Workers Compensation Fraud Unit
The Workers' Compensation Fraud Unit (WCFU) investigates reports of workers' compensation fraud and may refer cases for prosecution to the Illinois Attorney General or the county State's Attorney.
Report potential workers' compensation fraud:
Workers' Compensation Fraud Unit
122 S. Michigan Ave., 19th Floor
Chicago, Illinois 60603
Report potential workers' compensation fraud involving a State of Illinois employee:
Please 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.
Illinois Workers' Compensation Act overview:
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.
IDOI Brochure - Workers' Compensation Insurance Compliance