What is workers’ compensation fraud?

| Jul 7, 2021 | Criminal Defense |

California’s employers pay for workers’ compensation insurance. As a safety net, it covers medical costs for employees who sustained injuries or became sick because of the work they do. When someone files a fraudulent claim, he or she may need a criminal defense attorney. What constitutes fraud in this situation?

Who commits workers’ compensation fraud?

It’s a common misconception that only employees file fraudulent claims. Rather, employers, too, can try to game the system. Even health care providers may try to gain financially from the provisions of workers’ compensation.

What does workers’ compensation fraud look like?

Most people know about the cases where employees lie for financial gain. Someone may pretend that he or she is injured even though he or she actually isn’t. Others may have a real injury, but it didn’t happen at work. Even so, they file for workers’ compensation and claim that the injury happened while they were doing their jobs.

When employers commit fraud, they may misclassify employees as contractors to lower the cost of their insurance. Doctors and caregivers may attempt to defraud the system by submitting bills for services they did not provide.

Do you suspect fraud?

You don’t want to come right out and accuse someone of fraud. However, if you suspect that there’s a problem with the information you receive, it’s OK to ask some questions. For example, an employee’s story shouldn’t change when you ask him or her to repeat it a couple of times.

Also, if your business uses cameras, check to see what happened right before the accident and right afterward. If there were witnesses, interview them. As an employer, you don’t have to hire an investigator to check out the story. Instead, report suspected fraud to the state agency, which will handle the case from there.

When someone commits workers’ compensation fraud, he or she may need the assistance of a criminal defense attorney if an investigation uncovers irregularities.