• State Disability Insurance (SDI) defines insurance fraud as any claim for SDI benefits where a person, alone or in collusion with any other person, willfully makes a false statement or misrepresentation, or withholds a material fact for the purpose of collecting SDI benefits. For example, filing a claim with SDI for an injury or illness that does not exist or helping another person file a false claim is insurance fraud.
  
  An individual who commits fraud against the SDI program may be disqualified from receiving further benefits for the current claim and future claim(s), and may be liable to repay a 30 percent penalty in addition to the overpayment amount. Any person who falsely certifies to his/her medical condition or to the medical condition of any other person is subject to an additional 25 percent penalty on any overpayment made due to the false medical. If criminally prosecuted, the individual may face additional penalties.

• A false statement is something you tell SDI, verbally or in writing, that is not true. A misrepresentation is telling SDI something that appears to be true, but that gives SDI an untrue or misleading idea. A material fact is critical information that SDI must have to make a correct determination on your claim for benefits.

• We will always consider any and all information you give us. To avoid potential overpayments or other claim problems, it's always best to answer all questions completely and honestly, and to let SDI know about any situation you think might affect your benefits. If you don't understand the application, or don't know if some information is important, contact SDI for assistance or clarification.

• SDI has identified risk areas and developed processes to minimize them, trained staff on fraud awareness, improved our method of reviewing medical claims, hired specialized fraud detection staff throughout the state, pursued legislation to make fraud penalties more severe, and added automated systems which are better able to detect and deter fraudulent activity. Through these actions, we will continue to provide affordable benefits by maintaining low premium costs.

• If you suspect or know of SDI fraud, contact SDI or call the EDD Fraud Tip Hot-Line at 1-800-229-6297. Anonymous calls are accepted.

For more information please call SDI at 1-800-480-3287 or 1-866-658-8846 (En Español)