Workers’ compensation fraud poses a huge problem in Los Angeles
County. Fraudulent claims have cost the region jobs, chasing
companies to other states where they can avoid paying the
accelerated costs of workers’ compensation insurance. Fraudulent
claims have also undermined the integrity of the system, causing
unnecessary delays in treating real injuries and casting a shadow
over the thousands of legitimate claims that are filed each year.
The District Attorney’s Workers’ Compensation Fraud Division
has pursued an aggressive campaign to identify, investigate, and
prosecute workers’ compensation fraud. This crime – which is
committed by doctors, lawyers, employers, insurance company
employees and claimants – occurs in both the private and public
Everyone suffers because of workers’ compensation fraud. Tax
dollars are wasted, the price of consumer goods increases, and
employers and legitimately injured workers lose money. If you think
someone is committing workers’ compensation fraud, report it to your
workers’ compensation insurer or your employer. You may also report
it to the District Attorney’s Office by calling (213) 580-3200.
For more information on the most common types of workers’
compensation fraud, please click here.
Most Common Types of Workers’
Public Sector Fraud
Fraud perpetrated upon government entities has a direct negative
impact on all taxpayers. The District Attorney’s Office has
specially assigned prosecutors who handle only those frauds
committed within the public sector. It is an innovative approach,
which combines aggressive investigation and prosecution with a
comprehensive prevention program. The prevention aspect involves
prosecutors addressing groups of employees regarding the benefits
available for work related injuries while at the same time
describing the consequences of committing fraud.
Organized workers’ compensation fraud involving doctors and
lawyers have been an ongoing problem, especially in Southern
California. Fraud rings have made a practice of recruiting people to
file phony work injury claims. The workers are sent to medical
clinics or legal referral centers (commonly known as "claim mills"),
which in turn refer them to a doctor or lawyer who is in on the
Regardless of the legitimacy of the original claim, many medical
or other health practitioners fraudulently maximize the number of
medical reports and referrals in each case to increase the number of
billings. They may also over bill or render unnecessary treatment.
Premium fraud occurs when employers fraudulently misstate the
number of employees or the nature of their work, such as reporting a
roofer as an office worker. Other businesses are part of the
"underground economy" and carry no workers’ compensation insurance.
Under new California law, the Workers’ Compensation Fraud Division
can now prosecute the uninsured employer.
Employer and Insurance Carrier Fraud
In this type of fraud, employers or employees of an insurance
carrier will make a false statement regarding a workers entitlement
to benefits. The statement is designed to discourage the worker from
pursuing a legitimate claim.
These cases involve workers who fake an injury, lie about the
extent of their injury, lie by denying filing previous claims, fail
to disclose a prior injury to the same body part, claim a non-work
injury is work related, or illegally work while obtaining benefits.
Sub rosa surveillance tapes regularly expose applicants who are