DA promotes comp compliance

The San Diego District Attorney’s Workers Compensation campaign nears its conclusion in the South County and heads to North County in a few months.

The district attorney’s informational campaign has been presented to the Chula Vista and National City Chambers of Commerce and the Third Avenue Village Association.

Jesse Navarro, public affairs officer for the district attorney, said the purpose of the workshop is to inform employers and employees of their Workers Compensation rights and to prevent insurance fraud.

“(The campaign is) so the business community is well informed in regards to their rights and responsibilities but also consequences,” he said. “This is all about prevention, this is all about informing and educating our business community throughout the entire county of San Diego.”

Navarro said Workers Compensation protects employers and employees against each other in the event of an injury.

He said any company, whether it’s a small mom and pop business or a large company with thousands of employees, is required by state law to offer their employees Workers Compensation. He said the instant an employer has one employee, it must have Workers Compensation. If not, they are punishable by law, he said.

Depending on the severity of the crime, punishment can include a fine, prison time or both.

Navarro said the District Attorney’s Office has prosecuted both employers and employees because of insurance fraud.

Navarro said the most typical form of employers committing insurance fraud occurs when they do not offer Workers Compensation, which in itself is a misdemeanor.

“The District Attorney’s Office wanted to make sure they (employers) understand what their obligation as an employer is,” Navarro said. “What are their responsibilities in order to protect their employees, whether they have one employee or thousands of employees.”

He said business owners usually don’t have Workers Compensation because they are uninformed about the law or simply want to break the law to save their business money.

Another example of fraud, Navarro said, is when a company does offer Workers Compensation but does not include all of their employees, just offers it to the low risk employees like clerical employees, when it is the employees out in the field who are more susceptible of injury and nned to have Workers Compensation available to them.

Navarro said often employers try to work the system this way so the employer does not have to pay a higher premium on insurance for their employees who have a higher risk of injury.

A misdemeanor crime turns into a felony when an employer who offers Workers Compensation convinces an employee injured on the job not to file for Workers Compensation, Navarro said.

“They are basically denying that employee his right of being compensated and receiving treatment while he’s out on injury leave,” Navarro said.

Navarro said fraud doesn’t just happen with employers; employees have also been prosecuted for cheating to get Workers Compensation.

John Lopez, manager at J&C Carpet Company, recently learned about the district attorney’s workshop and invited the agency to his business to speak to his employees.

“We certainly believe in educating ourselves and our employees on what Workers Compensation is all about,” Lopez said.

Lopez said the campaign helps by providing details and answering any questions his employees may have.

Navarro said the typical thing employees do to commit fraud is to fake an injury.

Another example of employee fraud is when an employee who isn’t very good at his job is about to get terminated or laid off and fakes an injury that wasn’t related the job, Navarro said.

Navarro said an employee faking an injury that never happened is also a common case of fraud.

He said proving fraud in these cases is very difficult because proving an employee faked an injury is very hard to do.

Another example of insurance fraud by an employee is when they exaggerate an injury, Navarro said.

In this case, an employee is supposed to come back to work within days or weeks after an injury, but they keep exaggerating the extent of their injury to delay returning to work, Navarro said.

Navarro said another common occurrence of an employee illegally using Workers Compensation is when they are injured while on the job and receiving Workers Compensation but claim they are not able to work, yet they work for the competition or another company as they are getting paid cash.

Navarro said the ratio of employers to employees committing insurance fraud is about 50-50.

Of all fraud cases, Navarro said, Workers Compensation is the second most investigated behind tax evasion.

According to the district attorney, in the last three years there have been 293 convictions in Workers Compensation fraud cases against employers and employees.

Fifty-seven of those have been employees who were prosecuted for making false or exaggerated work injury claims.

The rest were employers and/or high level employees who aided and abetted an employer in committing fraud.
Navarro said he is hoping the workshop educates the business community so that no one will go to jail.

“We don’t want to prosecute employers, we don’t want to prosecute employees,” he said.