In California, workers’ compensation fraud involves providing false or misleading information in order to obtain benefits to which you are not legally entitled. The crime can be charged as a misdemeanor or a felony and carries penalties of up to 5 years in jail or prison.
“Workers’ compensation” is a system of insurance that provides medical care and payments for lost income to workers who are injured on the job.1 Fraud committed in connection with workers’ compensation insurance can lead to harsh criminal penalties.
Acts that are considered workers’ compensation fraud in California include:
- Knowingly making or presenting a false or fraudulent material statement for the purpose of either obtaining or denying workers’ compensation benefits;
- Making a false or fraudulent statement about eligibility for benefits in order to discourage an injured worker from claiming benefits;
- Knowingly aiding and abetting, or participating in a conspiracy to commit, workers’ compensation fraud;2
- Preparing or submitting multiple claims for payment of a health care benefit covered by workers’ compensation insurance, all for the same injury;
- Submitting a claim for a health care benefit covered by workers’ comp that was not actually used;3 and
- Soliciting, referring or accepting any business from a person, knowing that s/he intends to commit workers’ comp fraud.4
Examples
Here are some examples of people who could be charged with California workers’ compensation fraud:
- A man claims to have debilitating back pain due to a fall down the stairs at his office and collects workers’ comp payments for lost income. In reality, his back pain is minor, and he is working a new job under the table while also collecting benefits.
- An employer lies about the circumstances of an employee’s accident at work in order to prevent that employee from getting workers’ compensation benefits (which would raise the employer’s premium for workers’ comp insurance).
- A doctor specializes in treating patients injured in the workplace and regularly submits bills to workers’ comp insurance for treatments that the patients did not actually need or receive.
The following graphic shows some other examples of workers’ comp fraud:
Penalties
Most forms of workers’ compensation fraud are California wobblers. This means that they may be charged as either misdemeanors or felonies in California law.5
The potential felony prison sentence for most forms of workers’ compensation fraud is two (2), three (3) or five (5) years. Felony fines can go up to one hundred fifty thousand dollars ($150,000), or twice the amount of the fraud (whichever is greater).6
In most cases, workers’ comp fraud as a misdemeanor carries a potential county jail sentence of up to one (1) year.7
Legal defenses
If you are charged with workers’ compensation insurance fraud in California, you may be able to get the charges reduced or dismissed by arguing one of the following common legal defenses:
- You did not act knowingly or with fraudulent intent; and/or
- There is insufficient evidence to support the charges.
In this article, our California criminal defense attorneys8 will explain the following:
- 1. How does California law define worker’s compensation fraud?
- 2. What are the potential consequences?
- 3. How can I fight the charges in court?
- 4. What other crimes could I be charged with?
Filing a false claim is a type of worker’s compensation fraud.
1. How does California law define worker’s compensation fraud?
There are several different California laws that address workers’ compensation fraud. These are:
1.1. Insurance Code 1871.4
Insurance Code 1871.4 is California’s main workers’ comp fraud statute. The legal definition of workers’ compensation fraud under this law is doing any of the following:
- Making, or causing to be made, a knowingly false or fraudulent material statement or representation for the purpose of obtaining or denying any workers’ comp benefits;
- Presenting, or causing to be presented, a knowingly false or fraudulent written or oral material statement in support of, or in opposition to, a claim for workers’ comp benefits;
- Knowingly aiding and abetting or conspiring with anyone else to commit any act of workers’ compensation fraud; or
- Making or causing to be made a knowingly false or fraudulent statement with regard to entitlement to benefits, with the intent to discourage an injured worker from claiming benefits or pursuing a claim.9
Let’s take a better look at some of the terms in this legal definition to get a better sense of their meaning.
Workers’ compensation benefits
“Workers’ compensation” is a form of private insurance policy that employers are required to pay for in California. If a worker is injured on the job, the insurance company will pay him/her benefits for:
- Medical care;
- Temporary disability (that is, payments to make up for lost wages if s/he is unable to work while recovering);
- Permanent disability (payments to make up for lost wages if s/he is not able to work again after the accident); and/or
- Death benefits (payments to the worker’s spouse, children or other dependents if s/he dies from a work-related injury or illness).10
Injured workers are generally limited to seeking worker’s compensation, meaning they can’t sue their employer in civil court in California for on-the-job injuries.
