Workers' Compensation Fraud Reporting Form
If you would like to report someone
who you think may be committing
workers' compensation fraud, complete
the information below and press the
Submit button. You may
choose to submit this information
anonymously, however, this may limit
the scope of the investigation.
If you would like to report workers' compensation fraud in a state
other than Louisiana, please select the desired state's workers' compensation website .
(
* ) Entry Required
*
Name of the company or person you are reporting.
Address, city, state, and telephone number of the company or person.
Max 200, remaining 200. )
If you are reporting an individual, do you know the social security number,
race, date of birth, or approximate age?
SS#: Race: DOB: Age:
When was the person you are reporting injured, what type of injury does
he/she have, and to what part of the body?
Max 200, remaining 200. )
Who is the person you are reporting currently working for? Please include
address, city, state, and telephone number.
Max 200, remaining 200. )
*
Describe why you think the person is committing workers' compensation fraud.
Max 200, remaining 200. )
If you wish to be contacted by this office, please give us your name,
address, telephone number, and/or email address.
Max 200, remaining 200. )
E-Mail:
Any additional information you would like to submit.
Max 200, remaining 200. )
If you have any other questions, please email WCFraud@ldol.state.la.us
or call toll-free 1-800-201-3362.
