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Workers’ Compensation Fraud Unit

By Christopher S. Crawford

Leading up to the passage of the recent Workers’ Compensation Reform Bill, many have commented that fraud provisions and prosecutions within the Act need to be tougher. Prosecutions for workers’ compensation fraud were specifically addressed the last time Workers’ Compensation Reform was passed in Illinois. The law provides that those who are found guilty of making a false claim for benefits are guilty of a Class 4 felony punishable by up to 3 years in prison. In addition, the guilty party will be required to pay restitution and any appropriate fines.

Reports of fraudulent activity may be made to the Workers’ Compensation Fraud Unit (WCFU). The WCFU collects information from the party making the report and then conducts an investigation. The case will then be referred to the Attorney General, or local State’s Attorney, once it is determined there is sufficient evidence of fraud. The Attorney General, or State’s Attorney’s, office will then issue an indictment.

Since 2007 there have been 21 criminal convictions under the fraud provisions of the Act. Keep in mind, there are approximately 45,000-50,000 worker’s compensation cases filed each year. Clearly, the fraud unit and its mission to maintain integrity in the system has room to grow.

The most recent data is from 2009. A total of forty-five cases were open during 2009, thirteen from the prior year and thirty-two in new referrals. It was determined that twenty-three of these cases involved fraud on the part of the claimants. Twelve claims were investigated while seventeen were dismissed due to insufficiency of evidence. There were six indictments and two convictions in 2009.

These numbers indicate that more needs to be done. As you can see from Chris Galanosaccompanying article summarizing reform efforts, the recent legislation calls for the implementation of a system of analytics to detect and prevent fraud. Reporting requirements on the incidents of fraud are also strengthened. Nevertheless, Respondents and attorneys must be aggressive in reporting instances of fraud to the WCFU. It is important to assemble the information evidencing the fraud and present it in a concise manner so the investigation will not be ignored. We remain prepared to assist our clients in this important cause.

Originally published in the Summer 2011 edition of Quinn Quarterly.