As per the California laws, workers comp is no-fault.  It means when you face illness or injuries while at the workstation, you are entitled to compensation regardless of who caused the accident. The law doesn't require you to prove your injury resulted from someone else's fault. You will recover the medical expenses you encounter while seeking treatment for your injuries. Also, you will recover your lost wages due to illness or injuries.

Workers comp fraud is considered a serious crime in the state. Any person may suffer indirectly because of workers comp fraud. The crime attracts an increase in the value or price of consumer goods and the failure of legit businesses. Also, the crime will lead to the injured worker and the employer losing money. If you face a workers comp fraud charge, you want to seek legal help as soon as possible. Handling the case might be a complicated process, and that’s why you require the services of a skilled attorney. At Riverside Criminal Defense Attorney Law Firm, we are here to help you build a strong defense to fight the charge. Start by contacting us right away, and we will begin working on your case.

Understanding Workers Compensation Fraud

Workers' compensation frauds may occur in several ways. The frauds might involve lawyers and doctors taking part in claim mills. In California, it’s not unique for people to file false injury claims. A worker may visit a legal referral center or medical clinic referred to as claim mills. Upon visiting the centers, they refer the worker to the lawyers or doctors involved in the fraudulent schemes.

As a worker, you may also file a legit claim to health practitioners targeting to maximize the claim’s value. The medical experts may inflate the medical billings and reports to increase your medical bills. The medics may also engage in fraud when they overbill or offer unnecessary treatments.

An employer may engage in fraud by providing their employees the wrong number to engage in premium fraud. For example, the employer may lie that their employee is a roofer instead of an office employee. Also, several employers tend to work behind closed doors and fail to offer their employees workers compensation insurance. According to the state's laws, all employers must provide their workers with compensation coverage. Even the worker should have proof of their worker's compensation insurance.

The employees and employers may also agree to fraud by making false records about workers' compensation and benefits. The statements or documents focus on discouraging the injured employees from obtaining fair compensation.

The law disallows workers comp fraud in the state. Thus when you face the charge, you want to act as soon as possible. Start by discussing your situation with your criminal defense attorney. The attorney will help you understand more about the worker's comp laws in the state. Also, they will help you build a strong defense to fight the charges.

As a worker, you may engage in fraud when you lie about the extent of your injuries, or you fake your injury or illness while at your workplace. You may also engage in fraud by failing to reveal your previous work-related injuries. Also, you may be involved in fraud when you claim non-work-related damage is work-related or even by engaging in unlawful means when seeking compensation. In California, workers compensation fraud is discussed under various statutes, including:

Insurance Code 1871.4

Insurance code 1871.4 is the main employee’s compensation act in the state. You might face fraud charges under the law when you attempt to make or trigger fraudulent or false material representation or statements aiming to obtain or deny workers compensation benefits.

The court may find you guilty of engaging in fraudulent acts when you purposely aid, conspire or abet to engage in employees compensation fraud. It is unlawful to cause or make false or fraudulent records about workers' entitlement to their benefits to daunt a worker facing work-related injuries from obtaining fair compensation.

The law declares workers' compensation as an insurance policy every employer can pay for in California. When you face illness or injuries at your workstation, the insurance company must cover you for the medical expenses, temporary disabilities, and the compensation for the lost wages you will spend away from the work as you recover from the illness or injuries.

You may even suffer severe illness or injuries, leaving you unable to work again for the rest of your life. Under this situation, the insurance company must compensate you for the permanent disabilities. When you succumb to work-related illness, the insurance company will make payments to your children, spouse, or any other dependent.

However, the law limits you from seeking workers' compensation claims. For example, you cannot sue your employer in a California civil court for the illness and injuries you suffer while at your workstation.

The act outlines several ways to make false representations or statements. You might make a false oral representation or written statement. Other ways to make false statements may involve:

  • False x-ray tests
  • False proof of legal or medical expenses
  • Proof of your injuries
  • The issuance of a false notice

Other ways might involve making a false record about the service payment or other evidence of injury, expense, or loss.

The law considers any statement or representation provided relevant to your compensation claim investigations. Provided the statement or representation will bear directly or importantly on your investigation or evaluation of the compensation claim, its material.

Under the context of employees compensation claims, the law defines a false statement or fraudulent statement as an untrue statement. When a statement hides a fact purposely aiming to encourage someone to act to their detriment, it’s a false or fraudulent statement. As a worker, you might make a false or fraudulent statement when you fake illness or injuries and the nature of your injuries.

When the court finds you guilty of violating Insurance Code 1871.4, you may end up facing severe penalties. Thus you want to discuss the matter with your criminal defense attorney to help you know what to do next. An experienced attorney is preferable for the results of your case outcome.

California Penal Code 550

The law states various kinds of employees compensation claims which tend to overlap with health care frauds. It is illegal to cause or make false or fraudulent claims to bet or aid the California worker's compensation insurance payments.

