Workers' Compensation Fraud

In California, workers’ compensation insurance is a no-fault system. Injured employees need not prove an injury was someone else’s fault in order to receive workers’ compensation benefits for an on-the-job injury. In addition to medical expenses being covered for injured employees, some injured workers are entitled to recover a portion of lost wages resulting from injury. Fraudulent workers’ compensation claims can be an enticing target for criminals.

Workers’ compensation insurance fraud occurs in simple and complex schemes that often require difficult and lengthy investigations. Employees may exaggerate or even fabricate injuries. At the other end of the spectrum, white-collar criminals, including doctors and lawyers, entice, pay, and conspire with others to defraud the system by creating false or exaggerated claims, over treating, and over prescribing harmful and addictive drugs. Insurance companies “pick up the tab,” passing the cost onto policyholders, taxpayers and the general public.

Source: http://www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/10-anti-fraud-prog/Workers-Comp.cfm

 

What is Insurance Fraud?

Fraud occurs when someone knowingly lies to obtain a benefit or advantage to which they are not otherwise entitled or someone knowingly denies a benefit that is due and to which someone is entitled. According to the law, the crime of insurance fraud can be prosecuted when:

  • The suspect had the intent to defraud. Insurance fraud is a "specific" intent crime. This means a prosecutor must prove that the person involved knowingly committed an act to defraud.
  • An act is completed. Simply making a misrepresentation (written or oral) to an insurer with knowledge that is untrue is sufficient.
  • The act and intent must come together. One without the other is not a crime.
  • Actual loss is not needed as long as the suspect has committed an act and had the intent to commit the crime. No money necessarily has to be lost by a victim.

Source: http://www.insurance.ca.gov/0300-fraud/0100-fraud-division-overview/05-ins-fraud/

 

How We Can Help You!

Our team of experts can investigate these claims and help you save money! Don't settle your case when we can prove wrongdoing and fraudulent claims. Our investigators have over 20 years of law enforcement experience and will provide results that will help win your case. We'll provide a detailed report along with photographic and video evidence. Your target won't even know they're being watched and investigated. 

Call us today 213-262-9899 or complete the form below for a free consultation and learn more about our process and special rate. We’re always available to help solve your litigation challenges.


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