Fraud in the Workers’ Comp System

by Jack Goodchild

I have been involved as an applicant’s attorney, judge pro-tem, arbitrator, mediator, writer, lecturer and volunteer in this system since 1974. I have represented uninsured employers and have advised the Legislature regarding reform and legislation. I am currently the incoming Chair of the California Lawyers’ Association Workers’ Compensation Section’s Executive Committee. I care deeply about the integrity and reputation of our area of legal practice and of the practitioners involved in the daily processing and litigation of Workers Compensation cases.

Despite my efforts to practice in an ethical manner, bringing strong advocacy forward on behalf of those whom I represent, I have been woefully reminded over and over again that by and large the public and other practitioners think little of our practice and believe that it is rampant with fraud and that that fraud is largely, if not entirely, the fault of phony claims by allegedly injured workers and their attorneys.

While finger pointing is easy and probably a shallow way to address this issue, it is , in my opinion,  better to try to understand what the real facts are and how we may address them in our practices and careers so as to improve our overall reputation and the relationships between those on all sides who make our system work.

A review of the prosecutions and convictions  detailed per law in reports on a county by county basis will reveal that while fraud committed by faking or exaggerating workers compensation injuries is a large cost driver in our system, in fact the largest expenses seem to be a result of fraud committed by employers in the non-reporting and underreporting of injuries and even more so in  fraudulently understating their payrolls, in classification fraud and in fraud regarding the nature of the employment relationship versus independent contractor status. Failure to carry workers compensation insurance is also considered fraud.

Fraud, of course, can be and is sometimes committed by any of the multiple participants in our system including doctors, lawyers, vendors, etc.  Unfortunately, “one rotten apple can spoil the whole tree”. If we are to resurrect our good reputations , it is incumbent upon the people in our system who endeavor to keep it ethical and fair to work to improve our reputations by helping to weed out the “bad apples” and to report them so that they are prosecuted and punished and thereby so that our system is “inoculated” from their harm

I will be presenting a webinar on this topic on Friday October 25,2019 from 12 noon to 1 p.m. My co-presenters will be Teena Barton (Sr. SIU Investigator/ Special Investigation Unit/ICW Group Insurance Companies) and Mike Bender of ICW insurance company (SIU AVP for ICW Group Insurance Companies.) He is an internationally recognized expert in various insurance fraud schemes. In 2018 he was awarded the Johnnie Cochran Jr. Relentless Pursuit of Justice Award from the Criminal Courts Bar Association.

We will be going over the law and a review of examples of developments regarding fraud prosecutions and investigations in our state.

Please Join us! Together we can start the process of eliminating or at least reducing this scourge upon our system and reputations.

We are part of a benefit delivery system, after all, and we need to ensure that the purpose of our system-providing prompt and unencumbered benefits and treatment to the legitimately injured workers of our state remains our unmitigated priority. We ask that you join our effort and help us to remove the bad actors who seek to profit at the expense of those who legitimately need our help.

To learn more specifics about this very important subject, tune into Jack Goodchild’s webinar on this subject on 10/25/2019 from noon to 1pm.

© Copyright 2019 by Jack Goodchild. All rights reserved.