Insurance fraud is pervasive. According to the California Department of Insurance, Insurance Fraud exceeds over $15 billion each year.   In 2023-24, the California Department of Insurance received over 12,000 suspected fraudulent insurance claims here in California.  When insurance fraud is committed by those who use deceit for personal gain, we all pay higher premiums and higher costs for goods and services as a direct result.  

Our Continued Commitment

The San Mateo County District Attorney's Insurance Fraud Unit is comprised of four experienced prosecutors, six District Attorney inspectors and an investigative paralegal who are not only committed to diligently investigating and prosecuting insurance fraud but also to taking a proactive stance to prevent fraud by offering training to employers, unions, workers' compensation carriers, special investigations units and third-party administrators. 

Insurance companies are required by law to report suspected fraudulent claims. A significant number of fraudulent claims, however, do not get reported mainly because a person does not know that the act committed was a crime and/or does not know to whom to report the crime.  Please contact us or the California Department of Insurance if you believe insurance fraud has been committed. If you wish to remain anonymous, please provide as much suspect information as possible, and if you know, provide the name of the insurance carrier and/or employers. 

Contact Us

San Mateo County District Attorney's Office 
Bureau of Investigations 
Attn: Chief Inspector 
500 County Center 3rd Floor 
Redwood City, CA 94063 
Phone: (650) 363-4883 
Fax: (650) 363-4873 
Send email 

  
Or you can contact: 

California Department of Insurance 
Silicon Valley Regional Office 
18425 Technology Drive 
Morgan Hill, California 95037 
Phone: (408) 201-8800 
Fax: (408) 779-7299 

Types of Insurance Fraud

Insurance fraud can be committed in various ways but at the core in every case is a "Material Misrepresentation," that is, a false statement made to gain a benefit under an insurance policy. 

Worker’s Compensation Fraud  

  • Applicant Fraud: An employee makes a false statement(s) during the course of a workers' compensation claim in order to get benefits, such as temporary total disability payments and/or medical benefits. 

  • Employer Premium Fraud: An employer makes a false statement(s) in order to reduce workers' compensation premium. Typical lies include: (1) Misclassifying employees; (2) underreporting the number of employees; (3) Underreporting payroll; (4) reporting actual employees as independent contractors; (5) doing business under another name to avoid a higher rate; (6) Concealing employee injury from the insurance company  Employers who commit premium fraud have an unfair business advantage over their competitors since their reduced premiums allows them to place lower bids on projects than their competitors who are paying higher premiums. 

  • Employer Dissuasion: An employer makes a false statement(s) in order to deny workers' compensation benefits to an employee or prevent an employee from filing a claim. 

Claim Denial Fraud by Insurance Company: An insurance company makes a false statement(s) in order to deny workers' compensation benefits to an employee or prevent an employee from filing a claim. 

Medical /Health Care Provider Fraud: A doctor, chiropractor or other health care professional who bills for service not rendered, "up code" (billing for services that were more expensive than those actual provided), and who participate in an organized ring by paying others to recruit patients.  Medical Provider Fraud can occur under workers' compensation, auto insurance or any kind of health insurance policies. 

Auto Insurance Fraud: A person made a false statement(s) to an insurance company to obtain a benefit under an auto policy. For example: 

  • Falsely reporting that the insured car was stolen, burned, vandalized, etc. 

  • Falsely reporting the date and time of an auto accident in order to obtain coverage under a lapsed policy 

  • Submitting forged, altered, counterfeit receipts, invoices, etc. in support of damages 

  • Staging car accidents and reporting alleged sustained injuries 

  • Auto body repair shops falsely claiming repair work was done 

Penalty

Insurance Fraud is a penalty with a maximum penalty of 5 years in state prison and depending upon the type of fraud, a fine ranging from $50,000 to 150,000.  Actual Restitution will also be pursued and ordered as appropriate.