What is Workers Compensation Fraud?

Workers Compensation fraud criminal charges are increasing rapidly.  Disputes regarding Workers Compensation coverage are being referred by insurance companies to prosecutors. Criminal investigations and arrests take place even on claims where the insurer has not contested the injury. Workers Compensation fraud arrests target the injured worker but doctors and even Workers Compensation lawyers have been arrested. Daniel Horowitz has defended some the largest Workers Compensation fraud cases in recent years. Here is just a brief overview of the law.

The Basic Elements of Criminal Fraud

Workers Compensation fraud like most frauds, is a crime of deceit. Here are the elements of fraud crimes including Workers Compensation fraud:

1. Make or cause to be made a knowingly false or fraudulent material statement or material representation to get something of value

or

2. Knowingly assist or conspire with someone to falsely obtain a benefit of some type.

What is a False Claim or False Benefit?

The more difficult issues is what is a “false claim” or “false benefit”? Undercover investigations often involve taking video footage of a disabled worker performing physical tasks. The factual issue becomes whether this is evidence of criminal fraud or simply a person taking pain pills in order to have some level of function in life?

Insurance fraud and Workers Compensation fraud are legally complex. Statutes are interwined and mixed in charging documents. For example, Penal Code section 550 is a California insurance fraud law that prevents making false claims. That statute is often charged in conjunction with allegations that the false claim made violated yet another statute so that one charge involves multiple (alleged) criminal offenses.

Another example of statutes cross-connecting in a confusing manner is Penal Code Section 549 which makes it a crime to solicit, accept or refer work to a company if you either know or should know that they will commit workers' compensation fraud under Penal Code Section 550 or Insurance Code 1871.4.

Factually consider this scenario.  A truck driver is totally disabled but is seen taking wood from his pickup truck and bringing it to his backyard.  He then cuts the wood and makes a planter box.  Is this Workers Compensation fraud?   It is not clear.  Here are some issues.  

1. Was he taking pain medication that allowed him to work but which would make it illegal for him to drive?

2. After doing this work, did his pain get so bad that he had to sit in a chair for a few hours?

3. If he drove his truck six hours per shift how does that compare to the work he did at home that lasted 2 hours?

The issue of what constitutes fraud or a false claim is both factual and medical more than it is "legal".

What are the Penalties for Workers Compensation Fraud?

The penalties for Workers Compensation fraud are high. For a single count of conviction a person faces imprisonment in county jail for up to one year, or in state prison up to five years. The financial penalties include a fine up to $150,000, or double the amount of the fraud, whichever is greater. 

DOCTORS FRAUD (Workers Compensation)

Doctors treating Workers Compensation patients are sometimes charged with Workers Compensation fraud. The fraud may include kickback allegations involving referrals to and from attorneys. The medical fraud can include billing for services not provided, billing for spending more time or a higher complexity visit than actual performed, soliciting new patients in a kickback scheme and prescribing self formulated medications without a genuine medical need or benefit.

Attorney Fraud (Workers Compensation)

Recently prosecutors have been charging attorneys with Workers Compensation fraud. They are focusing on kickback allegations between attorneys and groups that refer clients.

Why the Horowitz Office is the Best Choice for Workers Compensation Defense

The Horowitz office represents workers and attorneys who are charged with Workers Compensation fraud. We have particular expertise in this area and our legal teams include medical professionals who are expert in the medical - legal issues that arise in many of these cases.    

Daniel Horowitz and his team of criminal defense lawyers have their office in Lafayette, California (Contra Costa County). His work takes him throughout the state. He recently had all charges dismissed in a Riverside (Orange County) workers compensation fraud case charged under PC 550. Daniel represents clients throughout the State of California and he is a criminal defense specialist (certified by the State of California, Board of Legal Specialization)

Call the Horowitz legal team of trial lawyers and our physician/lawyer (Dr. Mark Ravis) to fight your Workers Compensation fraud case.