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CDI Comments On Fraud Referral Trigger

The California Department of Insurance Enforcement Branch has decided against rolling back the suspected workers’ comp fraud referral standard. Special investigations units (SIUs) are required to complete fraud investigations before making a report to the Department. The agency considered returning to the prior standard, which required referrals within 60 days of the carrier having a … Read More »

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Appeals Court Approves Recovery In Workers’ Comp Fraud Case

The First District Court of Appeal says a trial court was correct in allowing the Receiver in a workers’ comp premium fraud case to collect on the proceeds from a bankruptcy sale of a seized property rather than allowing the money to go to another creditor. The action was taken under Penal Code section 186.11, … Read More »

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Anti-Fraud Commission Approves One-Time Funding Shift

The California Fraud Assessment Commission voted for a one-time change to the formula for splitting the $90 million California employers give county district attorneys and the California Department of Insurance’s Fraud Division. The commissioners were unsure if Insurance Commissioner Ricardo Lara was asking for a permanent change to the formula or only a change for … Read More »

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Fight Over Fraud Funds

Insurance Commissioner Ricardo Lara is asking the California Fraud Assessment Commission to approve a change to the formula that splits employers’ assessment dollars between local District Attorneys and the Department’s anti-fraud unit. The proposal would redirect millions of dollars from the DAs to the Department of Insurance. The DAs are pushing back against the effort. … Read More »

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Reformulated Fraud Assessment Commission

The California Department of Insurance’s Fraud Assessment Commission is holding a special meeting tomorrow to consider a major shift in where and how the dollars are distributed in the state’s fight against workers’ comp fraud (see related item on page 1). Five commissioners reviewed the proposal at the Commission’s January 10th meeting, but it is … Read More »

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SIU Fraud Reporting Rollback

The California Department of Insurance is floating the idea of undoing a change to the reporting rules for special investigations units (SIUs) amid concerns that the current standard undermines some prosecutions. The Department backed a change to the insurance code to get more complete reports of suspected fraudulent activity, but there are now new issues. … Read More »

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DWC Says Two Claims Shops Failed Audits In 2022

The Division of Workers’ Compensation’s annual report about its audits of workers’ compensation claims adjusting locations shows it inspected 48 shops and that 46 were able to pass the audit at the initial stage. Of the two shops that failed to meet the Profile Audit Review (PAR) standard, one passed a more in-depth Full Compliance … Read More »

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Bureau Targeting Restaurants for Inspection Audits

The Workers’ Compensation Insurance Rating Bureau will conduct targeted inspection audits on the food and beverage service industry next year. The audits will target many of the 16,000 experience-rated risks currently in the 9079 classification. That, as it prepares to deconstruct the 9079 Restaurants or Taverns classification into six new classes effective this year on … Read More »

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