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Could I Be Charged with Workers’ Compensation Fraud?

June 15, 2020

Certain actions may lead to a charge of workers’ compensation fraud.

Could I Be Charged with Workers’ Compensation Fraud?

If you are hurt on the job or develop an illness as a result of your work, you may be entitled to workers’ compensation. Workers’ comp is a no-fault system of insurance that allows sick or injured employees to get access to benefits — including medical care and payments — if their injury or illness resulted from their job.

When you’re filling out your workers’ compensation paperwork, it may be tempting to exaggerate your symptoms or tell a fib in order to get a higher level of benefits. But according to a fraud defense attorney in Orange County, CA, doing so can land you in serious hot water.

There are three separate laws that address workers’ compensation fraud in California. Under the Insurance Code, you can be charged with fraud if you:

  • Make, or cause to be made, a knowingly false or fraudulent material statement or representation for the purpose of obtaining or denying any workers' comp benefits;
  • 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 workers' comp benefits;
  • Knowingly aid or abet, or conspire with anyone else to commit any act of workers' compensation fraud; or
  • 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.

Under this law, you could be charged with workers’ compensation fraud if you make any type of false statement or present a false statement, as long as it is material (or important) to your claim. For example, if you claim that you fell down the stairs at work, when this actually occurred at your home, in order to get workers’ comp benefits, then you could be charged with fraud. Workers’ comp fraud may also include faking an injury, lying about how serious an injury is, collecting benefits for the same injury twice, failing to disclose a prior injury, or even illegally working while you are receiving benefits.

California’s penal code also makes it a crime to make a fraudulent claim for a health care benefit that is covered by workers’ comp insurance. This law applies to both employees and to health care providers who submit bills to the insurance agencies. Similarly, California’s penal code makes it a crime for anyone to commit workers’ comp fraud by soliciting, accepting or referring any business with the knowledge that (or with reckless disregard for) the other entity intends to commit workers’ comp fraud.

Any of these types of workers’ compensation fraud can lead to serious criminal penalties. For example, if you violate the insurance code’s provisions against fraud, you could be sentenced to anywhere from up to 1 year in county jail to 5 years in county jail, plus a fine of up to $150,000 or double the amount of the fraud, whichever is great. In addition, you’ll be required to pay restitution to victims of the fraud.

At the Chambers Law Firm, we represent people who have been charged with all types of offense, including those related to fraud. Contact us today at 855-397-0210 or dchambers@clfca.com to schedule a free initial consultation with a fraud defense attorney in Orange County, CA.

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