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San Diego Businesses Indicted for Major Workers’ Compensation Fraud

The San Diego County District Attorney announced charges against four San Diego companies and fourteen individuals for defrauding insurance companies and the state tax board out of more than one million dollars (1-29-2014). The businesses were charged with tax evasion, unemployment fraud, and workers’ compensation fraud, according to The San Diego County District Attorney’s Office.

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The Allegations Include:

  • Instructing an injured employee to claim he got hurt at home, when his injury actually resulted from falling at a job site.
  • Receiving unemployment benefits while being paid cash to work.
  • Intentionally lying about, or failing to report payroll in order to receive reduced workers’ compensation premiums.
  • Persuading employees to participate in workers’ compensation fraud.

Attorneys Beware: Severe Repercussions for Fraud

In addition to disbarment or license suspension, attorneys who participate in fraud could also owe fines and civil penalties to prosecuting parties and insurance companies. For an attorney who handles 200 workers’ compensation cases a year, implication in fraudulent activity is a serious risk that must be mitigated by constant vigilance and knowledge of the many rules and regulations that relate to fraud.

Activities that Can Get You in Trouble

• Producing advertisements that do not contain the name of at least one attorney from the advertising workers’ compensation practice

• Hiring runners, cappers, or steerers to recruit clients

• Facilitating medical referrals that benefit the referring doctor and/or the referrer’s family members, financially or otherwise

• Referring patients to medical professionals who are employed by the treating doctor or his/her medical facility (unless no other facility is available within a certain distance, in which case the doctor must abide by specific referral laws)

Constantly Updating Knowledge is the Best Fraud Defense

Workers’ compensation legislation changes frequently and attorneys are charged with internalizing new regulations in order to practice within the confines of the law. Every attorney understands that finding the time to research updated regulations can be challenging. Yet, the risks are too high to fall behind on learning the most recent legislation, so all attorneys specializing in workers’ compensation should make it a priority.

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In California Workers’ Compensation Law & Practice, Judges Daniel A. Dobrin, David L. Pollak, and Roger A. Tolman, Jr., keep you up-to-date in the ever-changing world of worker’s compensation. With the addition of 29 sections and revision of 60 sections and forms, the best book on California workers’ compensation law is now even better. New material added to this year’s revision includes:

  • Detailed WCAB rule revisions arising from SB 863 reforms with regard to “cost” claims.
  • Major revisions to the WCAB’s Policy and Procedural Manual, together with filing and activation fee rules and the impact of the Angelotti injunction.
  • In-depth coverage of such current issues as inflation rates applicable to for commutation petitions, CCPOA liens, lien assignments, and dismissals based on lien claimant nonappearances.
  • Generous references to hard-to-find “noteworthy” panel decisions covering key questions that arise in day-to-day practice.
  • And much more!

This 2-volume book will guide you through the process of readying and trying your workers’ compensation case.