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Fraud  

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Overview

It is illegal for anyone—a worker, employer, insurance carrier, medical provider—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;
  • Intentionally present a bill for medical services that were not provided.
  • 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 crime, ranging from a misdemeanor to a Class 1 felony. The guilty party may be sent to jail, and shall be required to pay complete restitution, including court costs and attorney fees.

Contact information

To report on a potentially fraudulent situation, contact:

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

Chicago Office:

    122 S. Michigan Ave FL 19 
    Chicago, IL 60603-6137

Springfield Office:

    320 W. Washington St.
    Springfield, IL 62786

To report on a potentially fraudulent situation involving a State of Illinois employee, call the State's risk management firm, TriStar, at 855-495-1550.

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.

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. 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
312-814-5394 or toll-free 877-923-8648