Special Investigation Unit

Taking the Lead in the Fight Against Fraud

State Fund is an industry leader in fighting workers’ compensation fraud. Our Special Investigation Unit (SIU) has been instrumental in both the prevention and prosecution of fraudulent activity.

Fraud Fighting Efforts

SIU coordinates anti-fraud programs, produces video programs to help combat fraud, and conducts training for State Fund employees. SIU also reports cases of suspected fraud to the California Department of Insurance’s Fraud Division and district attorneys throughout the state. These government agencies investigate and prosecute fraudulent activities. State Fund is also a member of California's Fraud Assessment Commission and participates in other anti-fraud committees.

The California State Legislature defined workers' compensation fraud in 1991 and imposed penalties on those involved in fraudulent activities. The legislation, combined with insurance industry programs, brought a dramatic new focus to fighting fraud. This has resulted in many arrests and convictions. State Fund continues its efforts by fighting all types of workers’ compensation fraud, including:

• Premium Fraud
• Claims Fraud
• Provider Fraud (medical, legal, and other service providers)

A Team Effort

Once fraud is suspected, State Fund's internal resources come into play. These resources include a network of frontline staff, designated fraud liaisons in each State Fund District Office, fiscal and data processing employees, underwriting specialists, and clerical support staffs.

Tips about suspected fraud come from many different sources, for example:

• A call placed to State Fund's toll-free Fraud Hotline, or to a local State Fund office, or by mail to:

  Special Investigation Unit
  900 Corporate Center Drive, 2nd Floor
  Monterey Park, CA 91754

• Restitution payments should be send to:

  State Compensation Insurance Fund
  Attention: Credit Investigation and Bankruptcy Unit / Restitution
  5860 Owens Drive, 4th Floor
  Pleasanton, CA 94588-3900

• A claims representative may notice something unusual about a claim that warrants further investigation.
• An outside caller may draw attention to an employer who is paying his employees in cash and not reporting it as payroll for purposes of premium calculation.
• Evaluation of State Fund data may draw attention to repeated, unusual, or suspicious billings from vendors.