Sandra L. T rend
7352 Huntington Square Lane
Citrus H eights, CA 95621
September 2, 2010
California Department of Insurance
Office of the Ombudsman
300 Capitol Mall, Suite 1600
Sacramento, CA 95814
! On the State of California; Department of Industrial Relations, Division of Workers Compensation
website; there are several questions and answers concerning workersʼ compensation fraud and who
investigates these cases.
Q. Isnʼt workersʼ comp fraud a crime? Who investigates these cases?
A. Yes, workersʼ compensation fraud is a crime and it can come in many forms: a worker
saying they were injured on the job when their injury really occurred while skiing; an employer
saying their employees work at desk jobs when theyʼre really construction laborers; a
medical provider billing for six treatments on an injured worker when they only provided two,
etc. These are just a few examples of fraud in the workersʼ comp system. Fraud is a serious
problem and should be reported to the California Department of Insurance (CDI) for
investigation. The CDI has a fraud page on its Web site at www.insurance.ca.gov. THE CDI
WORKS CLOSELY WITH OTHER AGENCIES TO INVESTIGATE POSSIBLE FRAUD CASES AND ALSO WORKS
WITH LOCAL DISTRICT ATTORNEYS OFFICES TO PROSECUTE THOSE CAUGHT VIOLATING THE LAW.
! The California Department of Insurance (referenced above) is very clear in defining what the
Fraud Division - Over is in Enforcement Overview:
"To protect the public from economic loss and distress by actively investigating and arresting
those who commit insurance fraud and to reduce the overall incidence of insurance fraud
through anti-fraud outreach to the public, private and government sectors."
! The California Department of Insurance further defines, “What is Insurance Fraud?”
Fraud occurs when someone knowingly lies to obtain some benefit or advantage to which they
are not otherwise entitled or someone knowingly denies some benefit that is due and to
which someone is