In theory, California’s workers’ compensation system serves a valuable purpose, ensuring that workers who sustain on-the-job injuries or who develop illnesses due to working conditions are able to receive compensation for their medical bills, lost wages, and other such economic losses. This system should also benefit employers by preventing them from being the targets of negligence claims or lawsuits.
However, there are instances when employees try to take advantage of the workers’ compensation system by fraudulently seeking benefits they may not be eligible to receive.
Additionally, workers aren’t necessarily the only ones who may participate in workers’ comp fraud. Even doctors can try to abuse the system at times.
For instance, as of this writing, in 2022 alone, the California Department of Industrial Relations’ Division of Workers’ Compensation has suspended nearly 200 doctors from participating in its workers’ compensation system. A DIR press release indicates doctors are often suspended from the system if they’ve been convicted of fraud-related crimes.
There are various ways in which medical professionals can commit workers’ compensation fraud in an attempt to benefit financially from a system that is meant to provide genuinely injured workers with access to the compensation they deserve.
For example, when a patient is seeking workers’ compensation insurance, their doctor should only provide them with the treatment and testing they legitimately need. However, some medical professionals provide unnecessary treatment or order unnecessary testing. This allows them to bill for additional services.
Some fraud schemes even involve collusion between doctors and attorneys representing clients with workers’ compensation claims. For example, there have been cases where doctors have informal agreements with lawyers. An attorney will promise to send their clients to a particular physician, and in exchange, that doctor will write favorable disability ratings for claimants. This allows a doctor to get more patients and a lawyer to earn more in fees.
None of this is meant to suggest that all workers’ compensation attorneys and doctors are corrupt. Far from it. It’s simply meant to highlight the ways in which abuse of the workers’ compensation system in California can take place at many levels.
Luckily, it appears the California Department of Industrial Relations’ Division of Workers’ Compensation is vigilantly taking steps to ensure doctors who engage in workers’ compensation fraud schemes are identified and held accountable.
If you’re an employer, you can also do your part to minimize the chances of unscrupulous workers “gaming the system.” If you have reason to believe a worker is seeking benefits for which they’re not eligible, you can deny their claim. So can your workers’ compensation insurance carrier.
That sai, when you deny a claim, an employee may still attempt to appeal your decision. Strongly consider enlisting the help of a legal professional if you find yourself in this situation.
At Sacks Law Group, APC, our experienced team of Los Angeles workers’ compensation fraud attorneys is on hand to offer the assistance you need in these circumstances. Learn more about what we can do for you by contacting us online or calling us at 310-216-7778.