Workers’ Compensation Fraud

Workers’ compensation is a no-fault system that benefits both employees and employers. It benefits employees by providing for prompt medical attention and other assistance to those injured on the job. It benefits employers by offering protection from civil lawsuits for job-related injuries. Unfortunately, fraud is a significant problem within the workers’ compensation system, costing billions of dollars each year.

Workers’ compensation fraud is a crime.

The Alameda County District Attorney’s Office is committed to preventing fraud, but we need your help. Below is a description and some examples of the most common types of fraud. If you are aware of such fraud, please contact either the Insurance Fraud division of our office DA-InsuranceFraud@acgov.org or the California Department of Insurance.

Workers’ Compensation Fraud brochure – English, Spanish & Chinese (PDF)

Fraud

UNINSURED EMPLOYERS

Failing to have workers’ compensation insurance when required by law is a crime punishable by up to one year in jail and at least $10,000.

 

APPLICANT FRAUD

An employee who lies to receive benefits may be guilty of a felony punishable by up to five years in prison and $150,000.

Examples include:

  • Making up an injury that did not happen
  • Lying about working another job
  • Failing to disclose prior relevant injuries
 

CLAIM DENIAL FRAUD

Employers or insurance companies that wrongfully deny claims may be guilty of a felony punishable by up to five years in prison and $150,000.

Example:

  • Making false statements to prevent an employee from filing a claim

PREMIUM FRAUD

Employers who lie to reduce their insurance premium may be guilty of a felony punishable by up to five (5) years in prison and $50,000.

Examples include:

  • Paying injured workers in cash, without reporting the injury to the insurance carrier
  • Misstating the employees’ job descriptions
  • Falsely claiming employees are actually “independent contractors”
  • Falsely reporting the company’s payroll

PROVIDER FRAUD

Medical providers who commit fraud in connection with workers’ compensation may be guilty of a felony punishable by up to five (5) years in prison and $50,000.

Examples include:

  • Billing for services not provided
  • Paying other people to recruit patients
 

CONTACT INFORMATION