Workers’ compensation is what is known as a “no-fault” system. This means that the injured employee does not have to prove that the injury was someone else’s fault in order to receive benefits.11
Example: Betty works as a word processor for a large law firm. The firm provides ergonomic chairs, but Betty refuses to use hers; instead she brings in a folding chair from home and sits on that.
Betty eventually acquires severe carpal tunnel syndrome from all the typing she has to do at work. She ends up needing to take several months off of work, and receive physical therapy, in order to recover.
Betty’s injury was arguably her own fault, not her employer’s, because she wouldn’t use their ergonomic chair.
But her injury is still covered by the employer’s workers’ compensation insurance policy because it is a “no-fault” system. The insurer pays her benefits for her therapy and lost wages.
Statement or representation
A “statement or representation” includes, but is not limited to, the following:
- An oral or written statement or representation by the claimant;
- A notice;
- A proof of injury;
- A bill for services;
- Payment for services;
- Hospital or doctor records;
- X-ray or test results;
- Proof of medical-legal expenses; or
- Any other evidence of loss, injury, expense or payment.12
Example: Catherine works as a cashier in a liquor store. She suffers injuries to her face and neck when she is injured in an attempted robbery.
Catherine receives workers’ compensation benefits to cover treatment by Darren, a chiropractor who is a friend of hers. She and Darren realize that they can make a little profit by submitting inflated bills to the workers’ comp insurer.
So Darren, with Catherine’s knowledge, submits bills for more frequent treatments than she actually receives.
Those bills for services count as “statements” under Insurance Code 1871.4, and both Catherine and Darren are guilty of workers’ compensation fraud.
“Material” statement or representation
A statement is considered “material” if it conveys information on subjects that:
- Are germane or reasonably relevant to the insurer’s investigation of the claim; and
- Could bear directly and importantly on the investigation and evaluation of the claim.13
Example: Vern injures his knee in a car accident unrelated to his work. Then he is hit by an electric cart at his workplace, injuring his knee again.
Vern eventually applies for and receives workers’ compensation benefits for his injury at work. He does not let the doctors or the insurance company know that he had an earlier, non-work-related injury to his knee.
Information about the prior injury could have supported a reduction or even a denial of benefits, if it turned out that it was partially responsible for Vern’s knee problems after his injury at work.
Therefore it was material to the insurer’s investigation of the claims—and Vern is guilty of workers’ comp fraud for not disclosing the prior injury.14
False or fraudulent
A false or fraudulent statement is any statement that is untrue, or any statement or concealment of a material fact that is intended to induce a person to act to his/her detriment.15
As the example of Vern above shows, knowing concealment of a material fact is considered a form of false or fraudulent statement or representation.16
There are a variety of forms that false or fraudulent statements can take under workers’ compensation law. Applicants for benefits (that is, injured employees) can make a false or fraudulent statement by:
- Faking an injury;
- Lying about the extent of an injury;
- Claiming that a non-work-related injury is work-related;
- Failing to disclose a prior injury;
- Denying having filed previous claims;
- Collecting benefits for the same injury from more than one employer; and
- Illegally working while receiving workers’ comp benefits (“double-dipping”).
Example: Henry works for a city water department. After work on Fridays, he and his colleagues go to a nearby basketball court to play basketball.
One day Henry injures his knee during the basketball game. He goes back to the water department yard, reports the injury, and claims it happened to him while he was working. Later he applies for workers’ compensation benefits for the injury.
Henry is guilty of workers’ compensation insurance fraud for trying to pass off a non-work injury as a work injury.17
Example : Tom seriously injures his back while working as a truck driver. He claims that this injury requires him to walk with a walker and prevents him from performing basic self-care.
His company’s workers’ comp insurance policy awards him lifelong medical benefits and a substantial sum for an in-home caregiver to help him with daily tasks. His girlfriend serves as the caregiver.
