How to Fight Workers’ Compensation Fraud Allegations in California

Workers’ compensation fraud in California carries serious legal consequences that can dramatically alter your future. While the workers’ compensation system exists to protect employees injured on the job, filing false claims or misrepresenting injuries isn’t just unethical—it’s criminal under California law.

If you’re facing allegations of workers’ compensation fraud, understanding the legal definition, potential penalties, and defense options is critical to protecting your rights and future.

What Qualifies as Workers’ Compensation Fraud in California

California Insurance Code § 1871.4 defines workers’ compensation fraud broadly to include any intentional misrepresentation made to obtain benefits. The law targets not just claimants but anyone participating in fraudulent activities.

Common forms of workers’ compensation fraud include:

False or Exaggerated Claims

• Claiming injuries that never occurred
• Exaggerating the severity of legitimate injuries
• Misrepresenting when or where an injury happened
• Claiming non-work-related injuries as work-related

“Double-Dipping” Violations

• Collecting workers’ compensation while secretly working another job
• Receiving benefits from multiple sources for the same injury
• Failing to report income while receiving disability benefits

Fraudulent Documentation

• Submitting falsified medical records
• Altering doctor’s notes or prescriptions
• Providing false statements about work capabilities

Conspiracy and Assistance

• Helping others file fraudulent claims
• Coaching claimants on how to fake or exaggerate injuries
• Participating in organized schemes involving multiple false claims

The law doesn’t just apply to workers; medical providers, attorneys, and claims adjusters can also face charges for participating in workers’ compensation fraud schemes.

Serious Penalties for Workers’ Compensation Fraud Convictions

California imposes strict penalties for workers’ compensation fraud, treating these cases as significant criminal matters rather than simple insurance disputes:

Misdemeanor Penalties

For smaller-scale cases, misdemeanor charges can result in:

• Up to one year in county jail
• Fines up to $150,000 or double the value of the fraud
• Restitution payments to the insurance company
• Loss of workers’ compensation benefits
• A permanent criminal record

Felony Penalties

More serious fraud cases face felony charges with:

• Up to five years in state prison
• Fines up to $150,000 or double the fraud amount (whichever is greater)
• Mandatory restitution
• Professional license consequences
• Potential immigration consequences for non-citizens

Additional Consequences

Beyond the direct criminal penalties, a workers’ compensation fraud conviction can lead to:

• Difficulty finding employment
• Professional license suspension or revocation
• Higher insurance rates
• Civil lawsuits from insurers
• Repayment of all benefits received

How Investigators Build Workers’ Compensation Fraud Cases

Understanding how these cases are investigated helps explain why the charges are so serious. Workers’ compensation fraud investigations typically involve:

Surveillance Operations

Investigators often conduct video surveillance to document activities inconsistent with claimed injuries. This might include filming someone with a claimed back injury carrying heavy items or participating in sports.

Social Media Monitoring

Your Facebook, Instagram, and other social accounts can become evidence if you post photos or videos contradicting your injury claims.

Medical Record Analysis

Investigators compare medical records across providers, looking for inconsistencies in reported symptoms or treatment.

Witness Interviews

Coworkers, neighbors, friends, and family may be interviewed about your activities and the circumstances of your claimed injury.

Employment Verification

Investigators check whether you’re working elsewhere while collecting disability benefits.

These extensive investigations often result in substantial evidence before charges are ever filed, making these cases particularly challenging to defend.

Building a Strong Defense Against Workers’ Compensation Fraud Allegations

If you’re facing workers’ compensation fraud accusations, a strong defense strategy is essential. Potential defense approaches include:

Challenging Intent

Workers’ compensation fraud requires intent to defraud. Mistakes, misunderstandings about filing requirements, or genuine differences in medical opinions don’t constitute fraud.

Questioning Surveillance Evidence

Surveillance footage often doesn’t tell the whole story. Brief moments of activity might not accurately represent your overall condition or might show you pushing through pain on a “good day.”

Medical Disputes

Different doctors might have different opinions about your injuries. Disagreements between medical professionals don’t automatically indicate fraud.

Procedural Violations

If investigators or law enforcement violated your rights during the investigation, some evidence might be excluded from court.

Insurance Company Errors

Sometimes insurance companies make mistakes in processing claims or misinterpret medical information, leading to false fraud allegations.

Why Legal Representation Is Critical in Workers’ Compensation Fraud Cases

Being accused of workers’ compensation fraud is life-altering. The criminal penalties are severe, and the investigation process can be intrusive and overwhelming. With so much at stake, professional legal representation is essential.

An experienced attorney can:

• Review all evidence against you
• Identify weaknesses in the prosecution’s case
• Negotiate with prosecutors for reduced charges or alternatives to incarceration
• Present your side of the story effectively
• Challenge improper investigation techniques
• Protect your constitutional rights throughout the process

At The Nieves Law Firm, we understand that not all workers’ compensation fraud allegations reflect reality. Sometimes legitimate claimants face accusations based on misunderstandings, honest mistakes, or overzealous insurance investigations.

Take Immediate Action if You’re Accused of Workers’ Compensation Fraud

If you suspect you’re under investigation or have been charged with workers’ compensation fraud:

1. Don’t discuss your case with anyone except your attorney
2. Avoid social media posts about your activities, injuries, or case
3. Gather documentation related to your injury and treatment
4. Contact an experienced defense attorney immediately
5. Don’t speak to investigators without your attorney present

The earlier you involve a defense attorney, the better your chances of achieving a favorable outcome. Early intervention can sometimes prevent charges from being filed or lead to pre-filing negotiations that significantly reduce penalties.

Workers’ compensation fraud allegations require immediate and strategic action. Contact The Nieves Law Firm today for a consultation to discuss your case and defense options.