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According to California fraud laws, which are stated under Insurance Code 1871.4 and Penal Code 549-550, workers compensation fraud is considered insurance fraud due to a connection with workers compensation benefits.
Workers compensation is defined as a form of insurance, which is used to give medical care and payments for workers who are not able to obtain income because they were injured while working at their job. In California, those who commit workers compensation fraud can face several criminal penalties.
California recognizes the following acts as workers compensation fraud:
When an individual intentionally makes or presents a fraudulent document to either obtain or be denied workers compensation benefits.
When an individual makes a false statement in regards to eligibility for benefits, which will persuade an injured worker not to file a claim to seek benefits.
When an individual participates in the aiding or abetting of a conspiracy to obtain workers compensation benefits.
When an individual prepares or submits one to many claims to obtain payment for health care, which is covered by workers compensation, but the claims are for only one injury.
When an individual submits a claim to obtain workers compensation for a health care service that was not used.
When an individual knowingly solicits, refers, or accepts business from an individual who has the intentions to commit workers compensation fraud.
What are the Penalties of Workers Compensation Fraud?
In California, most cases involving workers compensation fraud are wobblers, which means the individual who faces workers compensation fraud charges may be charged with either a felony or misdemeanor. In most cases, the prosecutor will determine if an individual will be charged with a felony or misdemeanor based on a variety of factors.
If an individual faces a workers compensation fraud charge that is a felony, then he or she may face two, three, or five years in a state prison. Furthermore, those who are convicted of a felony workers compensation charge may face fines up to $150,000 or twice the amount of the fraud.
If an individual faces a workers compensation charge that is a misdemeanor, then he or she may face a potential sentence of up to one year in a county jail. An individual who is convicted of a misdemeanor workers compensation charge may also have to pay a fine of up to $10,000.
In many insurance fraud cases, if there is a previous felony conviction for insurance fraud, then an individual could face a sentence enhancement. A sentence enhancement is when additional time is added to a sentence, which would be two years for each past offense.
Individuals who are convicted of workers compensation fraud charges may also have to pay restitution to the defrauded companies.
The Importance of a Strong Defense
If an individual is facing workers compensation charges in California, it is imperative he or she seeks legal counsel immediately. An experienced legal team has the ability to investigate workers compensation fraud charges and help their clients develop a solid defensive case. A legal team can develop defenses that include:
An individual did not knowingly commit workers compensation fraud, which means there was no intent.
The prosecution is not able to develop sufficient evidence that supports workers compensation charges.
For individuals who are facing workers compensation fraud charges in California, finding a skilled team of legal experts can prevent defendants from being incarcerated or having to paying fines. A prosector must prove beyond a reasonable doubt that an individual had intent to commit workers compensation fraud, which can be difficult. An experience attorney can help defendants build a strong case that can successfully fight the charges.