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Q: I have been approached by someone who says they are a customer service representative for a legal office or medical provider. He told me that I can receive a bonus for referring injured employees to them. Is this legal?

Q: I have some information that someone I know is defrauding the Workers Compensation system by receiving benefits for a phony injury. If I want to report this, what should I do?

Q: I received a copy of the billing my medical provider sent to my boss' WC insurance carrier, and they are billing for services I did not receive. What should I do?

Q: I have been injured at work and my employer says we dont have Workers Compensation insurance. What should I do?

A: It is illegal in California to refer someone to a medical professional for a commission or to be paid for going to a doctor or chiropractor for treatment. The medical or legal provider, the marketer or capper, and even the patient could be guilty of fraud and be sent to state prison. If someone approaches you at work, report it to your employer immediately.

Q: I have some information that someone I know is defrauding the Workers Compensation system by receiving benefits for a phony injury. If I want to report this, what should I do?

A: It is a crime to make a false Workers Compensation claim or to lie on Workers Compensation paperwork to receive a benefit. False claims cost jobs in California. Because premium costs to employers have risen, some cannot afford to do business here. If you have information that someone is falsely claiming to be injured, there are many places to report it. You can report it to the employer, to the insurance carrier if you know who they are, or you can report it to the California Department of Insurance on the form on their website at www.insurance.ca.gov. When you report the suspected fraud, you should provide all the information that you have which could include pictures, statements or paperwork associated with the claim.

Q: I received a copy of the billing my medical provider sent to my boss' WC insurance carrier, and they are billing for services I did not receive. What should I do?

A: Workers' compensation fraud can be committed by a worker, an employer, or a medical provider. Anyone in the system who makes false statements in order to get benefits or money they don't deserve has committed fraud and could be ordered to pay back the money they received, pay heavy fines and go to State Prison for up to five years. If you suspect a medical provider has billed for services not given, contact your employer, the employer's insurance carrier, or the State Department of Insurance Fraud Division at 714-712-7600.

Q: I have been injured at work and my employer says we dont have Workers Compensation insurance. What should I do?

A: All employers are required to have workers' compensation insurance coverage to pay for medical expenses and to pay for any disabilities a worker receives from an injury at work. If the employer has workers' compensation insurance, all medical expenses, salary replacement payments and compensation for disability are paid by the insurance company.

An injured worker who learns his employer doesn't have insurance should first seek any necessary medical treatment and then call the State Department of Insurance Fraud Division at 714-712-7600, or the District Attorney's Workers' Compensation Unit at 714-648-3650.

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