Workers' Compensation Insurance Fraud

The Shasta County District Attorney’s Office Workers’ Compensation Insurance Fraud Unit has a dedicated investigator who investigates cases from many sources, including referrals from insurance carriers, other law enforcement agencies, citizens, victims and through proactive enforcement activities.  The unit also includes a prosecutor who vertically prosecutes all workers’ compensation fraud cases from filing through sentencing. 

The Workers Compensation Insurance Fraud unit works closely with investigators from the California Department of Insurance (CDI), as well as other outside agencies such as the Contractor State License Board (CSLB), California Department of Industrial Relations (DIR), State of California Employment Development Department (EDD), other District Attorney’s Offices and local law enforcement agencies.

 There are many types of fraud within the workers' compensation system.  Some of the most common forms of workers’ compensation insurance fraud include: 

WCFraud

Claimant Fraud

Employees who lie to get workers’ compensation insurance benefits.
  • Reporting a false injury
  • Stating an injury occurred at work when it did not
  • Overstating the extent of injuries
  • Lying about working while receiving benefits
Felony – Punishable by up to five years in prison and a $150,000 fine

Dissuading an Injured Worker

Employers/insurance carriers deny workers’ compensation benefits to injured workers.

  • Employers persuading injured workers to accept cash in exchange for not filing a workers’ compensation claim
  • Employers paying for injured workers’ medical services without telling insurance carrier
  • Persuading an injured worker to lie to a medical provider about how an injury occurred

Felony – Punishable by up to five years in prison and a $150,000 fine

Premium Fraud

Employers lie to reduce workers’ compensation premiums.

  • Paying workers in cash and not reporting payroll accurately
  • Not reporting injuries to workers’ compensation carrier
  • Misstating the company’s employee job description
  • Company claims all employees are independent contractors when they are not

Felony – punishable by up to five years in prison and $50,000 fine

Uninsured Employer Fraud

Employers operating a business without workers’ compensation insurance.

  • Business with one or more employees that does not obtain workers’ compensation insurance

Misdemeanor - punishable by up to one year in jail and a minimum $10,000 fine

Provider Fraud

False billing by anyone who provides services or products in relation to a workers’ compensation claim.

  • Healthcare provider billing for services not rendered
  • Misrepresenting the nature of the medical services, procedures or supplies
  • Paying kickbacks for recruiting/referring patients to doctors, chiropractors or lawyers

Felony - punishable by up to five years in prison and a $50,000 fine

worker

Reporting Fraud

If you have information regarding any form of Workers’ Compensation Insurance Fraud, it can be reported to the Department of Insurance, or the Shasta County District Attorney’s Office, Workers’ Compensation Fraud Unit. 

If you are an employer who suspects an employee is committing workers’ compensation insurance fraud, you should report this to your insurance carrier. 

If you are an employee who suspects your employer of committing workers’ compensation insurance fraud, you can report this to the California Department of Insurance, or the Shasta County District Attorney’s Office Workers’ Compensation Fraud Unit. 

 Contacts for reporting Workers’ Compensation Insurance fraud

 Shasta County District Attorney’s Office

Workers’ Compensation Insurance Fraud
1355 West Street
Redding, CA. 96001
(530) 245-6300

 BadgeCDI

California Department of Insurance

Fraud Division
2400 Del Paso Road, Suite 250
Sacramento, CA. 95834
800-927-4357 (HELP)
Fraud@insurance.ca.gov

  Workers' Comp Fraud Brochure