Fraud

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

Pursuant to Section 25.5 of the Illinois Workers’ Compensation Act,

(a) It is unlawful for any person, company, corporation, insurance carrier, healthcare provider, or other entity to:

1.  Intentionally present or cause to be presented any false or fraudulent claim for the payment of any workers' compensation benefit.
2. Intentionally make or cause to be made any false or fraudulent material statement or material representation for the purpose of obtaining or denying any workers' compensation benefit.
3.  Intentionally make or cause to be made any false or fraudulent statements with regard to entitlement to workers' compensation benefits with the intent to prevent an injured worker from making a legitimate claim for any workers' compensation benefits.
4. Intentionally prepare or provide an invalid, false, or counterfeit certificate of insurance as proof of workers' compensation insurance.
5.  Intentionally make or cause to be made any false or fraudulent material statement or material representation for the purpose of obtaining workers' compensation insurance at less than the proper rate for that insurance.
6. Intentionally make or cause to be made any false or fraudulent material statement or material representation on an initial or renewal self-insurance application or accompanying financial statement for the purpose of obtaining self-insurance status or reducing the amount of security that may be required to be furnished pursuant to Section 4 of this Act.
7. Intentionally make or cause to be made any false or fraudulent material statement to the Department of Insurance's fraud and insurance non-compliance unit in the course of an investigation of fraud or insurance non-compliance.
8. Intentionally assist, abet, solicit, or conspire with any person, company, or other entity to commit any of the acts in paragraph (1), (2), (3), (4), (5), (6), or (7) of this subsection (a).
9. Intentionally present a bill or statement for the payment for medical services that were not provided.

For the purposes of paragraphs (2), (3), (5), (6), (7), and (9), the term "statement" includes any writing, notice, proof of injury, bill for services, hospital or doctor records and reports, or X-ray and test results.

(820 ILCS 305/25.5)

Violations of the Act range from a misdemeanor to a Class 1 felony and may result in imprisonment, civil liability, and or an order to pay restitution and attorney's fees and court costs.

To report on a potentially fraudulent situation, contact:

Illinois Department of Insurance
Workers' Compensation Fraud Unit
DOI.WorkCompFraud@illinois.gov
toll-free 877-923-8648

To report on a potentially fraudulent situation involving a State of Illinois employee, call the State's risk management firm, Gallagher Bassett Claims 800-452-5452.

You must provide enough specific information, including your name and contact information, to cause the unit to open an investigation. 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.

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. Insurance fraud information including annual reports and convictions may be found on the Illinois Department of Insurance website.

If you have questions about the annual report, contact the Illinois Department of Insurance fraud unit at 312-814-5394 or toll-free 877-923-8648.