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California Workers' Compensation Fraud Attorneys

Workers’ Compensation Fraud

What You Need To Know About Workers’ Compensation Fraud

Workers’ Compensation insurance is designed to provide employees injured on the job with medical benefits and wage replacement while they recover. But, this compensation comes at a cost. In exchange for workers’ compensation benefits, the employee gives up the right to sue the employer for negligence. It is a “no fault” system. All California employers are required to carry workers’ compensation insurance. One bad apple may not spoil the whole bunch, but it may tarnish the sheen of the other good apples. Because of a handful of workers, employers, attorneys, and physicians, fraud has become a serious problem in the system. Fraud makes insurers more skeptical of workers’ compensation claims, making it more difficult for injured employees to get benefits. For this reason, if you are filing a workers’ compensation claim, it’s vital to consult an experienced attorney.

The legal team at the Kenton Koszdin Law Office has represented injured Los Angeles employees for over a decade. We are passionate about workers’ rights.

Call us at (800) 438-7734 for a free consultation.

Types of Workers’ Comp Fraud

Employer or Insurance Carrier Fraud

It is considered fraud to misrepresent a worker’s injuries or illness in order to discourage the worker from seeking workers’ compensation coverage or to get the workers’ claim denied when it would otherwise be covered by the insurer.

Premium Fraud

Some employers try to reduce the amount they spend on workers’ compensation premiums by misrepresenting either how many employees they have, what kind of work those employees do, or both. For instance, an employer may lower the number of “employees” they have by wrongly claiming some of their workers are “independent contractors,” or an employer may claim that a worker with a high-risk job, like a roofer, actually has a lower-risk job, like a secretary. Both of these misrepresentations are considered fraud under California law.

Uninsured Employer

Employers are required by law to carry workers’ compensation insurance in almost every industry. However, some employers don’t purchase the required insurance, breaking the law and leaving their employees dangerously exposed in case of accidents.

Healthcare Overbilling

Injured workers need medical care, and doctor’s visits, tests, and treatments are a normal part of that care. Some providers, however, see the opportunity to overbill for services or to bill for services that the injured person never actually received. When these bills are part of a workers’ compensation claim, an investigation for fraud may result.

“Claim Mills”

Claim mills are typically organized fraud rings involving several people or businesses. The “mills” convince workers to file false injury claims, which are passed on to physicians and attorneys who are also involved in the scheme and so let the claims pass through. California law prohibits this type of fraud and allows investigators to double-check medical and other findings to ensure claims are legitimate.

The rates of workers’ compensation fraud change from year to year, according to the California Department of Insurance. When insurance rates are high, fraud caused by employers failing to report employees or employee claims tends to go up. Similarly, the greater the risk of injury in a particular workplace, the higher the temptation for the employer to under-report the number of employees or to skip workers’ compensation coverage altogether.

Helping Workers With Valid Claims in Los Angeles

Workers’ compensation fraud makes it harder for injured employees to get the benefits they deserve. If you or a loved one has suffered an employment related illness or injury, you need to contact an expert workers’ compensation lawyer. At the Kenton Koszdin Law Office, we take an employee’s rights seriously and are proud to have successfully represented hundreds of Southern California clients. Call us today at (800) 438-7734 for a free, confidential consultation. If your illness or injury prevents you from visiting our office, we will come to your home or hospital room. We’re there for you.

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