Workers’ Compensation Fraud
|Fraud Forum Information|
|December, 2012 Newsletter|
|June, 2012 Newsletter|
|December, 2011 Newletter|
Form to Report Insurance Fraud
The law makes it a felony to commit workers’ compensation fraud. What types of fraud can occur?
Claimant Fraud - This occurs when an employee or employer lies to obtain or deny benefits that are required by law. Examples would be to lie about how an injury occurred, the extent of their injury, or the employment status of an employee at the time of injury.
Medical Provider Fraud - This occurs when a medical provider submits bills for services never rendered, or embellishes the services actually provided with intent to be paid.
Premium Fraud - This is where an employer lies about his payroll, experience modification, or classification of his employees. All for the purpose of paying less premium than required.
Uninsured Employers - This occurs when an employer fails to provide workers compensation insurance to cover his employees.
Yolo County District Attorney Jeff W. Reisig believes in a fair market place. Through the efforts of his Insurance Fraud Unit, efforts are made to identify, investigate, and prosecute offenders for workers’ compensation fraud. Great strides have been made with recent workers’ compensation reform, but there are those that would look for a free ride and attempt to get benefits that they are not otherwise entitled to receive.
The cost of doing business in Yolo County is impacted by the cost of labor and the necessary insurance to cover employees in the event they are injured on the job. When fraud is introduced, it negatively impacts the entire county, as it raises the cost that we would otherwise have to pay for goods and services. Employers often attempt to skirt workers’ compensation laws by denying they have employees, or wrongly classifying their employees as sub-contractors.
The fact is, a sub-contractor has to be a bonafide business, with its own licenses and insurance to cover its employees. Those that pay under the table, without withholding the necessary taxes, are committing a felony and become personally liable for the taxes the employer fails to collect.
Furthermore, the property owner is exposed to liability, when they allow a person or business to work on their property who isn’t covered by workers’ compensation insurance. If their employee is hurt, the property owner can be sued.
It is wise to check your potential business out. Do they have a municipal business license? Are they licensed through the Contractor’s State Licensing Board? Do they have a bond? Do they keep and maintain workers’ compensation insurance for their employees or sub-contractor’s employees?
What if they claim to be a partnership? Does their advertising claim to be a partnership? Are they registered with the Secretary of State? Are both of their names on the municipal business license? Do they have a fictitious business name filing that identifies each of them as an owner? In the absence of any or all of these, you may not have a bonafide partnership. As such, should the non-interested business partner be injured on the job, the property owner could be liable.
Who should you call? When referring a concern to the District Attorney’s Office, you can call:
Investigator Paul Hillegass at 530-666-8442
Citizens may remain anonymous, but keep in mind, the investigation process is more expeditious when we can verify the reliability of the person making the complaint and how it is they know what they know.
301 Second Street | Woodland, CA 95695 | 530/ 666-8380 Phone | 530/ 666-8423 Fax