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What is Workers' Compensation Fraud?

Workers' compensation in California is an insurance system designed to provide payments and, if needed, medical care for workers that are injured on the job. Workers' Compensation Fraud is codified under California Penal Code Sections 549, 550 and Insurance Code Section 1871.4. Workers' Compensation Fraud is a very serious allegation. It is a "Wobbler", which means it can be charged as a misdemeanor or felony. The sentence for a misdemeanor conviction is up to one year in jail; up to three years for a felony conviction.

To establish that someone is guilty of Workers Compensation Fraud, the District Attorney must prove the following:

  1. The defendant presented or caused to be presented a false or fraudulent claim for payment for a loss or injury; or prepared, made, signed, or subscribed a document with the intent to present, use it, or allow it to be presented to support a false or fraudulent claim; and
  2. The defendant knew that the claim was false or fraudulent; and
  3. When the defendant did that act, he or she intended to defraud.

Intent to defraud has also been defined by the Court: An intent to defraud is an intent to deceive another person for the purpose of gaining a material advantage over that person or to induce that person to part with property or alter that person's position by some false statement or false representation of fact, wrongful concealment or suppression of the truth or by any artifice or act designed to deceive. (People v. Booth (1996) 48 Cal.App.4th 1247, 1253, 56 Cal.Rptr.2d 202.)

It is also important to note that it is not necessary under California Workers' Compensation Law that anyone actually be defrauded or actually suffers a financial, legal, or property loss as a result of the defendant's acts.

The District Attorney considers Workers' Compensation Fraud a very serious offense and takes a tough position on prosecuting these cases. You will need an experienced attorney to provide representation and protect your rights. If you have been charged with Workers' Compensation Fraud or you are under investigation, contact office today. I will provide a free, confidential consultation.