Colorado Workforce by the Colo. Dept. of Labor and Employment

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To Report Workers' Compensation (WC) Fraud:

To provide information about a Workers' Compensation (WC) claimant receiving compensation inappropriately (i.e. working, exaggerating injuries, not injured at work), please complete the following information and click on the "submit" button at the bottom of this form.

Who is committing Workers' Compensation Fraud?

What is their street address?

City State Zip

What is their telephone number?

What is their Social Security number? (optional)

What is their date of birth?

Explain briefly how they are committing fraud:

When did the alleged fraud start?

If they are working, what is their employer's name, address and telephone number?

Employer's name

Employer's street address

City State Zip

Employer's telephone number

What is your name, address, and telephone number? (optional)

Keep my name and information confidential : Yes No

Name

Street address

City State Zip

Telephone number

Email address

We will review the necessary files and records in light of the information you provided, to determine the most appropriate action. If you provided information about yourself, you will be contacted again only if it is necessary to complete our review or investigation.

If your concern involves PAYMENT OF WAGES, OR ISSUES OF EMPLOYMENT, please contact the Colorado Department of Labor and Employment, Division of Labor at www.coworkforce.com/LAB

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