Top Laguna Niguel, CA Workers' Compensation Fraud Lawyers Near You
When Results Matter Most, Put 42 Years of Criminal Defense to Work For You! Open 24/7. Free Consultation.
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Arrested? Or Think You May be Arrested? Call David. Interviewed by NBC & Dr Drew for his Criminal Defense Success.
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SoCal Super Lawyers 16 years in a row, AV rated. Criminal defense attorney offering experience, skill and personal attention.
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16520 Bake Parkway, Suite 280, Irvine, CA 92618
Representing people in Laguna Niguel, California with their Workers' Compensation Fraud issues.
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260 St. Ann's Drive, Laguna Beach, CA 92651
Clients who need legal help with Workers' Compensation Fraud concerns can contact Law Offices of Barry T. Simons, a reputable law firm in Laguna Niguel, California.
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6345 Balboa Blvd, Suite 247, Encino, CA 91316
If you need Workers' Compensation Fraud help in California, contact Law Office of Gregory Rubel, a local practice in Laguna Niguel, for legal representation.
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23679 Calabasas Road, Suite 412, Calabasas, CA 91302
Assisting people in California with their Workers' Compensation Fraud needs. Learn More.
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1440 N Harbor Blvd, Suite 900, Fullerton, CA 92835
Contact Law Offices of David Borsari for experienced Workers' Compensation Fraud guidance in Laguna Niguel, California.
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424 South Beverly Drive, Beverly Hills, CA 90212
433 North Camden Drive, Suite 400, Beverly Hills, CA 90210
17581 Irvine Blvd., Suite 108, Tustin, CA 92780-3123
2600 Michelson Dr, Suite 900, Irvine, CA 92612
1400 N. Harbor Blvd., Suite 601, Fullerton, CA 92835
355 S Grand Ave, Suite 2850, Los Angeles, CA 90071
15915 Ventura Blvd, Ste. 203, Encino, CA 91436
19800 MacArthur Blvd, Suite 300, Irvine, CA 92612
301 East Colorado Boulevard, Suite 520, Pasadena, CA 91101
1500 Rosecrans Avenue, Suite #500, Manhattan Beach, CA 90266
535 Anton Blvd., Suite 850, Costa Mesa, CA 92626
6565 Sunset Blvd., Suite 410, Los Angeles, CA 90028
10940 Wilshire Blvd, 16th Floor, Los Angeles, CA 90024
1999 Avenue Of The Stars, Suite 1100, Los Angeles, CA 90067
888 West 6th St, 4th Floor, Los Angeles, CA 90017
225 Avenue I, Suite 201, Redondo Beach, CA 90277
3838 Carson Street, Suite 302, Torrance, CA 90503
201 E Center St, Suite 112 #3377, Anaheim, CA 92805
2049 Century Park E, Suite 3500S, Los Angeles, CA 90067
2030 Main Street, Suite 1300, Irvine, CA 92614
Laguna Niguel Workers' Compensation Fraud Information
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What Is Workers’ Compensation?
Workers’ compensation provides benefits for workers who are injured on the job or suffer a work-related illness. Most employers are required to provide workers’ comp insurance for employees. When an employee is injured in the workplace, a workers’ comp claim provides medical coverage and partial wage replacement while the employee is unable to work.
The workers’ compensation process is generally a no-fault system. The employee is supposed to be covered for any work-related accident or occupational diseases. The worker does not have to show the employer was negligent. In return, the employer is protected from most personal injury lawsuits related to the accident and the compensation claims are limited to wage benefits, medical care, and disability benefits.
If employers or workers comp insurance carriers suspect the employee is committing fraud, they may investigate the claim to deny coverage or report the employee for fraud. If criminal fraud is suspected, law enforcement agencies may work with the insurance provider and employer to investigate the worker and could prosecute the worker for criminal charges.
What Qualifies as Workers’ Comp Fraud in California?
Workers’ comp fraud involves fraud or misrepresentation in a workplace injury claim. Fraud may involve the worker trying to claim benefits for a non-covered injury or claim benefits when they are still able to work. Some examples of workers’ comp fraud include:
- Claiming a non-workplace injury happened on the job
- Claiming to be disabled when the worker can still perform their job functions
- Intentionally causing an accident or injury to get benefits
- Working another job under the table while receiving benefits
- Advising other workers on how to fraudulently claim workers’ comp benefits
- Filing multiple claims for the same injury
Fraud in workers’ comp claims can also involve health care providers. Doctors, medical service providers, and chiropractors may work together to defraud the workers’ comp system. Workers’ compensation insurance fraud rings may recruit workers to claim workplace injuries, with a medical provider making a false diagnosis of an injury, and doctors fraudulently treating the injured employees or billing for medical procedures that were never provided.
What Investigators Look For in Workers’ Comp Fraud
Some insurance providers or employers look for “red flags” that may indicate possible fraud. This may be a clue to further investigate the claim, talk to other employees, or use a private investigator to monitor the injured worker. Some possible red flags of workers’ compensation fraud may include:
- No witnesses to the accident
- Employee refusing treatment or examination
- Worker is difficult to contact after filing a claim for workers’ comp
- Injury occurred right before or after a planned vacation
- Injury occurred shortly before the employee was to leave the job
- Employee reported the injury after a poor performance review or workplace incident
- Treatment is inconsistent with the alleged injury
- Extent of injury and accident time frame do not match up
Is Workers’ Comp Fraud a Felony?
Workers’ compensation fraud can be charged as a misdemeanor or a felony, depending on the situation. As a misdemeanor, a conviction for fraud could result in up to a year in county jail and a fine. If fraud is charged as a felony, penalties can include more than a year in prison, fines, and restitution.
Some incidents of workers’ comp fraud can include additional criminal charges. The defendant may face related charges for:
- Identity theft
- Insurance fraud
- Health care fraud
Investigating Workers’ Comp Fraud
Insurance companies and the employer may investigate employees even without indications of claimant fraud. The insurance company and employer have a financial interest in denying workplace injury claims. As a result, they may wrongly deny a legitimate claim for an injured worker. Many employees do not go through the process to appeal the denial, and end up going without the benefits they deserve.
Do Private Investigators Follow Workers After a Claim?
A private investigator may follow the worker with video surveillance. Investigators may also talk to co-workers or neighbors about the worker’s activities. Social media accounts may also be reviewed for evidence that could hurt the worker’s claim. Some of the things investigators look for when an employee makes a workers’ comp claim include:
- Participating in sports or leisure activities
- Doing yard work, home improvement projects, or heavy lifting
- Going on vacation after making a claim
- Social media post showing the cause of the injury that is unrelated to work
- Medical bills for appointments the worker never attended