C-IV.B · Commercial Casualty Insurance
Workers' compensation fraud
Employee fraud: Insurance Code §1871.4(a) makes it unlawful to make a knowingly false or fraudulent material statement to obtain compensation. Example: a worker hurts his back moving furniture at home over the weekend and tells his employer on Monday that it happened at work.
Penalty under §1871.4(b): county jail for one year, or two, three or five years under Penal Code §1170(h), or a fine of up to $150,000 or double the value of the fraud, whichever is greater, or both jail and fine. Restitution must be ordered.
Employer fraud: §11760(a) makes it unlawful to knowingly make a false statement of any fact material to the premium, rate or cost of a workers' compensation policy in order to reduce it. Classifying roofers as clerical workers or understating payroll are examples. The penalty is county jail for one year, or two, three or five years under Penal Code §1170(h), a fine of up to $50,000 or double the value of the fraud, whichever is greater, or both. No injury is needed: the false statement is the offense. Section 11880 has the same rule for SCIF policies.
Remember
· Claim fraud (Ins. Code §1871.4): fine up to $150,000 or double the fraud, plus restitution.
· Premium fraud (§11760; §11880 for SCIF): fine up to $50,000 or double the fraud.
· Misclassifying workers or understating payroll to cut premium is a crime even with no injury.
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