It's a fraud to intentionally submit a claim for your health care benefit issued under compensation coverage not used by you. Commission of compensation fraud isn't limited to employees or applicants. It's also a fraud to submit several similar claims to seek payment for health benefits.

Doctors and other health care providers commonly commit fraud. The medical professionals offer treatment covered by workers' compensation insurance. Speak with your criminal defense attorney to help you learn more about penal code 550.

California Statute Penal Code 549

Another statute that outlines workers' compensation fraud in California is PC 549. Under the law, a business owner or an employee may commit workers' compensation claims through soliciting, accepting, or referring any business from or to any entity or person. You will face the charges for the crime as long as you know the person or entity focused on committing the crime.

The PC 549 is commonly violated by chiropractors, doctors among other medical practitioners. The medical experts might be part of commercial kickbacks or bribery to defraud the California worker's compensation. The punishment and penalties for defrauding workers' compensation will vary based on various factors. For instance, the court will consider your criminal records when punishing you.

Penalties for Fraud Under Penal Code 549

When you engage in the crime under PC 549 by referring, accepting, or soliciting a business knowingly, the entity or business aims to engage in fraud actions; the offense is considered a wobble when you are a first-time offender. When a second-time offender, the court will charge you with a felony charge.

For a misdemeanor, you will remain behind bars for 12 months. Also, the court will impose harsh penalties, which include $50,000, or even double it, whichever is huge. Alternatively, when a felony, the penalties include up to 3years in county jail. You will also pay a fine of $50,000, or double the money or the amount of the fraud, the higher one. Speak with your criminal defense attorney to help convince the court to lower the charge or issue another sentence option.

Penalties for Fraud Under Penal Code 550

Committing fraud under PC 550 is a wobbler in California. Do, you will face charges of either misdemeanor or felony. For a misdemeanor charge, you will include serving a probation term or jail term for 12 months in county jail. The court may also impose harsh fines of up to $10,000. When a felony, you will serve felony probation. Also, you may serve a jail term for a period between two years, three years, or five years. The court may also impose fines of up to $50,000.

Penalties for Fraud Under Penal Code 1871.4

When you violate California Penal code 1871.4, the crime becomes a wobble. Thus you will face charges as either a felony or misdemeanor based on your criminal record and the nature of the case. When the court considers the charged misdemeanor, you will face misdemeanor probation. You will also face 12 months jail term in county jail. You may also pay a fine of up to $150,000 or double the item value, whichever is higher.

You may also end up paying restitution fees. The restitution fees involve the reimbursement to the victim for the incurred losses by the victim. When the prosecution team charges the crime as a felony, the punishment will include serving felony or formal probation. When the court imposes the probation, you will become subject to various conditions of the probation, like visiting your probation expert regularly.

Ensure you carefully follow and adhere to the conditions of the probation when issued by the court. Violating the conditions of the probation will lead to additional penalties. For instance, you will not be eligible to expunge your criminal record. Remember, a criminal record will affect you when seeking a job, professional license, among other effects.

Under the California realignment program, you may become subject to up to five years in jail. The California criminal court may also impose a fine not exceeding $150,000 0r double the money, whichever is huge.

What are the Civil Penalties for Workers Compensation Insurance?

The state laws also come with severe penalties for specific types of workers comp frauds. The heavy fines will apply for the following parties:

  • A person is willingly misrepresenting facts to receive workers comp benefits with lower rates.
  • A person is knowingly soliciting, offering, paying, receiving, or accepting any unlawful commission for referring or soliciting clients for the services offered by workers comp insurance.
  • Causing or presenting knowingly any fraudulent or false information to obtain workers comp benefits
  • You are knowingly participating or operating targeting to refer a patient to receive medical services provided by workers' compensation insurance for profit.
  • You are knowingly conspiring or assisting someone else in carrying out any of the above acts.

The above facts will attract harsh penalties, including:

  • A fine not exceeding $4,000 and $10,000 for every unlawful claim
  • An assessment for three times the amount of medical expense covered by workers comp as an effect of the fraud

What the Prosecutor Must Prove

Before you face conviction for a workers compensation fraud, the prosecution team must prove all the elements of the crime. When they fail to prove the elements of the crime, you will not face conviction for the offense. You may also challenge their evidence through your experienced criminal defense attorney. The elements include the following:

  • A misleading or false statement or even an omission you make about your worker's compensation
  • The withheld/provided information is relevant to the total amount of money in your compensation claim
  • You had a fraudulent intent to obtain illegitimate benefits

Can I Fight Worker’s Compensation Fraud Charges?

