CALIFORNIA INSURANCE CODE 1871.4 CIC – WORKERS’ COMPENSATION FRAUD

Workers’ compensation is a crucial safety component designed to protect employees who suffer injuries or illnesses on the job. It ensures that injured workers receive the necessary medical treatment and financial support while they recover. However, the system is vulnerable to fraud, which can undermine its effectiveness and lead to increased costs for employers and insurers. California Insurance Code 1871.4 specifically addresses workers’ compensation fraud, outlining the legal boundaries and consequences for those who attempt to exploit the system. In this blog post, we will delve into the specifics of California Insurance Code 1871.4, exploring what constitutes workers’ compensation fraud, the penalties for violating this law, and the potential defenses available to those accused. Understanding these elements is essential for both employers and employees to navigate the complex landscape of workers’ compensation and protect their rights. Workers’ compensation fraud happens when someone lies or gives false information to try to get benefits they aren’t entitled to. It can involve employees, employers, doctors, or others trying to cheat the system for financial gain. Such Fraud is a severe offense in California, which includes intentionally providing false information or deceptive claims about an injury to fraudulently obtain benefits like medical treatment or compensation for lost wages. Whether you’re a business owner looking to protect your company from fraudulent claims, an employee seeking to understand your rights and responsibilities, or a legal practitioner aiming to deepen your knowledge of California’s insurance laws, this comprehensive overview of Insurance Code 1871.4 will provide valuable insights and practical guidance.

Insurance Code 1871.4 says, (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. Source: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS&sectionNum=1871.4.

ELEMENTS

To establish workers’ compensation fraud, the prosecution must demonstrate the following elements:

• Providing false or fraudulent information to either obtain or deny workers’ compensation benefits;
• Making false or fraudulent statements in favor of or against the payment of workers’ compensation benefits;
• Issuing false or fraudulent statements regarding eligibility to dissuade an individual from filing a legitimate workers’ compensation claim;
• Assisting or engaging in a conspiracy with others to perpetrate workers’ compensation fraud;
• Soliciting or encouraging others to partake in workers’ compensation fraud.

EXAMPLE

John knowingly submits a fraudulent insurance claim for damages to his car, claiming that the damage was due to a recent accident. However, upon investigation, it is discovered that John intentionally caused the damages himself in order to collect insurance money. In this case, John could be charged under California Insurance Code 1871.4 for committing insurance fraud.

PENALTIES, PUNISHMENT, AND SENTENCING

Violating Insurance Code 1871.4 can lead to either a misdemeanor or felony charge, depending on the specific details of the case. If convicted of a misdemeanor, you could face up to one year in county jail. For a felony conviction, the potential prison sentence ranges from two to five years. Moreover, being found guilty of workers’ compensation fraud carries severe financial consequences, including a hefty fine of $150,000 or double the amount of the fraud, whichever is greater. Additionally, you would be required to compensate any victims of the fraudulent activity. Furthermore, if convicted, you may face civil penalties of up to $10,000 for each false claim made. Prior convictions could result in additional fines of $4,000 per fraudulent item or service.

HOW CAN I FIGHT WORKERS’ COMPENSATION FRAUD CHARGES?

• Lack of Intent

One of the key elements the prosecution must prove is that you intentionally committed fraud. If you can demonstrate that there was no intent to deceive or that any inaccuracies in your claim were honest mistakes, you may have a strong defense. For instance, if you misunderstood the forms or the severity of your injury changed, this might help show a lack of fraudulent intent.

• Insufficient Evidence

The prosecution must provide sufficient evidence to prove that you committed fraud beyond a reasonable doubt. If the evidence against you is weak, contradictory, or circumstantial, your attorney can argue that the prosecution has not met its burden of proof. For example, if there are discrepancies in witness statements or a lack of documentation supporting the fraud claims, these points can be raised in your defense.

• Legitimate Change in Condition

In some cases, injuries can legitimately worsen or improve over time. If you are accused of exaggerating your injury, but you can provide medical evidence showing that your condition changed after the initial report, this could be a valid defense. Medical records, doctor’s notes, and expert testimony can be crucial in supporting this defense.

