Chapter 3 – Personnel, Training, and Employee Relations

31140.23 Workers Compensation Fraud Investigations

• The OIAOffice of Internal Affairs is responsible for investigating Workers’ Compensation fraud. Penal Code Section 550 and Insurance Code Section 1871.4 define the law relating to Workers’ Compensation insurance fraud.

• It is a felony to present a false or fraudulent claim to receive Workers’ Compensation benefits. Fraud can occur at any time during the life of a Workers’ Compensation claim; from the initial filing of the claim, to false statements to the employer, doctor, medical care personnel, physical therapist, claim representative, or anyone else involved in the administration of the claim and the determination of available benefits. Fraud can occur even if the initial injury was legitimate and the filing of the claim was warranted if the employee later makes a material false statement or misrepresentation.