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News & Press: Legislative Issues

Employers Fraud Task Force Annual Conference Recap

Thursday, July 12, 2018  
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Employers Fraud Task Force Annual Conference Recap
Bruce Wick attended this conference on June 21 and 22, 2018. This is a symposium of employers, district attorneys, and SIU (Special Investigations Unit) personnel from workers' compensation insurers. Discussions and breakout sessions involved types of WC fraud, provider, premium, and applicant(employee) fraud. Some noteworthy items:
  1. 86% of the charged WC fraud in California came from Southern California, even though that area only has 48% of the labor force.
  2. Organized crime continues to be involved in WC provider fraud, and it appears as enforcement efforts have increased in Southern California, they are beginning to move to Northern California regions.
  3. The typical provider fraud case is $20 million and up.
  4. The typical premium fraud case is $500,000.
  5. The typical applicant(employee) fraud case is $30,000.
Bruce reminds our members how important it is to have an effective SIU group in your insurance program. Even though the applicant cases are the smallest amount, they can still be prosecuted by the District Attorneys, if the SIU does much of the work. We continue to encourage employers to seriously consider the effectiveness of the SIU group in whatever WC insurer or program they are looking at. At a recent meeting, a District Attorney prosecutor of WC fraud from Southern California advised that even though all insurers are required to have SIUs, only about 30% have functioning SIUs, and less than 10% have highly effective SIUs.
 

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