• Medical Advice and Documentation

Following the advice of medical professionals and keeping thorough documentation of your injury and treatment can be critical. If you can show that your actions were based on medical advice and that you consistently followed your treatment plan, it may counter claims of fraud. This defense relies on detailed and accurate medical records.

• Mistaken Identity

In some rare cases, fraud charges may arise from cases of mistaken identity or clerical errors. If someone else used your information to file a fraudulent claim or if there was an administrative mistake, you may be able to prove that you were not the person responsible for the fraud.

• Administrative Errors

Workers’ compensation claims can involve significant paperwork and complex processes. Administrative errors or misunderstandings during the filing process can sometimes be mistaken for fraudulent activity. If your defense can show that any alleged discrepancies were the result of administrative errors rather than intentional deceit, this can be a strong defense.

• Witness Testimony

Witnesses who can testify to the legitimacy of your injury and your adherence to medical advice can be very valuable. Coworkers, supervisors, and healthcare providers who can attest to your injury’s impact and your behavior following the injury can help bolster your defense.

IMMIGRATION CONSEQUENCES

For non-citizens, a conviction under California Insurance Code 1871.4 can have serious immigration repercussions. The following are the primary immigration consequences that could result from such a conviction:

• Deportability

A conviction for insurance fraud can make a non-citizen deportable under U.S. immigration laws. The Immigration and Nationality Act (INA) specifies several grounds for deportation, including convictions for crimes involving moral turpitude (CIMT). Insurance fraud is generally considered a CIMT because it involves deceit and intent to defraud.

• Inadmissibility

A non-citizen convicted of insurance fraud may be deemed inadmissible to the United States. This means that they could be barred from re-entering the country if they leave, or from adjusting their status to that of a lawful permanent resident. The INA outlines that individuals convicted of CIMTs, among other offenses, can be denied admission to the U.S.

• Impact on Immigration Relief

Convictions for insurance fraud can also impact eligibility for various forms of immigration relief, such as:

• Asylum: A conviction can disqualify an individual from obtaining asylum in the U.S.
• Cancellation of Removal: This form of relief may be unavailable to individuals with certain criminal convictions.
• Deferred Action for Childhood Arrivals (DACA): A conviction may render an individual ineligible for DACA benefits.
• Adjustment of Status: A conviction can affect the ability to adjust status to that of a lawful permanent resident.

If you or someone you know is charged with this crime, it is strongly advisable that you also consult with an immigration lawyer. If you do not have or know of an immigration lawyer, the Tabibnia Law Firm can refer you to one.

CAN A DEFENDANT GET A CONVICTION EXPUNGED?

Yes, in many cases, a defendant convicted under California Insurance Code 1871.4 for insurance fraud may be eligible to have their conviction expunged. Expungement can offer significant benefits, such as improving employment prospects and alleviating certain legal disabilities. However, it is important to understand the eligibility criteria, the expungement process, and the limitations of an expungement. Under California Penal Code § 1203.4, individuals convicted of certain crimes, including insurance fraud under Insurance Code 1871.4, may petition the court to have their conviction dismissed. To be eligible for expungement, the defendant must meet specific criteria:

• The defendant must have successfully completed their probation period. This includes adhering to all the terms and conditions set by the court.
• The defendant should not have been convicted of any new criminal offenses during the probation period or after.
• The defendant must not be currently serving a sentence for any other offense, on probation for another offense, or charged with another offense.

RELATED CRIMES

• Penal Code 550 PC – Submitting Fraudulent Insurance Claims
• Penal Code 549 PC – Referring or Soliciting Business for Fraud
• Penal Code 487 PC – Grand theft
• Penal Code 470 PC – Forgery
• Penal Code 118 PC – Perjury

CALL LOS ANGELES WORKERS’ COMPENSATION FRAUD DEFENSE ATTORNEY

If you’ve been accused of committing workers’ compensation fraud in violation of California Insurance Code 1871.4 or Penal Code Sections 549-550, it’s important to take immediate action to protect yourself. Contacting an experienced criminal defense attorney like Cyrus Tabibnia at Tabibnia Law Firm should be your next step. A conviction for this type of offense can lead to severe civil and criminal penalties, and it can also significantly affect your future employment opportunities. By having a skilled lawyer on your side early in the process, you can improve your chances of obtaining a favorable outcome in your case. Call Cyrus Tabibnia at 866-713-2159