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The act of filing falsified workers’ compensation claims is a criminal act. Workers’ compensation fraud is a serious criminal offense that could result in confinement in state prison or county jail, steep fines, and other notable consequences. You could fight back against these charges with the help of a Martinez workers’ compensation fraud attorney who could help guide you from the beginning of your case to the end. Do not hesitate to speak with a criminal defense attorney.

Understanding Workers’ Compensation Fraud

The offense of workers’ compensation fraud is governed by California Insurance Code § 1871.4. This statute makes it unlawful to knowingly make a fraudulent misrepresentation in order to obtain workers’ compensation benefits. This could involve a written statement, an oral statement, or some other form of material representation. It also applies to any person that assists, conspires, aids, or solicits another person to seek benefits through fraudulent means.

There are numerous ways that a fraudulent statement could result in improper workers’ compensation benefits. Often, these cases involve a person filing a fraudulent injury claim with their employer’s insurer. This type of fraud could involve a person faking an injury or seeking benefits for an injury that was not work-related.

Workers’ compensation fraud can also involve claims of “double-dipping.” Double-dipping is the act of seeking benefits from more than one source. For example, it could involve a person filing an injury claim with two different employers based on the same injury. The end result of this type of fraud would be the insurance company paying benefits for the same injury twice.

Penalties for Workers’ Compensation Fraud

There are multiple factors that will determine the potential sentence for a conviction of workers’ compensation fraud. This type of fraud is considered a “wobbler” under state law. A wobbler is a crime that could be either a felony or a misdemeanor. It is up to the prosecutor to decide whether to pursue misdemeanor or felony charges.

A misdemeanor offense brings a maximum of one year in county jail. While a felony could result in as much as five years in state prison. It should be noted that worker’s compensation fraud is a crime involving moral turpitude and can be treated as an aggravated felony; therefore, in addition to criminal penalties, there are immigration consequences that can arise and other collateral consequences that can affect an individual’s livelihood, career, and future.

Workers’ compensation fraud cases are notorious for hefty fines and restitution amounts. It is mandatory that restitution be ordered if an individual is convicted of workers’ compensation fraud.  In addition to having to pay back restitution of owed amounts, the accused can also face fines in the amount of $150,000 or double the value of the fraud – whichever is greater.

A workers’ compensation fraud lawyer in Martinez can not only help mount a defense and prepare the case for litigation but can also negotiate with the District Attorney about mitigating circumstances or evidentiary issues that could result in a dismissal or a reduction in the charges. If the District Attorney charged this case as a felony, a skilled workers’ compensation lawyer could work on negotiating the felony down to a misdemeanor. A workers’ compensation lawyer can also look for insufficiencies in the evidence that could lead to a dismissal or gaps in the accounting that could lead to a reduction in the restitution amount claimed.

Aiding and Abetting in Workers Compensation Fraud

Most cases of workers’ compensation fraud involve a fraudulent statement made by an employee. However, some instances of fraud involve the actions of an employer or a third party. Most of these cases involve a form of kickback from an employee filing a fraudulent claim and a business owner that plays along for a share of the benefits. This type of workers’ compensation fraud is governed by California Insurance Code § 1871.4(3) which makes it unlawful to assist, abet, solicit or conspire with a person in committing workers’ compensation fraud.

It is critical to understand that making fraudulent statements can happen in various ways. A false statement can be included in:

  • a notice
  • a bill for services
  • payment for services
  • proof of injury
  • hospital or doctor records
  • X-ray
  • Test results
  • medical-legal expenses
  • other evidence of loss, injury, expense, or payment

Workers’ compensation fraud can be a minefield and one false move can create a domino effect of serious consequences, so it is important to work with a Martinez defense attorney.

Speak to a Martinez Workers’ Compensation Fraud Attorney Today

Whether the prosecutor treats the charge as a misdemeanor or a felony, your future remains uncertain when facing prosecution for workers’ compensation fraud. Thankfully, your case is not guaranteed to result in a conviction and a skilled workers’ compensation lawyer can work with you and for you in defending against these charges.

With the right legal counsel by your side, you can mount a strong defense to the fraud charges you are facing and have someone to guide you through the stressful process. Talk to a Martinez workers’ compensation fraud lawyer today to learn more.

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