If you live in the Los Angeles area and are facing charges of worker's compensation fraud, you are potentially looking at very serious consequences and should not hesitate to reach out for legal advice and representation.

The surge in worker’s compensation fraud incidents in California, and the impact fraud has on the wages/benefits of others, has made it easy for overzealous agencies to file charges against innocent parties. At Los Angeles Criminal Attorney, we know how to defend your rights and will fight tenaciously to secure the best possible outcome to your case.

About the California Workers' Compensation System

In California, workers' compensation insurance is provided by private insurance companies, but it is mandated by state law that all employers must provide it for their workers.

In the event an employee is injured or killed on the job site or during work-related activity, workers comp will cover the medical expenses, lost wages for temporary/permanent disabilities, and death benefits due to close relatives.

Workers comp is a no-fault system in Los Angeles, meaning that there is no need to prove whose fault the injury/fatality was, so long as it occurred while the employee was on the job.

What Is Worker's Compensation Fraud?

Any falsification of information provided to insurers in order obtain workers comp benefits or increase the amount of the claim constitutes worker's compensation fraud. Workers comp fraud can also occur when an employer attempts to fraudulently thwart valid claims.

This type of fraud is covered under California Insurance Code 1871.4 and Penal Code Sections 549 and 550. Some of the most common instances of worker’s compensation fraud listed in the relevant statutes include the following:

  • Making a false/misleading statement with the intent to fraudulently secure workers comp benefits or to increase a claim amount.
  • Making a false/misleading statement about a worker's injury or salary in order to fraudulently deny or diminish a rightful benefit.
  • Conspiring with others to commit any form of worker’s comp fraud.
  • Submitting multiple claims for the same workplace injury.
  • Submitting a claim for a medical expense that never occurred, even if the injury itself did.
  • Submitting a claim for an injury that did not occur on a job site or while in the employ of any business.
  • Presenting injuries as much more severe than they truly are in order to get a bigger claim.
  • Working while simultaneously collecting temporary disability payments from a worker’s compensation insurer.
  • For healthcare workers, double-billing or billing for a service never provided.

Possible Penalties

Since 1991, the L.A. Workers' Compensation Fraud Program (WCFP) has been charged with the task of rooting out all instances of worker’s comp fraud. The WCFP has generously funded, and insurers are required to report to them every time fraud is even suspected.

Additionally, many kinds of worker’s compensation fraud are now felonies, though some are misdemeanors and some can be either, depending on the circumstances.

All this goes to show how seriously this kind of fraud is taken by both the state of California and the City of Los Angeles. 

First, we should mention that the penalty for an employer failing to provide workers' compensation insurance is up to 18 months in jail and a maximum fine of $11,000.

The punishments for worker’s comp fraud are very complex, but if a violation falls under California Insurance Code 1871.4, possible sentences include:

  • For a felony, 2 to 5 years in jail and a fine of twice the amount defrauded but not less than $150,000.
  • As a misdemeanor, a year in county jail and the same fine as for the felony.
  • In all cases, full restitution of the monies taken by fraud and to anyone hurt financially by the fraudulent activity.

For violations of Penal Code Section 549, the punishments are as follows:

  • As a felony, 16 months to 3 years in jail and a fine of twice the amount defrauded but not less than $50,000.
  • As a misdemeanor, up to a year in jail and the same fine as for the felony.

Violations of PC 550 are punishable as follows:

  • As a felony, a 2 to 5 year jail term and a fine of double the amount defrauded but not less than $50,000.
  • As a misdemeanor, a year in jail, probation, and a maximum fine of $10,000.
  • If the amount defrauded is $950 or less (petty theft), including all false claims across 12 months' time, it is a misdemeanor and punishable by 6 months in jail and a fine of up to $1,000.

In addition to other punishments, doctors, pharmacists, and nurses could likely lose their jobs or suffer professional discipline.

What Must the Prosecution Prove?

To gain a conviction on charges of worker's compensation fraud, the prosecutor must establish the following elements of the crime beyond all reasonable doubt:

  1. A false/misleading statement or an omission was made by the defendant in relation to a worker’s compensation claim.
  2. The information provided/withheld was materially relevant to the approval or the amount granted concerning a worker’s comp claim.
  3. The defendant had a fraudulent intention in his actions, purposefully attempting to secure illegitimate claims.

Available Defense Strategies

Here are some of the defense strategies we use at Los Angeles Criminal Attorney on a regular basis:

  1. The defendant had no fraudulent intent. He believed he was providing factual information, made a simple mistake, or did not realize information omitted was legally required.
  2. The information in question was not material, not likely to significantly affect decisions on paying out a claim.
  3. There is insufficient evidence to convict. The "facts" may be indiscernible, seemingly conflicting, and certainly inconclusive.

Contact Us Today

At Los Angeles Criminal Attorney, we have well seasoned expertise in the legal practice area of worker's compensation fraud defense. We have a long track record of securing favorable outcomes across a wide range of welfare fraud case types, and we will know how to build a solid defense for your case.

For a free legal consultation, call us anytime 24/7 at 424-333-0943, and we will be happy to assist you.