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.

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(*) Entry Required

1. * Name of the company or person you are reporting.
   
2. Address, city, state, and telephone number of the company or person.
   
   Character Count: (Max 200, remaining 200.)
3. If you are reporting an individual, do you know the social security number, race, date of birth, or approximate age?
   SS#:     
   Race:    
   DOB:    
   Age:     
4. When was the person you are reporting injured, what type of injury does he/she have, and to what part of the body?
   
   Character Count: (Max 200, remaining 200.)
5. Who is the person you are reporting currently working for? Please include address, city, state, and telephone number.
   
   Character Count: (Max 200, remaining 200.)
6. * Describe why you think the person is committing workers' compensation fraud.
   
   Character Count: (Max 200, remaining 200.)
7. If you wish to be contacted by this office, please give us your name, address, telephone number, and/or email address.
   
   Character Count: (Max 200, remaining 200.)
   
   E-Mail:
8. Any additional information you would like to submit.
   
   Character Count: (Max 200, remaining 200.)

If you have any other questions, please email WCFraud@lwc.la.gov
or call toll-free 1-800-201-3362.