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Los Angeles Employer Workers' Compensation Law Blog

Signs of workers' compensation fraud

If you are an employer in California, you want to maintain a safe and fair working environment for your employees, but some people may try to take advantage of you. Unfortunately, some employees file false workers' compensation claims in order to avoiding paying for an injury sustained elsewhere, or to get undeserved time off work. We at Sacks and Zolonz recognize the pressure employers have to discern between legitimate and fraudulent claims, and we stand ready to help you when dishonesty does occur.

While not every fraudulent claim will look the same, many have similar warning signs. Particularly if a case has several of the following elements, you may want to investigate its veracity. One red flag is a difficulty to specify the details of the claim. If no one else saw the injury, or if the claimant's account of the incident changes, it may be a false claim. The same may be true if an injury report does not support the details of the claim.

Securing a better outcome as an uninsured employer

If you are an uninsured employer and do not have workers' compensation coverage when an employee is hurt at work, you may face harsh consequences. Not only could you spend time behind bars, but you may also be hit with steep fines and have a shattered reputation. At Sacks & Zolonz, we understand the different ways that failing to offer workers' comp can completely upend the lives of business owners in Los Angeles, and the rest of California.

There may be any number of reasons why an employer fails to provide employees with workers' compensation coverage. For example, a business owner may be facing financial hardships due to a struggling economy and find themselves in a position where they are unable to pay for the coverage. Additionally, someone who has recently launched a new business may not even realize that they were required to have workers' compensation. Regardless of the reasons why a business lacks insurance, it is pivotal for you to explore your options and take steps to obtain a better outcome if you are going through these challenges personally.

2 California workers involved in deadly jobsite accident

On-the-job accidents take many forms, whether they involve motor vehicle accidents in construction zones or repetitive strain injuries that occur in office spaces. For injured employees, a long road to recovery may lie ahead. In Los Angeles, and across the state of California, injured workers may experience financial problems due to missing work or costly medical bills. Furthermore, they may have debilitating pain and mental trauma following a workplace accident, which highlights the importance of taking action.

Two construction workers in California were recently involved in a jobsite accident that left one dead and another hurt. The incident, which is being investigated by authorities, resulted in the closure of lanes and stopped nearby construction work. The two workers were hit by a dump truck while they were on Highway 17 in the Santa Cruz Mountains trying to clear a large landslide.

What happens if I do not have workers’ compensation insurance?

As an employer in California, you have to be concerned with what happens if an employee gets injured on the job. The California Department of Insurance notes that all employers must have workers’ compensation insurance. It does not matter if you have only one employee or you have 200 employees, you are legally required to carry the insurance. Trouble starts if you do not have it.

Because carrying coverage is required under the California Labor Code, if you do not have coverage, you are in violation of the law. It is categorized as a misdemeanor. Your business can be closed down, or you can be fined by the Division of Labor Standards Enforcement. Since it is a criminal offense, you may also face up to one year in jail and/or a fine of up to $10,000. The state may also fine you a maximum of $100,000. It is also important to note that the Uninsured Employers' Benefit Trust Fund has the right to file charges against you for fraud if you willfully do not carry insurance coverage.

Types of workers’ compensation fraud

Workers’ compensation fraud is a serious issue in California. According to the Collation Against Insurance Fraud, fraudulent claims cost everyone money, even consumers. This is because the costs of paying claims get passed down until eventually it is the consumer who is paying for them through higher prices everywhere they go.

Common fraud issues involve employees and employers. Employees may try to pretend that an injury is worse than it is, especially if the injury is not one that can easily be tracked through diagnostics. For example, it is difficult to judge pain through tests, so an employee may claim excruciating pain as a result of an injury when the pain was only minor or no longer exists. Employers, on the other hand, may omit information or report false information on insurance applications in an attempt to get lower premiums. However, it is not only employees and employers who are trying to cheat the system.

Can illegal employment risk workers’ compensation?

When it comes to your company’s workers; compensation policy, non-traditional contracts and loopholes can create significant stress, both for you as well as your employee. Injuries that occur to employees who are working illegally in California may disqualify the worker from receiving any compensation. In order to understand how this works, it is important to clarify the multiple meanings of the word “illegal” in this statement.


What is a malingerer and how do you spot one?

If you are in charge of managing your California company’s workers’ compensation and disability cases, you may already be aware of the threat that a malingerer presents. A person who falls under this label is usually guilty of exaggerating their symptoms in hopes of receiving more compensation. They may even make a completely false claim of injury.


A whistleblower's rights and protections

California employees who notice wrongdoings in their workplace may be tempted to become a whistleblower in order to call attention to the issues at hand. The Occupational Safety and Health Administration, or OSHA, provides protection for those people so they do not have to fear backlash from employers for calling them out. Additionally, whistleblowers have rights to keep them protected, as well.

According to OSHA, employer retaliation against an employee for their participation in whistleblowing can give an employee the right to file a complaint with OSHA against said employer. There are many different types of unfavorable actions that are considered reportable, and they can include:

  • Discipline
  • Benefit or promotion denial
  • Wage or hour reduction
  • Intimidation and threats
  • Firing or suspension
  • Blacklisting

What is a whistleblower?

Workers in California like you have the right to carry out your jobs in a safe environment where you don't fear for your safety, life, or job security. So what happens if your upper management is making attaining those things impossible?

This is where whistleblowers come in. The Government Accountability Project defines this as the report of wrongdoings done by an employee, as long as they go through the proper legal channels for it to be considered legal whistleblowing. In these cases, wrongdoings can be defined as:

  • Fraud
  • Mismanagement
  • Power abuse
  • Illegal activities
  • Public health and safety dangers

If your employee tests positive for marijuana use

Employers in California have a responsibility to their employees to provide a safe workplace, but if an employee is hurt on the job, it is the workers’ compensation insurance that covers the costs related to the injury. Carrying this insurance saves a company money, but the high costs of claims may drive up the rates. This factor makes it important to ensure that worker claims are valid, and that injuries are caused by a compensable incident.

Occupational Health & Safety magazine notes that, with the changes regarding the recreational use of marijuana, employers may have some questions about their rights and responsibilities, and workers’ compensation. Although an employee may not be smoking or ingesting the drug illegally, it still creates significant hazards on the job due to its effects on the body, including problems thinking, paying attention, reacting safely and controlling movement. Employers may still perform drug tests to ensure that workers are not creating safety hazards for themselves and others on the job.

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