Workers Compensation Fraud Committed by Employer - PDF

							“They are stealing our money!”




   PHILLIP J. CLINE
   D ISTRICT A TTORNEY
   Office of the Tulare County
   District Attorney
Abuse Versus Fraud

Workers’ Compensation Abuse is any practice
that uses the Workers’ Compensation system
in a way that is contrary to the intended
purpose of the system, or the law. This is not
fraud and cannot be prosecuted.

Workers’ Compensation Fraud occurs when
someone knowingly lies to obtain a benefit to
which they are not entitled to claim.

Reporting Fraud

Insurance companies are mandated by the
Insurance Code to notify both the local
District Attorney’s Office, and the California
State Department of Insurance, when that
insurer knows, or reasonably believes a
fraudulent act relating to a Workers’ Compen-
sation claim has occurred. The insurance com-
pany must make the suspected fraud notifica-
tion within thirty days of discovering the
fraudulent activity.
Fraudulent Workers’ Compensation claims are
costing jobs in the State of California and Tulare
County! The fraudulent claims are driving Work-
ers’ Compensation premiums up. They are causing
employers to leave both Tulare County and the
State of California.

Workers’ Compensation Fraud undermines the
integrity of the system and causes unnecessary
delays to the thousands of legitimate claims
that are filed each year.

The Tulare County District Attorney’s Office has
created a Workers’ Compensation Fraud Unit to
prosecute unscrupulous doctors, lawyers, employers,
and applicants who help set up false claims. By
halting the flow of fraudulent medical billings,
we hope to restore confidence in the Workers’
Compensation system for employers
and employees.

We want to make the Workers’ Compensation
system work for those who need it.

Phillip J. Cline
District Attorney
What is Workers’ Compensation Fraud?

Workers’ Compensation Fraud is committed
when:

  An employer gives false information to the
  insurance company for the purpose of
  reducing premiums.

  An employee lies about receiving an injury
  for the purpose of obtaining free medical
  care and undue compensation.

Workers’ Compensation Fraud is committed
when an employee supplies material misinfor-
mation in any of the following manners:

  An employee claims a work related injury,
  when in fact he/she was injured off the job.

  An employee claims a legitimate work
  related injury but lies about his/her injuries
  or symptoms to the degree that he/she
  collects benefits they would not have been
  entitled to claim.

  An employee claims a work-related injury
  when in fact no injury occurred.
Workers’ Compensation Fraud is committed
when an employer lies to his Workers’ Compen-
sation insurance carrier when the:

  Employer does not report the total number
  of employees he has on payroll.

  Employer falsifies total gross payroll.

  Employer mis-classifies the employees job
  description.

  Employer purchases Workers’ Compensa-
  tion insurance but does not provide that
  insurance to employees.
The Tulare County District Attorney’s
Office has a Workers Compensation
Fraud Unit to investigate and prosecute
persons committing Workers’ Compen-
sation Fraud.

If you know of someone who is filing a
fraudulent Workers’ Compensation
claim, please call the Office of the
Tulare County District Attorney, Investi-
gations Unit at (559) 733-6600. You
may call anonymously.

If you would like information regarding
the Workers’ Compensation Laws and
Reporting Responsibilities, the Office of
the Tulare County District Attorney ,
Workers’ Compensation Unit will pro-
vide speakers to any interested group
or any individual seeking information.




               PHILLIP J. CLINE
               D ISTRICT A TTORNEY
               Office of the Tulare County
               District Attorney