WORKERS’ COMPENSATION INSURANCE FRAUD
The District Attorney Workers’ Compensation Insurance Fraud Unit investigates and prosecutes insurance fraud.
It does not handle individual workers’ compensation claims. This Unit handles five different areas of fraudulent conduct:
TYPES OF FRAUD WE INVESTIGATE
To learn more about a particular type of fraud, click on the title of the fraud.
PROVIDER FRAUD
Provider Fraud is defined as fraud committed by both Medical/Chiropractic providers and legal providers. This includes over billing for services not rendered to injured employees; or billing for treating injured employees when no such medical visit ever occurred; and for billing for medical equipment provided that is improperly billed or is not necessary for the treatment of the injured employees.
PREMIUM FRAUD
Premium Fraud is when an employer is not truthful about the number of employees to be covered by the insurance or is not truthful about the nature of the work the employees are doing (paying less due to a smaller risk of injury because the employer has not been truthful about the nature of the work); or is when a person takes money from an employer under the pretense that the money will be used to purchase insurance to cover the employer’s employees.
APPLICANT FRAUD
This occurs when an employee makes a false claim of an injury; or when an employee does not disclose other precedent injuries to the same body part; or when an employee does not divulge money being earned while receiving payments for the injury, or for any other material misstatement during the claims process.
DENIAL OF BENEFITS
This occurs when a business, with workers’ compensation insurance, willfully denies insured benefits to an injured employee. This is often done by requiring the employee to use their health insurance to cover the treatment of occupational injuries, or where the employee is told there is no coverage.
UNINSURED EMPLOYER
Any employer that does not have worker’s compensation insurance coverage on his regular employees is in violation of the law. This is a violation of Labor Code 3700.5.
FREQUENTLY ASKED QUESTIONS
Fraud is lying about something in order to receive a benefit that you are not eligible to receive.
It is serious. You could be arrested and charged with a felony. If convicted, you could be sentenced to prison or county jail and be required to pay restitution.
In California, if a contractor has employees, the contractor is required to carry workers’ compensation insurance. If a worker is injured working on your property and the contractor does not have insurance, you could be financially liable to pay for injuries and rehabilitation. Your homeowner’s insurance policy may or may not cover those costs. You should check with your insurance carrier to make sure the workers’ compensation insurance coverage being provided by the contractor is adequate. (Source: Contractor License Board.) Read more here.
Before hiring a contractor or signing a contract, the Contractors State License Board (CSLB) recommends that you check the status of their license here or call (800) 321-CSLB (2752).
Send an email to our unit at DAWorkersComp@sbcda.org.
If you are injured at work and your employer refuses to provide workers’ compensation insurance information to you, please send an email to our unit at DAWorkersComp@sbcda.org.
Send an email to our unit at DAWorkersComp@sbcda.org.
If you believe your medical provider billed the insurance company for services, appointments, or treatment that you did not receive, send an email to our unit at DAWorkersComp@sbcda.org.
DOWNLOADS FOR EMPLOYERS
Show you care to your employees with these posters suitable for display at your business.
CALIFORNIA DIVISION OF WORKERS’ COMPENSATION
SAN BERNARDINO OFFICE
464 W. Fourth Street
Suite 239
San Bernardino, CA 92401-1411
(909) 383-4341
GENERAL INFORMATION
Units within the San Bernardino office
- Disability Evaluation Unit
- Information & Assistance Unit
COURT HOURS
- Court is in session 8:30 AM to 12:00 PM and 1:30 PM to 5 PM
- The court lobby is open from 8:00 a.m. to 5:00 p.m. five days a week (except for holidays).
- Walk-through hours are 8:00 a.m. to 11:00 a.m. and 1:00 p.m. to 4:00 p.m. Monday through Friday.
- Children should not be brought to court.
- Smoking is permitted outside only in designated outdoor areas.
PARKING INFORMATION
The state parking structure north of the Rosa Parks building is $5 per day. There is free parking located in a public lot one block from the building.
BUILDING SECURITY
The San Bernardino district office is located in the Rosa Parks building. All visitors are required to check in at the security desk upon entry into the building. Visitors are required to sign in and show a picture I.D.
ADDITIONAL RESOURCES
California Employment Development Department
California Department of Industrial Relations
Fraud Division of The California Department of Insurance