TABLE OF CONTENTS
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
(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'
(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
(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
(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
(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).
present a bill or statement for the payment for medical services that were not
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
(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
122 S. Michigan Ave FL 19
Chicago, IL 60603-6137
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