The presence of a new district attorney has given hope to antifraud investigators who are waiting to see if a changing of the guard will mean more fraud prosecutions in Los Angeles County.

John P. Kamin

Investigators, adjusters and claims managers who work with defendants’ Special Investigation Units are optimistic that the November 2024 election of L.A. County District Attorney Nathan J. Hochman will result in more prosecutions of workers’ compensation fraud.

If you haven’t had the pleasure of talking with an SIU staffer about the odds of prosecuting a slam dunk fraud case in L.A. County for the last few years, let me be the bearer of bad news: The odds of getting prior D.A. George Gascon’s office to pick up the case were slim to none. (That's me paraphrasing multiple longtime SIU professionals.)

Those same SIU folks would also point out that neighboring counties did not have that problem. Go to Orange County, and they prosecute fraud. San Diego County? They prosecute fraud, too. Northern California? Same story — they are interested in prosecuting fraud.

For reasons unknown to anyone and everyone, the L.A. County D.A.’s office just didn’t seem to care about fraud.

So when Gascon lost the 2024 election to Hochman, eyes and ears perked up in SIUs across the state. Suddenly, there is new hope that L.A. will no longer be the outlier, but rather rejoin its brethren in prosecuting the bad guys.

That remains to be seen, as it’s still early in Hochman’s tenure. But at least there’s hope.

If you suspect fraud in your case

One thing I picked up on years ago at a fraud prevention conference was that:

• Many adjusters make the mistake of focusing on how much money was spent on a claim.
• They ignore whether there are clear material misrepresentations of fact and fraudulent material statements for the purpose of obtaining workers’ compensation benefits.

A simpler way to say it is: If you want a D.A. to even sniff your case, you had better have crystal clear evidence of the applicant telling black-and-white lies that are easily disproven. Why is that?

Keep in mind that when these cases go before a jury, the jurors tend to take a sympathetic view of the criminal defendant — the applicant. Therefore, the better fraud cases are the ones that feature obvious lies, evidence to show that those statements are lies and that those lies were made in an attempt to get more workers’ compensation benefits.

There are many strategies to achieve that goal. For instance, one common lie is that the applicant cannot lift a certain weight due to his work injury. Then, surveillance video shows him lifting more than that weight numerous times on multiple days. Another is lying about preexisting injuries to the same body part, only for subpoenaed records to prove the exact opposite.

A case with a minor misstatement impacting only one of these examples isn’t likely to move the needle. But if you have 10-20 examples of numerous misstatements, that is something worth running up the SIU ladder so investigators can put together a well-organized referral to your local district attorney’s office.

John P. Kamin is a workers’ compensation defense attorney and partner at Bradford & Barthel’s Woodland Hills location. He is WorkCompCentral's former legal editor. This entry from Bradford & Barthel's blog appears with permission.