The insurance company develops suspicions about Tom and sends an investigator to follow him. The investigator videotapes Tom living a very active life as a commercial fishermen engaged in strenuous work.
Tom is guilty of workers’ comp fraud for lying about the extent of his injuries and “double dipping” (working while collecting benefits).18
Employers can also commit Insurance Code 1871.4 workers’ comp fraud by making false or fraudulent statements or representations. Common forms of workers’ compensation fraud by employers include:
- Lying to their insurance company about the number of employees;
- Misrepresenting an employee’s job duties; and
- Lying to an employee about the extent of benefits to discourage him/her from submitting a claim.19
Example: Maria is the owner of an appliance store. George, one of her employees, injures himself while moving a heavy appliance.
Maria tells George that he is not covered under her workers’ compensation policy because he has only been working for her for a few months. This is untrue, and Maria knows it—but she doesn’t want her premiums to go up because of George’s application for benefits.
Maria is guilty of workers’ compensation fraud under Insurance Code 1871.4.
1.2. Penal Code 550 PC
Penal Code 550 PC describes several forms of California workers’ compensation fraud that overlap with California health care fraud. This law makes it a crime to do any of the following:
- Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit covered by workers’ comp insurance;
- Knowingly submit a claim for a health care benefit covered by workers’ comp insurance that was not used by the claimant; or
- Knowingly present multiple claims for payment of the same workers’ comp health care benefit, with an intent to defraud.20
This form of workers’ compensation fraud can be committed by employees/applicants—but it is also sometimes committed by doctors and other medical professionals who provide treatment covered by workers’ compensation insurance.
Example: Eli is a chiropractor who advertises his services to people suffering from chronic pain after on-the-job injuries. He sometimes submits bills to workers’ comp insurance companies for treatments that an injured employee did not actually receive.
Eli is guilty of workers’ compensation fraud under California Penal Code 550.
Doctors who are convicted of this and other kinds of workers’ compensation fraud may lose their medical license in addition to standard criminal penalties.
1.3. Penal Code 549 PC
Under California Penal Code 549 PC, a business owner or employee can commit workers’ compensation fraud by:
- Soliciting, accepting or referring any business to or from any person or entity,
- With the knowledge that, or with reckless disregard for whether that person or entity intends to commit workers’ comp fraud.21
Often this form of workers’ compensation fraud is charged against doctors, chiropractors or other health care providers involved in a scheme of commercial bribery and/or kickbacks that is designed to take advantage of the workers’ compensation system.
Example: Kareem owns a company that manufactures a special prescription cream used to treat pain. He pays large kickbacks to a dozen doctors and chiropractors in exchange for them prescribing the cream to their patients, all of whom are receiving workers’ compensation benefits.
Due to the technical details of how the ingredients in the cream are reimbursed by insurance, the workers’ comp insurance companies end up paying astronomical sums for the cream.
The doctors and chiropractors who participated in Kareem’s scheme are guilty under PC 549—because they referred business to Kareem with reckless disregard for whether he was engaging in workers’ compensation fraud.22
Worker’s comp fraud can be a felony or a misdemeanor.
2. What are the potential consequences?
2.1. Insurance Code 1871.4 penalties
Workers’ compensation fraud under Insurance Code 1871.4 is what is known as a wobbler.23 This is a crime that may be charged as either a misdemeanor or a felony, depending on:
- The circumstances of the charges; and
- The defendant’s criminal history.
When it is charged as a California misdemeanor, Insurance Code 1871.4 workers’ compensation fraud carries the following penalties:
- Misdemeanor (summary) probation;
- Up to one (1) year in county jail;
- A fine of up to one hundred fifty thousand dollars ($150,000) or double the amount of the fraud, whichever is greater; and/or
- Restitution to any parties who were victims of the fraud.24
When this form of California workers’ compensation fraud is charged as a felony, the potential penalties are:
- Felony (formal) probation;
- Two (2), three (3) or five (5) years in county jail under California’s realignment program;
- A fine of up to one hundred fifty thousand dollars ($150,000) or double the amount of the fraud, whichever is greater; and/or
- Restitution to any parties who were the victims of the fraud.25
2.2. Penal Code 550 penalties
Workers’ comp fraud in relation to health care benefits under Penal Code 550 is also a wobbler. The potential misdemeanor penalties under this law are:
- Misdemeanor probation;
- Up to one (1) year in county jail; and/or
- A fine of up to ten thousand dollars ($10,000).26
And the felony penalties for this form of workers’ compensation fraud include:
- Felony probation;
- Two (2), three (3) or five (5) years in county jail; and/or
- A fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater.27
The exception is if the total amount of the fraud is nine hundred fifty dollars ($950) or less (this includes the aggregate of multiple claims over a period of twelve (12) consecutive months).
