Workers’ Compensation Fraud
Workers’ Compensation or (Workers’ Comp or Workman’s Comp) is a type of insurance that provides compensation and benefits to employees who sustain on-the-job injuries and work-related illnesses. Benefits include payments for medical costs, wage replacement, expenses associated with the injury and job retraining. An employee can be charged with Workers’ Comp fraud if they allegedly seek to obtain or actually obtain these benefits through fraudulent means, such as by claiming that a non-workplace injury was work- related or by lying to a doctor about the nature or severity of one’s injuries. Filing a false Workers’ Comp claim is a serious crime in California that comes with harsh penalties if convicted
California Law- Insurance Code section 1871.4
California Insurance Code section 1871.4 defines Workers’ Compensation fraud as doing any of the following:
- Knowingly making false statements with the intent of obtaining or denying Workers’ Compensation benefits;
- Knowingly making a false oral or written statement in support of a claim to obtain insurance benefits;
- Knowingly conspiring with or assisting someone in carrying out a fraudulent Workers’ Compensation claim; or
- Knowingly making false statements regarding a person’s eligibility/entitlement to workers’ compensation for the purpose of discouraging the individual from filing a Workers’ Compensation claim and/or seeking benefits.
Employees, employers and health care providers can be charged with Workers’ Comp fraud.
Examples of workers’ compensation fraud include:
- Falsely claiming an injury is work-related;
- Exaggerating or faking an injury;
- Lying to a medical provider about an injury;
- Failing to report work conducted while collecting workers’ compensation;
- Filing multiple claims for the same injury;
- Misclassification of employees as independent contractors/ineligible workers;
- Medical providers billing for services not provided;
- Inflating the cost of provided medical care;
- Offering kickbacks to medical providers for patient referrals (with intent to commit fraud).
Workers’ Compensation fraud is a “wobbler,” meaning it can be charged as either a misdemeanor or felony, and the penalties for a conviction vary. If you are charged with misdemeanor Workers’ Compensation fraud, you face the following penalties:
- Up to one year in county jail;
- Fines up to $150,000 or two times the amount of fraud, whichever is greater.
If you are charged with felony Workers’ Compensation fraud, you face the following penalties:
- Up to five years in state prison;
- Fines up to $150,000 or two times the amount of fraud, whichever is higher.
Whether you are charged with a misdemeanor or a felony, you could be required to pay restitution to the employer and/or the insurance company victimized by the fraud. .
Fighting Workers’ Comp Fraud Charges in Los Angeles
If you are under investigation or charged with Workers’ Comp Fraud it is important to consult with an experienced criminal lawyer immediately. The Los Angeles criminal defense attorneys at Stephen G. Rodriguez & Partners are prepared to put their extensive experience and record of results on your side.
Contact us online to request a confidential case evaluation today.