Insurance fraud is a felony. Those who commit fraud are criminals.
Workers’ Compensation Insurance Fraud
“RED FLAGS”
Employee Circumstances
• • • • • • • Disgruntled, soon-to-retire, or facing imminent firing or layoff; Involved in seasonal work that is about to end; Nomadic and has a history of short-term employment; New on the job; Has a history of reporting subjective injuries; Protests about returning to work; Never seems to improve. • • •
Questions Frequently Asked by Employers:
Q: Do I need to have workers’ compensation insurance? A: California law requires employers to have workers’ compensation insurance. Even outof-state employers may need workers’ compensation coverage if an employ ee is regularly employed in California or a contract of employment is entered into here. Q: What is employer fraud? A: It is unlawful to make or cause to be made any knowingly false or fraudulent statement, whether made orally or in writing, of any fact material to the determination of the premium, rate, or cost of any policy of workers’ compensation insurance, for the purpose of reducing the premium rate or cost of the insurance. Q: What are the penalties for Workers’ Compensation Fraud? A: Any person, employer or employee, who commits workers’ compensation insurance fraud is guilty of a felony, punishable by: 1. 2. 3. Up to 5 years in prison, Fines up to $50,000 or double the value of the fraud (whichever is greater), and Restitution for benefits wrongly obtained.
Accident/Injury Circumstances
• Occurs late Friday afternoon or shortly after employee reports to work on Monday; Not witnessed, or witnesses’ version of accident conflict with applicant’s version or with one another’s; Fellow workers hear rumors circulating that accident was not legitimate; Accident occurs just prior to disciplinary action, or near end of probationary period; Details of accident are vague or contradictory, have inconsistencies, are not credible; Incident is not promptly reported by employee to supervisor; Injuries are all subjective.
•
•
•
What may look like easy money can lead to hard time behind bars!
Solano County District Attorney’s Workers’ Compensation Insurance Fraud Unit 675 Texas Street, Suite 4500 Fairfield, CA 94533-6340
So...what’s the big deal?
From 10% to 30% of the over $10 billion in workers’ compensation insurance claims filed annually in California are fraudulent. This costs California businesses and consumers a reported $5 billion per year! Both medical and legal fraud “mills” specialize in recruiting so-called patients to bilk insurance carriers for fraudulent or non-existent services. Fraud results in higher insurance premiums for all employers, and it raises the price of the goods and services we by every day! So...if you have information about workers’ compensation insurance fraud or if you are the victim of fraud, please contact my office immediately.
WORKERS’ COMPENSATION INSURANCE FRAUD
“TRUTH OR CONSEQUENCES”
David W. Paulson
Solano County District Attorney
Solano County District Attorney’s Workers’ Compensation Insurance Fraud Unit
Solano County District Attorney’s Workers’ Compensation Insurance Fraud Unit 675 Texas Street, Suite 4500 Fairfield, CA 94533-6340 (707) 784-6800
David W. Paulson
Solano County District Attorney