Workers’ Compensation Fraud 

August 19, 2021
Sacks & Zolonz, LLP
Workers’ Compensation Fraud

Workers’ Compensation fraud is a serious problem in the state of California. The National Insurance Crime Bureau reported that workers’ compensation fraud accounts for roughly $30 billion annually in the United States. Workers’ compensation fraud costs the state of California an estimated $1 to $3 billion per year. In order to combat this problem, California signed a bill into law that mandates the posting of individuals that have been convicted of workers’ compensation fraud to the Department of Insurance’s public website.

Workers’ compensation can occur in simple or complex schemes because it is a no-fault system—meaning that you do not need to prove an injury was someone else’s fault. This makes it easier for individuals to file fraudulent claims.

If you, the employer, have dealt with or are dealing with a worker filing a potentially fraudulent claim for workers’ compensation, you need an experienced Los Angeles employer workers compensation defense attorney. The lawyers at Sacks & Zolonz LLP have offices throughout Southern California and specialize in protecting an employer’s best interest when it comes to workers’ compensation fraud, trials, and strategy.

Workers’ Compensation Fraud in the News

In a recent headline, a Los Angeles Landscaper was arraigned for alleged workers’ compensation fraud for over $50,000 in disability payments. As posted on the Department of Insurance’s website, Frank Simplicio was guilty of multiple felony counts of insurance fraud and perjury.

The investigation revealed false allegations that Simplicio was “too injured to work” and collected over $50,000 in disability payments for his alleged injuries. The payments to Simplicio came from the employer’s insurance company. During the time he was collecting insurance payments for disability, he was illegally working for another employer.

They have security footage of Simplicio working for a landscape company when he was allegedly suffering from neck and back trauma, as well as diabetes, internal injuries, and sleep deprivation. While he was collecting workers’ compensation, Simplicio earned $450,000 from landscape clients. The original employer set off an investigation that later resulted in Simplicio’s self-surrender.

Workers’ Compensation Fraudulent Acts

Workers’ compensation is a system set up to provide medical care and payment for lost income to workers who have been injured while on the job. If a false claim is filed seeking workers’ compensation when an injury did not actually occur, or when the injury did not occur at work, it is considered a fraudulent claim and can lead to severe criminal penalties.

Under California law, the following action is considered workers’ compensation fraud:

  • Knowingly making a fraudulent statement to obtain workers’ compensation benefits
  • Making a fraudulent statement about eligibility for benefit in order to prevent a worker from claiming workers’ compensation benefits
  • Aiding and abetting someone who is committing workers’ compensation
  • Submitting multiple claims for the same injury to recover additional workers’ compensation
  • Submitting a claim for workers’ compensation that was not actually used for a health care benefit
  • Soliciting, referring, or hiring someone who is collecting workers’ compensation and knowing they intended to commit fraud by doing so

All of these will result in a charge for workers’ compensation fraud and the penalties can be grave.

Contact Us Today

Employees who file fraudulent workers’ compensation claims should be brought to justice for their wrongdoing. If you are an employer dealing with suspected fraudulent claims and want to discuss your legal options with a Los Angeles workers compensation fraud attorney, the expert legal staff at Sacks & Zolonz, LLP can help you.

We defend employers in all matters related to workers’ compensation claims, including resolving issues related to fraudulent claims. Contact us today for a consultation with an experienced and knowledgeable lawyer who specializes in handling workers’ compensation fraud cases.

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