Last Updated on May 15, 2025
Workers’ compensation insurance benefits were designed as a way for employees to seek compensation for on-the-job injuries without having to prove that their employer was responsible for the injury. While the program has been successful overall, some take advantage of the system by committing fraud, violating California Insurance Code section 1871.4 (CIC). If you have been accused of this serious crime, contact a top Vista and San Diego workers’ compensation fraud lawyer as soon as possible.
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Examples of Workers’ Comp Fraud in Vista
There are many ways people commit fraud under 18741.4 (CIC). These incidents can range from a simple, single-person swindle to a multi-level operation that involves many people. Most commonly, this form of insurance fraud is performed by a person making a false claim that they were injured at work. To help make their case, they usually claim to have an employee injury that is hard to prove because it is based solely on a person’s word that they feel pain —such as a non-herniated back injury.
In some cases, the person will have a real, albeit minor, injury that would not normally warrant medical care, but they exaggerate to stay out of work. Alternatively, some people suffer real injuries, but they falsely claim the injury occurred at work when they were injured doing something on their own time. Some people are so focused on getting workers’ comp that they will even purposely hurt themselves at work, which is still fraud even though the injury is real, new, and did occur on the job. Occasionally, doctors and attorneys may be involved in the scheme, receiving part of the cut from the “injury victim” in exchange for helping them commit insurance fraud.
When Businesses Face Criminal Charges
On the other side of the issue, employers are frequently charged in San Diego County with failing to maintain employee workers’ compensation benefits. Business owners sometimes treat employees as independent contractors when these definitions are quite narrow. The civil and criminal penalties for employer failure to have sufficient insurance coverage are significant and include heavy penalty assessments. A skilled defense attorney with experience handling corporate clients accused of violating criminal law statutes is indispensable in fighting these legal allegations.
A Real Example of Worker’s Compensation Fraud in North County
In one notable case, attorney Peter Liss represented the owner of an Escondido landscaping company accused of underreporting their company payroll so they could reduce their worker’s compensation payments. His client was charged with five counts of insurance fraud, punishable by up to nine years in prison.
Mr. Liss was able to have the felony charges dropped in a plea bargain, so she was only convicted of a misdemeanor and went through a diversion program to keep the offense off of her criminal record.
These Cases Should Not be Taken Lightly
California takes this form of fraud very seriously, as it costs employers in the state up to $3 billion every year. The California Department of Insurance and local district attorneys thoroughly investigate these crimes and urge the public to report anyone they suspect of committing this crime. These departments may process around 1,400 criminal cases involving 1,600 suspects every year. Evidence may include photos and videos documenting a suspect performing activities incongruent with their stated injuries.
Workers’ compensation insurance fraud is a felony offense in California under 1871.4 (CIC). If you have been accused of committing workers’ compensation fraud in San Diego, you could face up to five years in prison, plus heavy fines and mandatory restitution to the company. You may also lose any professional certificates you have to operate in your chosen field, drastically limiting your future career prospects.
Fighting Fraud Charges
The good news is that it is possible to fight these charges, provided you have the right criminal defense lawyer on your side. Defenses will vary drastically depending on the specifics of your crime, so refuse to speak to the police without your attorney present, or you may say something that could hurt your case.
If you have been accused of defrauding your employer’s workers’ compensation program or believe you are under investigation for this crime, please schedule a free consultation with criminal defense attorney Peter M. Liss. You can contact his law firm by calling (760) 643-4050. He has over 40 years of experience fighting white collar crime charges just like these in and out of court, and he can help you too.