In that case, PC 550 workers’ compensation insurance fraud is always a misdemeanor. The potential penalties are up to six (6) months in county jail, and/or a fine of up to one thousand dollars ($1,000).28
2.3. Penal Code 549 penalties
PC 549 workers’ comp fraud—soliciting, accepting or referring business from someone knowing they intend to commit workers’ compensation fraud—is a wobbler for the first offense, and a felony for the second and subsequent offenses.29
As a misdemeanor, this offense is punishable by up to one (1) year in county jail, and/or a fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater.30
As a felony, it carries a potential jail sentence of sixteen (16) months, two (2) years or three (3) years, and a fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater.31
2.4. Workers’ compensation fraud and professional discipline in California
California doctors, nurses and pharmacists who are accused of being involved in workers’ compensation fraud naturally need to be concerned about professional discipline.
For California doctors, any criminal conviction for an offense that is “substantially related” to the qualifications, functions, or duties of a physician can trigger professional discipline.32 Many forms of workers’ compensation fraud (for example, billing for services not actually rendered) could be deemed to fall into this category.
Nurses can also face nurse discipline and license revocation (in some cases) as a result of a workers’ compensation fraud conviction.33
Pharmacists are another class of professionals that need to worry about the effect of a workers’ comp fraud charge on their professional license.34
2.5. Civil penalties for workers’ comp insurance fraud
California law also provides for hefty civil fines for certain forms of workers’ compensation fraud.
These fines apply to parties who do any of the following:
- Willfully misrepresent any fact in order to obtain workers’ compensation insurance at a lower rate than the proper rate (this form of workers’ comp fraud is committed by employers);
- Present or cause to be presented any knowingly false or fraudulent statement in support of, or in opposition to, any claim for workers’ compensation benefits, for the purpose of either obtaining or denying those benefits;
- Knowingly solicit, receive, offer, pay, or accept any unlawful rebate, refund, commission or other compensation for soliciting or referring clients for services covered by workers’ compensation insurance;
- Knowingly operate or participate in a service that, for profit, refers patients to obtain medical or medical-legal services covered by workers’ comp; or
- Knowingly assist or conspire with anyone else to do any of the above.35
Any of the above facts will lead to:
- A civil penalty of at least four thousand dollars ($4,000) and up to ten thousand dollars ($10,000) for each illegal claim for compensation; and
- An assessment of up to three (3) times the amount of the medical treatment or medical-legal expenses paid by a workers’ compensation insurer as a result of the fraud.36
Plus, if you have a prior felony conviction for workers’ compensation fraud under Insurance Code 1871.4 or Penal Code 549, you will face an additional civil penalty of four thousand dollars ($4,000) for each item or service with respect to which the fraud occurred.37
Lack of fraudulent intent is a defense to worker’s comp fraud.
3. How can I fight the charges in court?
According to Newport Beach criminal defense attorney Neil Shouse38:
“Workers’ compensation fraud is one of the fastest-growing types of insurance fraud in the country. As a result, the California Department of Insurance, insurance carries, and district attorneys’ offices throughout the state are pouring many resources into uncovering fraudulent claims. Special investigative units often conduct undercover sting and surveillance operations to try to catch workers or employers who may be trying to ‘cheat the system.’”
Of course, this kind of vigilant—and often politically-motivated—law enforcement leads all too often to people being wrongly accused.
