California law requires that all employers (with a few exceptions) maintain workers’ compensation insurance. The purpose is to make sure that any employee who sustains a work-related injury will be fairly compensated. In recent years, the California legislature has recognized that fraud in the workers’ compensation system is an enormous problem, and is costing tax-payers and voters dearly. Penalties for fraud for both employees and employers can be severe. It is important to understand what penalties an employer could face if he or she is found to have committed fraud in the workers’ compensation system.
First, it is important to understand that fraud is a criminal act. Fraud in this context is a person that receives, accepts, offers, or delivers benefits he or she is not entitled to may be guilty of fraud. These benefits may be in several forms, including commissions, refunds, preferential treatment, discounts, or other profit. The penalty could be a fine of up to $10,000 and incarceration for up to a year. These fines and jail sentences may all stack up, resulting in fines that can easily run into the six figures. Moreover, some employers convicted of certain types of fraud, such as insurance premium fraud, could find their information publically published on the California Department of Insurance website.
Fraud can include several different acts for an employer. These could include making false representations to the workers’ compensation insurance company, done with the intention of obtaining cheaper insurance coverage. It could also include presenting false information with the intention of denying benefits to an employee with a work-related injury. A third way it could occur would be to knowingly aid someone in engaging in fraud. An example of that could be sending referrals to a medical provider the employer knows will be engaging in some sort of medical provider fraud. Other common examples of employer fraud would be misreporting payroll or underreporting the number of employees.
Anyone who believes that fraud is occurring must report this suspicion to the DWC. The reporting individual is not liable for defamation or slander suits, as long as the report is made with a good faith belief that fraud is actually occurring, and acts without malice. The purpose of this is to make sure that fraud does not go unreported simply because the reporter is concerned about potential civil liability in the form of a lawsuit.
Workers’ compensation fraud can result in serious and sometimes ruinous consequences. If you have questions about fraud and workers’ compensation, contact us today at (714) 252-7078 to discuss your business and how to protect it.