Workers' Compensation Fraud Investigations

If a person willfully makes a false statement or representation material to a Workers' Compensation claim for the purpose of obtaining benefits, payments, compensation, or awards such person commits a class 5 felony, punishable as provided in §18-1-105 C.R.S.

To be convicted of Workers' Compensation fraud in Colorado, it must be proved that material false statements or representations were made.

In order for the Workers' Compensation Fraud Investigation Unit to build a prosecutable case, we must be able to prove:

  1. the statements or representations made are false
  2. claim decisions were made based on false statements or representations material to the claim
  3. the statements or representations were made with intent to defraud

Recognizing Fraud

Possible "red flags" of fraudulent behavior may include:

  • A "Monday morning" injury - The injury is reported early on the first work day of the week.
  • Injury is not witnessed
  • Claimant is disgruntled or has been reprimanded
  • There is material misrepresentation of facts
  • Claimant malingers - Prolongs recovery and/or exaggerates symptoms.
  • Services billed seem inappropriate for type of injury

Report Fraud

​Resources

Colorado Workers' Compensation Act, §8-43-402 C.R.S.


Contact Us

Division of Workers' Compensation | 303-318-8700 |