TABLE OF CONTENTS

Overview
Contact information
2005 law on workers' compensation fraud
WC Fraud Unit's accomplishments

Overview

It is illegal for anyone—a worker, employer, insurance carrier, medical provider, etc.—to intentionally do any of the following:

• Make a false claim for any w.c. benefit;

• Make a false statement in order to obtain or deny benefits;

• Make a false statement in order to prevent someone from filing a legitimate claim;

• Make a false certificate of insurance as proof of insurance;

• Make a false statement in order to obtain w.c. insurance at less than the proper rate;

• Make a false statement in order to obtain approval to self-insure or reduce the security required to self-insure;

• Make a false statement to the state’s fraud and noncompliance investigation staff in the course of an investigation;

• Help someone commit any of the crimes listed above;

• Move, destroy, or conceal assets so as to avoid payment of a claim.

A “statement” includes any writing, notice, proof of injury, or any medical bill, record, report, or test result. 

Anyone found guilty of any of these actions is guilty of a Class 4 felony, punishable by 1-3 years imprisonment and a $25,000 fine. The guilty party shall be required to pay complete restitution, and may be found civilly liable for up to three times the value of benefits or insurance coverage that was wrongfully attained.

Contact information

You must submit complaints in writing.  You must identify yourself and, at some point, the person you are reporting will be given your name. You must provide a written complaint, provide enough information to cause the unit to open an investigation, and be prepared to testify.  Anyone who intentionally makes a false report is guilty of a Class A misdemeanor, punishable by up to 12 months imprisonment and a $2,500 fine.

Francis "Buzz" Walsh
Workers' Compensation Fraud Unit
Illinois Department of Insurance
francis.walsh@illinois.gov
312/636-9457
toll-free 877/923-8648
320 W. Washington
Springfield, IL  62786

WC Fraud Unit's accomplishments

The Illinois Department of Insurance WC Fraud Unit investigates cases, while the Illinois Attorney General or the county State's Attorney decides whether to prosecute.  As with any new venture, it takes time for people to identify the best way to coordinate their efforts.  And it takes time for cases to work through the court system.  Convictions are starting to come in.  To see the list of convictions, click here. 

2009 annual report

2008 annual report

2007 annual report

If you have questions about the annual report, contact Adam Monreal at the Illinois Department of Insurance (312/814-1323 or toll-free 877/923-8648).