Insurance Fraud

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Insurance fraud is a felony.

Those who commit fraud are criminals.

Easy money? Hard time. Insurance fraud is a felony.
5 years in state prison. $50,000 fine.

The California Department of Insurance Fraud Division together with district attorneys, insurers and employers will investigate and prosecute persons suspected of insurance fraud crimes.

What’s the big deal?

The high cost of doing business in California includes the high cost of insurance fraud.  Some people see nothing wrong in committing insurance fraud.

      • “Insurance premiums are too high. I deserve to get something back.”
      • “My employer’s insured; he can afford to cover this.”
      • “Insurance companies are big organizations. What can it cost for one measly little claim?”
      • “Everybody does it. What’s the big deal?”

The “BIG DEAL” is that widespread insurance fraud ultimately translates into higher premiums, which can result in elevated costs of goods and services, and, ironically, layoffs, plant closures, and out-of-state relocation.

Insurance fraud is a “growth industry” costing Californians billions of dollars annually. Fraud is about big money, and as long as that money is out there, someone will be after it.

  • From 10% to 30% of the $10 billion in workers’ compensation claims filed annually in California are fraudulent, costing California businesses and consumers a reported $1 billion to $3 billion per year. Both medical mills and legal mills specialize in recruiting so-called patients to bilk insurance carriers for fraudulent or non-existent services.
  • An employee knowingly files a claim for an injury that did not occur at all, or for an injury that did not occur on the job or in relation to the job.
  • An employee receives total temporary disability benefits as a result of lying about outside employment, re-employment, or their ability to work. A medical or legal provider bills for services that were never provided.
  • A medical or legal provider regularly bills for more time than was actually spent seeing a client or for more services than were actually provided.
  • Kickbacks are given to insurance representatives or employees as an inducement or reward for the referral or settlement of a workers’ compensation claim.

Every insured Californian pays from $200 to $250 a year for inflated and fraudulent auto claims (according to a Rand Corporation study).

Auto Property Fraud:

  • False reports that parts of vehicles have been damaged or lost
  • False reports of vehicles stolen or vandalized
Staged Accidents:
  • Creation of accidents that exist only on paper
  • Preplanned maneuvers that set up an innocent party for a rear-end collision
  • Report suspected fraud involving recorded real estate documents
  • The California Legislature has placed an emphasis on fraud against individuals where residences are in danger of, or are in, foreclosure
  • False health-related treatment claims
  • Other medical/legal provider claims
  • False life insurance claims
  • Property claims, including arson

Report Suspected Fraud

The County of El Dorado District Attorney’s Office acts as a hub of information to refer residents to appropriate regulatory agencies for various complaints. Often complaints tend to be civil in nature but the complainant still wishes to make a formal complaint. This is your opportunity. To report a suspected violation of these laws call the Fraud Hotline @ (866) 629-0171 or complete the following form:

Please submit the completed form to:
County of El Dorado District Attorney
778 Pacific Street
Placerville, CA 95667
Attn: Fraud Unit