2015 Workers' Comp Fraud Public Service Announcement Bus Ad Campaign targeting Claimant Fraud
The District Attorney Workers’ Compensation Insurance Fraud Unit investigates and prosecutes insurance fraud. It does not handle individual workers’ compensation claims. This Unit handles five different areas of fraudulent conduct:
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 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.
This occurs when an employee makes a false claim of an 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, or for any other material misstatement during the claims process.
Deputy District Attorneys Scott Byrd and Mike Chiriatti of the Workers’ Comp Fraud Unit gave a presentation to over 120 employees of the Victor Valley Transit on the subject of the workers’ compensation system. A number of topics were discussed including procedures, benefits, fraud reporting, etc. This was part of the Unit’s ongoing dedication to education in the community. We are committed not only to fighting fraud where it is found, but also in reducing the instances of fraud through education and outreach.
Denial of Benefits
This occurs when a business, with workers’ compensation insurance willfully denies insured benefits to an injured employee. This is often done by requiring the employee to use their health insurance to cover treatment of occupational injuries, or where the employee is told there is no coverage.
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.