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               Integrated Disability Management

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     Workers' Comp  

    Fraud

     

    Workers’ Compensation fraud occurs when someone receives workers’ compensation benefits or prevents someone from receiving benefits to which they might be entitled. Payments made for workers’ compensation benefits, if stemming from fraud, divert funds from our classroom. Any suspicion of workers’ compensation fraud will be investigated. The information reported is confidential. Suppose the activity rises to the level of fraud. In that case, it will be reported to the State of California Department of Insurance and the Los Angeles City District Attorney’s office, as state law requires.

        

             LAUSD Workers' Compensation   

                                       

     

                                                 Sedgwick                                       

               

                     Office of Inspector General           

     

  • Overview

     
    Workers' Compensation fraud and abuse cost the District money that could be used for other purposes such as textbooks and supplies. It is every District employee's responsibility to protect the District's assets by reporting suspected fraud.

    WHAT IS THE PENALTY FOR COMMITTING WORKERS' COMPENSATION FRAUD?
     
    Every person who violates subdivision (a) shall be punished by imprisonment in a county jail for one year; or, pursuant to subdivision (h) of Section 1170 of the Penal code, for two, three or five years; or, by a fine not exceeding one hundred fifty thousand dollars ($150,000.00) or double the value of the fraud, whichever is greater; or, by both that imprisonment and fine. Restitution shall be ordered, including restitution for any medical evaluation or treatment services obtained or provided.
     
    SPECIAL INVESTIGATION UNIT 
     
    The LAUSD Workers' Compensation program has a Special Investigation Unit staffed by experienced professionals to conduct investigations into the validity of claims. The SIU routinely conducts the following: 
    1. Reviews all workers' compensation claims where an employee has lost time from work for potential fraud or abuse;
    2. Investigates all reports of suspected fraud or abuse; and,
    3. Refers suspected fraud to the local District Attorney and State Department of Insurance, as required by law.
                      
     
     
     Report suspected workers' compensation fraud and abuse to
    the Workers' Compensation Special Investigation Unit (SIU) at 866.247.2287 x79271
    or the Office of the Inspector General (OIG) Fraud Hotline at 213.241.7778