If you are charged with California workers’ compensation fraud, you and your criminal defense attorney may want to consider the following legal defenses:
You did not act with knowledge or fraudulent intent
You are not guilty of workers’ compensation fraud unless you acted with either:
- Knowledge that a particular statement or behavior was false or fraudulent; or
- Fraudulent intent.39
Many times a careless mistake on your part will be flagged as potential fraud by an insurance investigator—and reported to the authorities.
But the burden is on the prosecution to prove, beyond a reasonable doubt, that you knew you were submitting a false or fraudulent statement, and did not simply make a mistake.
A skilled criminal defense attorney may be able to cast enough doubt on this assertion to lead to charges being dropped—or a not-guilty verdict in a jury trial.
There is insufficient evidence that you committed workers’ compensation fraud
Many workers’ comp insurance cases revolve around a complicated set of facts. Often these facts involve highly technical and sometimes conflicting medical diagnoses, doctor’s reports, and other evidence that can be difficult for defendants and juries to make sense of.
But prosecutors may not take advantage of this complexity and ambiguity to convict someone unjustly.
It is a good criminal defense attorney’s job to find the weaknesses in the prosecution’s case—and to help you collect the strongest evidence for your innocence.
4. What other crimes could I be charged with?
Other California crimes that are frequently charged along with workers’ compensation fraud include:
4.1. Grand theft
Like most fraud crimes, workers’ compensation fraud frequently overlaps with Penal Code 487 PC California grand theft.
You commit grand theft when you unlawfully take property that is worth nine hundred fifty dollars ($950) or more.40 Cases of workers’ compensation fraud often meet the legal definition of “theft by false pretenses,” a form of grand theft.41
Grand theft is a California wobbler. The maximum misdemeanor sentence is one (1) year in county jail. The potential felony sentence is sixteen (16) months, two (2) years or three (3) years.42
4.2. Forgery
Penal Code 470 PC California forgery is the act of doing any of the following with intent to commit a fraud:
- Signing someone else’s name;
- Faking a seal or someone else’s handwriting;
- Changing or falsifying a legal document; or
- Faking, altering or presenting as genuine a false financial document.43
So, for example, if you fake a doctor’s signature on a report about an injury and use that report to obtain workers’ compensation benefits, you may be charged with both workers’ comp fraud and forgery.
Forgery is a wobbler and carries the same potential sentence as grand theft.44
4.3. Perjury
You commit Penal Code 118 PC perjury when you deliberately give false information while under oath.45
You could be charged with both perjury and workers’ compensation fraud if you deliberately lie while being deposed, or in a formal declaration, as part of an insurer’s investigation into workers’ compensation benefits.
Perjury is always a felony and carries a potential sentence of two (2), three (3) or four (4) years.46
For additional help…
Contact our law firm for help.
For questions about California’s workers’ compensation fraud laws, or to discuss your case confidentially with one of our California criminal defense attorneys, do not hesitate to contact us at Shouse Law Group.
We have local criminal law offices in and around Los Angeles, San Diego, Orange County, Riverside, San Bernardino, Ventura, San Jose, Oakland, the San Francisco Bay area, and several nearby cities.
For more information on Nevada’s workers’ compensation insurance fraud laws, please see our page on Nevada’s workers’ compensation insurance fraud laws.
Additional Resources:
California Department of Industrial Relations, Division of Workers’ Compensation
Legal References:
- See California Department of Industrial Relations, Injured Worker Guidebook, Chapter 1: The Basics of Workers’ Compensation.
