Workers Compensation Insurance Fraud Unit

The area of Workers Compensation Insurance has been a hot topic due to the growing cost of the insurance and a growth in the work force and fraudulent claims and abuses. This unit has two senior deputy district attorneys with over forty years of legal experience and four investigators.

This Unit handles four different areas of law enforcement:

• Provider Fraud
  
  Provider Fraud is defined as fraud committed by both Medical/Chiropractic providers and legal providers. This includes over billing for services not rendered to injured employees; or billing for treating injured employees when no such medical visit ever occurred; and for billing for medical equipment provided that is improperly billed or is not necessary for the treatment of the injured employees.
   
• Premium Fraud
  
  Premium Fraud is when an employer is not truthful about the number of employees to be covered by the insurance; or is not truthful about the nature of the work the employees are doing (paying less due to a smaller risk of injury because the employer has not been truthful about the nature of the work); or is when a person takes money from an employer under the pretense that the money will be used to purchase insurance to cover the employer’s employees.
   
• Applicant Fraud
  
  This occurs when an employee makes a false claim of a injury; or when an employee does not disclose other precedent injuries to the same body part; or when an employee does not divulge money being earned while receiving payments for the injury.
   
• Uninsured Employer Cases
  
  Any employer that does not have workers compensation insurance coverage on his regular employees is in violation of the law. This is a violation of Labor Code 3700.5.