Los Angeles Workers’ Compensation Fraud Defense Lawyer

Workers’ Compensation laws are designed to compensate those who are injured on the job. It covers medical care and lost wages, among other losses. The system is funded by employers, who are prohibited from taking contributions from their employees. If you suffer a work-related injury, the workers’ compensation system is designed to cover treatment costs, including doctor visits, hospital costs, physical therapy, medications, and any other out of pocket medical expenses incurred as the result of the injury.

What is Workers’ Compensation Fraud?

When most people think about workers’ compensation fraud, they envision an employee filing a false claim, i.e., alleging an injury that occurred on the job, but which actually never happened. In fact, fraud in the area of workers’ compensation goes far beyond the filing by an employee of a false claim.

First, there are many different ways in which an employee could attempt to commit fraud in order to gain workers’ compensation benefits. And second, employers can also be charged with workers’ compensation fraud. Here are some specific examples of workers’ compensation fraud by an employee:

• Fictitious Injury. An employee files a claim alleging that he was injured on the job. In fact, there was no injury.
• Non-Work Related Injuries. The employee files a claim based on an injury that the employee says happened on the job. However, the injury was the result of activities having nothing to do with the work performed by the employee for his employer.
• Extent of Injury. Exaggerating the extent of an illness or injury. Claiming that the injury is more extensive than it actually is.
• Ability to Work. Falsely claiming that the injury prevents the employee from working.

As noted above, employees are not the only ones who can be accused of workers’ compensation fraud. Examples include:

• Employee Classification. Note that the system is funded by employers based in part upon the number of employees. Also, the system is experience-rated, meaning that past accidents and injuries will increase an employer’s contribution to the workers’ comp fund. By improperly classifying an individual not as an employee, but rather as an independent contractor, that employee ceases to be counted for purposes of workers’ compensation, thus lowering the employer’s workers’ comp premium.
• Falsifying Payroll Records. Improperly reducing the payroll amounts submitted to the workers’ comp insurance carrier, thus lowering the premium paid by the employer.
• Failing to purchase workers’ compensation insurance when legally required to do so.
• False Statements. The employer makes a fraudulent or false statement regarding benefits with the goal of discouraging an employee from making a claim under the workers’ compensation law.

These are just some examples of the types of fraud claims that could be asserted against an employee or an employer.

Penalties for Workers’ Compensation Fraud

The California Penal Code treats workers’ comp fraud harshly. A first offense is a wobbler, which means you could be charged with a felony. A subsequent conviction after a prior felony conviction under INS 1871.4 is a felony. In addition, the total amount of fines and restitution could easily reach more than $100,000.

Defenses to Workers’ Comp Fraud Claims

It is possible to be accused of workers’ comp fraud by any of those involved. It could be the employee vs. the employer; or the employer vs. the employee; or the insurance company or the state against one or more of the other participants.

Common workers’ comp fraud allegations involve the employer (or the employer’s insurance carrier) claiming that your injuries are either non-existent or exaggerated. The defense to this type of claim may be that you have been instructed by your physician to engage in certain activities or exercises in order reduce back pain caused by a job-related injury. The insurance company (or the employer) understands this but produces pictures of you exercising at the gym. While they may falsely claim the pictures demonstrate the lack of an injury, in fact your doctor will testify that the exercise was and is part of your recovery from the injury.

Many injuries, particularly regarding the extent of damage, include an element of subjectivity. Because of this, employee claims, in particular, are open to various explanations, and those explanations are often the crux of a defense to the fraud claim.

Workers’ Compensation Fraud Defense Attorney in Los Angeles

Workers’ Compensation involves a complex network of laws and rules concerning filing for a claim, the extent of and compensation for that claim, employer responsibilities, and more. Simply because an attorney handles some personal injury work does not mean that the attorney is qualified to represent a person (or a company) charged with workers’ compensation fraud. At CBS Law, we represent clients charged with fraud. We understand the workers’ compensation laws, and we will provide you with an analysis of your case, including any defenses that may exist. Contact us for a free consultation. Call CBS Law at (213) 800-8005