- Insurance Code 1871.4 – Unlawful conduct; penalties. (“(a) It is unlawful to do any of the following: (1) Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any compensation, as defined in Section 3207 of the Labor Code. (2) Present or cause to be presented a knowingly false or fraudulent written or oral material statement in support of, or in opposition to, a claim for compensation for the purpose of obtaining or denying any compensation, as defined in Section 3207 of the Labor Code. (3) Knowingly assist, abet, conspire with, or solicit a person in an unlawful act under this section. (4) Make or cause to be made a knowingly false or fraudulent statement with regard to entitlement to benefits with the intent to discourage an injured worker from claiming benefits or pursuing a claim. For the purposes of this subdivision, “statement” includes, but is not limited to, a notice, proof of injury, bill for services, payment for services, hospital or doctor records, X-ray, test results, medical-legal expense as defined in Section 4620 of the Labor Code, other evidence of loss, injury, or expense, or payment. (5) Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying any of the benefits or reimbursement provided in the Return-to-Work Program established under Section 139.48 of the Labor Code. (6) Make or cause to be made a knowingly false or fraudulent material statement or material representation for the purpose of discouraging an employer from claiming any of the benefits or reimbursement provided in the Return-to-Work Program established under Section 139.48 of the Labor Code. (b) Every person who violates subdivision (a) shall be punished by imprisonment in a county jail for one year, or pursuant to subdivision (h) of Section 1170 of the Penal Code, for two, three, or five years, or by a fine not exceeding one hundred fifty thousand dollars ($150,000) or double the value of the fraud, whichever is greater, or by both that imprisonment and fine. Restitution shall be ordered, including restitution for any medical evaluation or treatment services obtained or provided. The court shall determine the amount of restitution and the person or persons to whom the restitution shall be paid. A person convicted under this section may be charged the costs of investigation at the discretion of the court. (c) A person who violates subdivision (a) and who has a prior felony conviction of that subdivision, of former Section 556, of former Section 1871.1, or of Section 548 or 550 of the Penal Code, shall receive a two-year enhancement for each prior conviction in addition to the sentence provided in subdivision (b). The existence of any fact that would subject a person to a penalty enhancement shall be alleged in the information or indictment and either admitted by the defendant in open court, or found to be true by the jury trying the issue of guilt or by the court where guilt is established by plea of guilty or nolo contendere or by trial by the court sitting without a jury.”)See also Labor Code 3207 – Compensation. (“Compensation” means compensation under this division and includes every benefit or payment conferred by this division upon an injured employee, or in the event of his or her death, upon his or her dependents, without regard to negligence.”)
- Penal Code 550
- Penal Code 549
- See endnotes 2-4, above.
- Same.
- Same.
- Our California insurance fraud defense attorneys have local Los Angeles law offices in Beverly Hills, Burbank, Glendale, Lancaster, Long Beach, Los Angeles, Pasadena, Pomona, Torrance, Van Nuys, West Covina, and Whittier. We have additional law offices conveniently located throughout the state in Orange County, San Diego, Riverside, San Bernardino, Ventura, San Jose, Oakland, the San Francisco Bay area, and several nearby cities.
- Insurance Code 1871.4 – Unlawful conduct; penalties [workers’ compensation fraud], endnote 2, above.
- See Division of Workers’ Compensation: Fact Sheet, California Department of Industrial Relations.
- See “Obtaining Workers’ Compensation,” California Governor’s Office of Business and Economic Development.
- Same.
- People v. Gillard (1997) 57 Cal.App.4th 136, 151-52. (“Materiality of the false statement is an element of the offense described in section 1871.4, subdivision (a)(1) [California’s workers’ compensation fraud law]. The trial court instructed, without objection, that “A statement or representation is material if it concerns a subject reasonably relevant to the insured’s … investigation of the [insured], and if a reasonable insurer would attach importance to the fact represented.” Gillard contends the instruction should have advised the jury that to be material the false statement must have had a “tendency to influence” the decision of a reasonable insurance company. . . . These cases confirm that materiality of false statements to obtain insurance benefits is met if the statements convey information on subjects which are “germane” or “reasonably relevant” to the insurer’s investigation and which could bear directly and importantly on the investigation and evaluation of the bona fides of the claim. The instruction in this case adequately conveyed these concepts.”)
- Based on the facts of the same.
- Black’s Law Dictionary (9th ed. 2009), fraud. (“1. A knowing misrepresentation of the truth or concealment of a material fact to induce another to act to his or her detriment. • Fraud is usu. a tort, but in some cases (esp. when the conduct is willful) it may be a crime [such as workers’ compensation fraud].”)
