The presence of a new district attorney has given hope to anti-fraud investigators, who are waiting to see if a changing of the guard will mean more fraud prosecutions in Los Angeles County.
Investigators, adjusters, and claims managers who work with defendants’ Special Investigation Units (SIU) 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 a 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 L.A. County D.A. George Gascon’s office to pick up the case were slim to none. (That would be your humble blogger 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 former D.A. George Gascon lost the 2024 election to Nathan Hochman to be L.A. County District Attorney, 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 THE CASE YOU’RE DEFENDING
One thing your humble blogger picked up on years ago at a fraud prevention conference was that:
- Many adjusters make the mistake of focusing how much money was spent on a claim, and
- Ignore whether there are clear:
- material misrepresentations of fact for the purpose of obtaining workers’ compensation benefits
- 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, ie the applicant. Therefore, the better fraud cases are the ones that feature 1) obvious lies, 2) evidence to show that those statements are lies, 3) that those lies were made in an attempt to get more workers’ compensation benefits.
There are many strategies to achieve that goal, and we at the Law Offices of Bradford and Barthel can help. For instance, one common lie is saying that the applicant cannot lift a certain weight due to their work injury, then sub rosa video shows them 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 they can put together a well-organized referral to your local district attorney’s office.
Got a question about workers’ compensation defense issues? Feel free to contact John P. Kamin. Mr. Kamin is a workers’ compensation defense attorney and partner at Bradford & Barthel’s Woodland Hills location, where he monitors the recent legislative affairs as the firm’s Director of the Editorial Board. Mr. Kamin previously worked as a journalist for WorkCompCentral, where he reported on work-related injuries in all 50 states. Please feel free to contact John at jkamin@bradfordbarthel.com or at (818) 654-0411.
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