The Insurance Fraud Division at the San Francisco District Attorney’s Office is dedicated to combatting the significant issue of workers’ compensation insurance fraud, which results in higher premiums, higher taxes and higher prices for the law-abiding California citizen. Our dedicated team investigates and prosecutes a wide range of fraud cases in criminal court in San Francisco County. Here are some common types of workers’ compensation insurance fraud we tackle:  

Fraud by Employees  

Fraud by employees typically occurs when individuals provide misleading information to tap into benefits they have no right to claim. For example, employees who falsely claim that an injury occurred at work, employees who fail to disclose additional income while receiving benefits, and employees who misrepresent their recovery status to extend their benefits.  

Fraud by Employers  

Fraud by employers takes various forms, including underreporting payroll, misclassifying employees as independent contractors, and misrepresenting job duties to illegally reduce workers’ compensation.   

Fraud by Medical Providers  

Doctors, chiropractors, lawyers and other professionals sometimes exploit the system. This fraud may occur when these professionals bill insurance companies for services they never provided or administer unnecessary procedures, medical supplies or prescriptions. Additionally, we prosecute professionals who engage in kickbacks, paying others to recruit or refer patients.  

FAQs 

Q: What should I do if I believe an employee’s worker’s compensation claim is invalid?  

A: Report your concerns to your workers’ comp claims administrator, providing all relevant facts, any witnesses and contact information for further investigation.  

Q: Is workers’ compensation fraud considered a crime, and who handles these cases?  

A: Fraud should be reported to the California Department of Insurance (CDI link), which collaborates with other agencies and local district attorneys to investigate and prosecute these cases.  

Q: Are there penalties for committing workers’ compensation fraud?  

A: Yes, penalties can include fines, restitution and imprisonment. The severity of the penalty depends on the nature and extent of the fraud committed.  

For more Workers Compensation Employer FAQs visit: 

Department of Industrial Relations(DIR) 

Primary California state-run insurance provider:  

State Compensation Insurance Fund(SCIF)