges related to workers’ compensation fraud can be charged as either misdemeanors or felonies, including IC 1871.4.
- If charged as a misdemeanor, the custody time is imprisonment in county jail up to one (1) year.
- If charged as a felony, the custody time is two (2), three (3) or five (5) years.
- There are also fines up to one hundred fifty thousand dollars ($150,000), or twice the amount of the fraud (whichever is greater).
- Further, you can be ordered by the Court to reimburse any medical evaluation or treatment services obtained or provided as well as the costs of investigation.
- There can be additional penalties if there are prior conviction(s) for this offense (ie. additional 2 year imprisonment per conviction if IC 1871.4, former Section 556, of former Section 1871.1, or of Section 548 or 550 of the Penal Code).
4. Defenses To Workers Compensation Fraud Charges
There are defenses to worker’s compensation fraud which can allow charges and potential penalties to be reduced or dismissed. This includes:
- Insufficient evidence to support the charges filed against you.
- You did not act knowingly or with fraudulent intent when making or pursuing your claim, or in receipt of benefits received.
As if being injured on the job and losing not only your ability to work
is not frustrating enough, subsequently being charged with Workers’
Compensation Fraud can really turn your life upside down. I understand how stressful this time in your
life can be, particularly with the serious potential consequences associated
with this or related charges.
Call Attorney Phil Hache at 818-336-1384 to discuss your situation confidentially in more detail.