- People v. Gillard, endnote 13, above, at 153. (“Gillard’s principal contention is that when a claimant is prosecuted for violating section 1871.4, subdivision (a)(1) based on failure to disclose a prior injury, an essential element of the offense is that the claimant’s prior injuries produced a labor-disabling condition which remained extant at the time of his new injury. Absent that evidence, Gillard reasons, a claimant’s intentional concealment of those prior injuries cannot be material because they have no effect on the award for the current industrial injury. . . . We reject Gillard’s claim.”)
- Based on the facts of Tensfeldt v. Workers’ Comp. Appeals Bd. (1998) 66 Cal.App.4th 116.
- Based on the facts of People v. Webb (1999) 74 Cal.App.4th 688.
- Insurance Code 1871.4 – Unlawful conduct; penalties, endnote 2, above.
- Penal Code 550 PC – False or fraudulent claims or statements; prohibited acts, endnote 3, above.
- Penal Code 549 PC – False or fraudulent claims against insurers; solicitation, acceptance or referral of business; penalties and restitution, endnote 4, above.
- The facts of this example are based on a real workers’ compensation fraud case that was charged in Orange County in 2014. See, e.g., The price of pain: Indictments allege a massive compound cream scam, Southern California Public Radio, Sept. 11, 2014.
- Insurance Code 1871.4 – Unlawful conduct; penalties, endnote 2, above.
- Same.
- Same.
- California Penal Code 550 PC – False or fraudulent claims or statements; prohibited acts, endnote 3, above.
- Same.
- Same.
- Penal Code 549 PC – False or fraudulent claims against insurers; solicitation, acceptance or referral of business; penalties and restitution, endnote 4, above.
- Same.
- Same.
- See Business & Professions Code 2236 – Criminal convictions and doctor discipline.
- See Business & Professions Code 2761 – Criminal convictions and nurse discipline.
- See Business & Professions Code 4301 – Criminal convictions and pharmacist discipline.
- Labor Code 3820 – Legislative declarations; prohibited acts; penalties.
- Same.
- Same.
- Our Newport Beach criminal defense attorneys have conducted dozens of jury trials and juvenile adjudication hearings, defending a variety of California white-collar crimes, including multiple forms of insurance fraud.
- See Insurance Code 1871.4 – Unlawful conduct; penalties, endnote 2, above; Penal Code 550 PC – False or fraudulent claims or statements [including in connection with workers’ compensation insurance]; prohibited acts, endnote 3, above.
- See also People v. Dieguez (2001) 89 Cal.App.4th 266 (holding that there is no need to prove specific intent to defraud under Insurance Code 1871.4); but see Judicial Council of California Criminal Jury Instructions (“CALCRIM”) 2000 – Insurance Fraud: Fraudulent Claims (Pen. Code, § 550(a)(1), (4)-(7) & (9)) (specifying intent to defraud as an element of insurance fraud under Penal Code 550).
- Penal Code 487 PC – “Grand theft” defined. (“Grand theft is theft committed in any of the following cases: (a) When the money, labor, or real or personal property taken is of a value exceeding nine hundred fifty dollars ($950), except as provided in subdivision (b).”)
- Penal Code 532 PC – False pretenses; obtaining money, labor or property; punishment; evidence necessary to support conviction [overlaps with many forms of insurance fraud]. (“(a) Every person who knowingly and designedly, by any false or fraudulent representation or pretense, defrauds any other person of money, labor, or property, whether real or personal, or who causes or procures others to report falsely of his or her wealth or mercantile character, and by thus imposing upon any person obtains credit, and thereby fraudulently gets possession of money or property, or obtains the labor or service of another, is punishable in the same manner and to the same extent as for larceny of the money or property so obtained.”)
- Penal Code 489 PC – Grand theft; punishment. (“Grand theft is punishable as follows: . . . (c) In all other cases, by imprisonment in a county jail not exceeding one year or pursuant to subdivision (h) of Section 1170.”)
- Penal Code 470 PC – Forgery; signatures or seals; corruption of records.
- Penal Code 473 PC – Forgery; punishment. (“(a) Forgery is punishable by imprisonment in a county jail for not more than one year, or by imprisonment pursuant to subdivision (h) of Section 1170.”)
- Penal Code 118 PC – “Perjury” defined
- Penal Code 126 PC – Punishment.