Workers comp fraud is among the common types of fraud in the country. Thus, the insurance departments, district attorney offices, and insurance carriers heavily invest in unveiling the many fraud crimes in the state and country. Also, other special units perform undercover operations to catch the employers and employees trying to cheat the system. But, sometimes, you may also be falsely accused of the crime. Thus when the police arrest you over a suspected workers compensation fraud in California, the law allows your criminal defense attorney to consider the following defenses to fight the charge:

Insufficient Evidence

Many worker's insurance cases are complex. The facts of the case often involve the trained technicians, doctor’s reports, medical diagnoses, and other evidence which might be challenging for the prosecutor to prove.

The prosecution team should not take advantage of the complicated evidence to convict you. So, your criminal defense attorney has to discover the prosecutor’s weaknesses and help you gather strong evidence to prove your innocence. You want to work closely with your criminal defense attorney to help challenge the prosecutors' evidence and credibility. When the court discovers the prosecutor has insufficient evidence, they will either reduce the charges or drop the case.

You Didn’t Have a Fraudulent Intent

One of the key elements of the crime is intent to commit the offense. Thus the prosecutor must prove you intended to engage in the crime. You cannot face conviction for the crime unless you behaved either:

  • Fraud intent
  • You knew a particular behavior or statement was fraudulent or false

Sometimes your careless mistake might be considered fraudulent and even reported to the authorities. However, the task will fall on the prosecution team to prove you knew you were submitting fraudulent or false statements and you never made a mistake. Your criminal defense attorney will convince the court that you only made a mistake and didn’t have fraudulent intent. Thus the court will drop or dismiss the charges.

Self Inflicted Illness and Injuries

The injuries and illness resulting from the defendant are not entitled to compensation. The injuries include when you suffer illness intentionally and file for compensation under the California workers comp. Also, when you suffer injuries because of engaging in fights while at the workstation are not entitled to comp. So, you want to work closely with your attorney to ensure they help you understand the types of injuries referred to as work-related. When the court discovers you faked the illness, you may even face penalties instead of compensation.

Statute of Limitation

You have a limited period to file your worker's comp claim in California. The limit is usually up to three years. The statute of limitations is often flexible for cases that involve occupational diseases like illness resulting from exposure to toxins with time. For instance, the law may require you to file a comp claim with a specific period. When you fail to do so within the provided time limit, you will not be subject to compensation for your injuries. Consult your attorney if you suspect the statute of limitation for your case.

Failing to Issue a Notice to Your Employer

The law requires you to notify your employer of your work-related injuries within a period of one to three months. You should provide a notice to your supervisor either in writing or verbally and might be issued by the employee's doctor, spouse, or another third party.

When the total value or amount of the fraud involved is $950, and below, the crime is considered a misdemeanor. The court will consider 12 consecutive months. The penalties for the crime include six months imprisonment in county jail. The court may also impose a fine of up to $1,0000.

Other Related Crimes to Workers Compensation Fraud In California

Workers' compensation fraud is charged alongside other crimes in California. The criminal charges alongside workers comp fraud include:

Grand Theft – California PC 487

The crime usually overlaps with other crimes in California. For instance, it overlaps with California PC 487. You engage in grand theft when you receive property worth $950 0r above. The cases of a workers comp claim often meet the lawful definition of false pretense. The crime in the state is a wobbler. Thus you will face the charges as either felony or misdemeanor. For a misdemeanor, you will face 12 months imprisonment. You will also remain in jail for up to 3 years.

Perjury – California PC 118

You engage in perjury when you issue false information while under oath. A defendant may face perjury charges when they lie when under formal declaration or disposed of. The crime comes with harsh penalties, including a sentence of up to 4 years. Thus when you face charges for the crime, you want to work closely with your criminal defense attorney. The attorney will provide legal help throughout the legal process.

Forgery – PC 470

Forgery is another crime charged alongside workers' compensation fraud in California. The crime involves carrying out any of the following:

  • Faking someone else handwriting or seal
  • Signing another person's name in a document
  • Presenting, altering, or faking false financial report
  • Falsifying or changing a lawful document

You may face charges for the crime, for instance, when you face a physician's signature in a medical report about your injuries and illness to obtain workers' comp benefits. The crime is a wobble in California and carries the same penalties as grand theft. Always when you face charges for the crime, work closely with your criminal defense attorney to help you fight the charges. The attorney will come up with a strategy to build strong defenses to fight the charge.

Contact a Criminal Defense Attorney Near Me

Having gone through the seriousness and complexity of workers comp fraud, you don’t want to fight the charge alone. Thus when you face the charges, you want to seek legal help from a competent workers comp attorney. At Riverside Criminal Defense Attorney Law Firm, we are here for you. We have extensive experience in handling workers' compensation cases in California. We are familiar with California laws, and we will observe time when handling your case. Our experienced attorneys offer unmatched legal services throughout California. Thus contact us at 951-946-6366 and speak with one of our highly trained attorneys.