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Workers’ Compensation Fraud
Workers’ compensation fraud poses a huge problem in Los Angeles County. Fraudulent claims have cost the region jobs, chasing 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 District Attorney’s Workers’ Compensation Fraud Division has pursued an aggressive campaign to identify, investigate, and prosecute workers’ compensation fraud. This crime – which is committed by doctors, lawyers, employers, insurance company employees and claimants – occurs in both the private and public sectors.
Everyone suffers because of workers’ 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 Office by calling (213) 580-3200.
For more information on the most common types of workers’ compensation fraud, please click here.
Most Common Types of Workers’ Compensation Fraud
Public Sector Fraud
Fraud perpetrated upon government entities has a direct negative impact on all taxpayers. The District Attorney’s Office has specially assigned prosecutors who handle only those frauds committed within the public sector. It is an innovative approach, which combines aggressive investigation and prosecution with a comprehensive prevention program. The prevention aspect involves prosecutors addressing groups of employees regarding the benefits available for work related injuries while at the same time describing the consequences of committing fraud.
Claim Mills
Organized workers’ compensation fraud involving doctors and lawyers have been an ongoing problem, especially in Southern California. 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 bill or render unnecessary treatment.
Premium Fraud
Premium fraud occurs when employers fraudulently misstate the number of employees or the nature of their work, such as reporting a roofer as an office worker. Other businesses are part of the "underground economy" and carry no workers’ compensation insurance. Under new California law, the Workers’ Compensation Fraud Division can now 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 from 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. Sub rosa surveillance tapes regularly expose applicants who are fraudulent.
Workers' Compensation Fraud Division
Los Angeles County District Attorney's Office
201 N. Figueroa St., Suite 1500
Los Angeles, CA. 90012
Phone: (213) 580-3200
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Site updated: 01 Feb 2006
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