In California, businesses, non-profit organizations, and legal entities are required to provide no-fault workers’ compensation insurance coverage to their employees. When someone is hurt on the job, they can pursue a workers’ compensation claim. Unfortunately, not all employees play by the rules. Workers’ compensation fraud remains a significant problem in our state.

The California legislature has officially declared that workers’ compensation insurance fraud harms employers” since it directly increases the already high cost of obtaining insurance coverage. Here, our Fresno workers’ compensation defense attorneys provide an overview of workers’ compensation fraud in California.

Estimate: Between $1 Billion and $3 Billion in Annual Workers’ Compensation Fraud in California

Citing a comprehensive report from the National Insurance Crime Bureau (NICB), the California Department of Insurance estimates that workers’ compensation fraud costs our state between $1 billion and $3 billion each year. Workers’ compensation fraud is a serious problem that damages many parties. Of course, employers bear the financial burden through higher workers’ compensation insurance premiums. Injured employees with legitimate claims are also hurt as fraud undermines the overall faith in the system.

An Overview of California’s Workers’ Compensation Fraud Statute

In California, workers’ compensation fraud claims are generally governed by California Insurance Code Section 1871.4. Under the statute, it is strictly unlawful (fraud) to commit any of the following acts or omissions:

  • False Statements or Representations: It is workers’ compensation fraud to make, or cause, a knowingly false statement or knowing misrepresentation of material fact for the purpose of obtaining benefits. Both written statements and oral statements are covered by the statute.
  • Assist, Abet, and Conspire: It is workers’ compensation fraud to assist, conspire, or abet another party’s unlawful, illegitimate claim for benefits. The fact that a party did not actually obtain benefits for themselves is not necessarily a defense against workers’ compensation fraud charges. Conspiring to assist another party’s fraudulent claim violates the statute. 

Notably, California’s workers’ compensation fraud statute defines the term “statements” in a broad manner. For the purposes of the law, a statement can include a fraudulent bill for services, fraudulent medical/doctors records, fake X-ray results, and any other document or oral representation used to support an illegitimate workers’ compensation claim. 

Insurers, employers, and claims administrators can protect themselves against workers’ compensation fraud. All parties handling claims have the right to investigate and evaluate these cases to ensure legitimacy. If you believe that workers’ compensation fraud is occurring, an experienced Central California workers’ compensation defense attorney will protect your rights.

Get Help From Our California Workers’ Compensation Defense Lawyers

At Yrulegui & Roberts, our Fresno workers’ compensation defense lawyers possess the skills and legal expertise upon which you can rely. We know workers’ compensation fraud claims. If you have any questions or concerns about workers’ compensation fraud, a lawyer can help. Contact our law firm right away for a strictly confidential assessment of your case. Our law firm represents clients throughout Central California, including in Fresno County, Madera County, Santa Clara County, Kern County, Sacramento County, and San Joaquin County.