Types of Workers Comp Fraud: Recognizing Schemes | Sacks Law Group
If you are a business owner who suspects an employee of engaging in workers' compensation fraud, Reach out to our experienced employers workers comp defense attorneys at Sacks Law Group, APC.
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Common Types of Workers Comp Fraud

December 15, 2021
Sacks Law Group, APC
Workers’ Compensation Fraud

The vast majority of employers across the state of California are required to provide their employees with workers’ compensation insurance coverage. Not only is this designed to protect your employees in the event of an on-the-job injury or illness, but it is designed to protect your business as well.

Unfortunately, workers’ compensation fraud is not uncommon. It is not unusual for employees to attempt to take advantage of their employer’s workers’ compensation insurance coverage. This can often lead to various fraudulent claims, increased insurance costs, and put your business at risk.

To recognize the signs, here are a few of the more common types of workers compensation fraud that you might see as a business owner in California. You can also learn more about the steps you should take if you suspect an employee of yours has committed workers’ compensation fraud.

Workers Comp Fraud in California

According to EMPLOYERS, workers’ compensation fraud generally Falls into one of two categories: premium fraud and claimant fraud. Premium fraud is workers’ compensation fraud that is committed by businesses.

This might include a misrepresentation of payroll numbers, falsely changing important workers’ compensation documents in order to obtain lower premium costs, and misclassification of employees, for example.

Claimant fraud involves fraudulent claims committed by workers in order to receive benefits that they may not be entitled to. Some other examples of applicant/claimant fraud could include:

  • Faking or exaggerating Injuries
  • Knowingly making false statements
  • Making a workers comp claim for injuries that occurred outside of work
  • Failure to report income
  • Filing multiple claims for benefits using different identities

Other types of workers compensation fraud that you may find yourself dealing with as a business owner include:

  • Attorney fraud
  • Premium fraud
  • Billing/provider fraud
  • Adjuster fraud

What to Do if You Suspect an Employee of Workers Comp Fraud

If you suspect an employee of yours is engaging in workers’ compensation fraud, it is important that you take steps to report it. Here is how:

  • Step one: Start documenting your suspicions. Create a report that includes your employee’s contact information, a description of your concerns, your contact information, and other relevant information.
  • Step two: Report the workers’ compensation fraud to the California Department of Insurance. You can visit their online portal here if you are interested in filing a complaint.
  • Step three: Report the fraud concerns to your workers’ compensation insurance provider. Make sure you have notified your attorney so your lawyer can speak with the insurance company on your behalf.

Get Help From an Employers Workers Comp Defense Attorney

If you are a business owner who suspects an employee of engaging in workers’ compensation fraud, it is critical that you take action to protect yourself and your business.

Reach out to our experienced employers workers comp defense attorneys at Sacks Law Group, APC to find out more about what your next steps should be. You can complete our online contact form or give our office a call at 310-216-7778 when you are ready to take action.


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