How Workers Comp Investigations Work

In most cases, workers comp benefits can amount to thousands of dollars. It’s no surprise then that some bad eggs will take advantage of the system. To try and prevent this, employers and insurance companies often conduct workers comp investigations, particularly on dubious claims.

If you’re someone who is truly injured, this might seem unfair. Especially since employers and insurance companies are known to deny workers comp claims at the slightest doubt. It can also be extremely stressful as one wrong move could cost you your benefits. But due to the rising number of workers comp fraud cases over the past years, it can’t be helped.

So how do you pass a workers comp investigation?

The best strategy is to be prepared. If you know how workers comp investigations work, you’ll know what to expect and how to deal with it. This lessens the risk of doing things that might jeopardize your claim.

To help you out, here are some of the things you need to know about workers comp investigations.

What Counts as Workers Comp Fraud?

In a nutshell, workers comp fraud is when an employee willfully lies to claim workers comp benefits. The most common examples of which are:

  • faking an injury or illness
  • working while collecting benefits
  • exaggerating injuries to collect more money or prolong benefit payments
  • claiming a non work-related injury as work-related

As mentioned, workers comp investigations are conducted primarily to prevent workers comp fraud. But even if your claim is legit, some unintentional actions may give the impression of fraud. So it’s important that you know what counts as such to avoid being charged as a fraudster.

The Workers Comp Investigation Process

When you file a workers comp claim, a claims administrator will review the circumstances of your injury. Depending on the evidence presented, they may approve or deny it. But in some cases, they may suspect fraud. That’s when a workers comp investigation is launched.

Most insurance companies hire workers comp investigators. Others have an in-house team dedicated to investigating potential frauds.

A tab on a file that says 'investigations'

Workers comp investigators use a variety of methods to gather evidence. The most common of which are:

  • Online Surveillance. They will check your social media posts, status updates, tagged photos, and everything they can uncover about you online.
  • Video Surveillance. Workers comp investigators are often portrayed hiding out in a car while holding cameras. That’s not far from reality. It’s not uncommon for workers comp investigators to follow you around recording your every movement.
  • Interviews or Other Forms of Direct Communication. Workers’ comp investigators will sometimes call you or knock at your door to ask questions. You’re not legally required to answer them but denying them an interview won’t help your case.
  • Interviews or Conversations With Your Relatives, Friends, or Co-workers. The people around you are also excellent sources of information about your injury. So expect workers’ comp investigators to also ask them questions.

During the interview, some of the questions you might be asked are:

  • a description of the accident in detail
  • the location of the accident
  • who are the witnesses (if any)
  • a description of your work and duties
  • the nature of your injury
  • if company protocols were followed
  • if you’ve ever sought workers’ compensation before
  • if your job can be modified
  • what actions could have prevented the accident

If the workers’ comp investigator determines that your claim is fraudulent, your claim will obviously be denied. But you can still file an appeal with your claims administrator. If that doesn’t work, you can take your case to court.

How Long Does a Workers Comp Investigation Take?

Most states require employers and insurance companies to decide on a workers’ comp claim within a reasonable amount of time. That’s why workers’ comp investigations often last only for a few days to several weeks. Some states also enforce strict timetables for this type of investigation – usually between 14 to 30 days. If the insurance company needs more time to gather evidence, they may also ask for an extension.

What To Do When Your Claim Is Investigated

If your claim is being investigated, it’s important to be constantly mindful of your actions. Always assume that a workers comp investigator is watching you.

For example, if you’re claiming back pain, avoid posting on social media photos of you doing strenuous activities. It might be that you’re on pain meds when the photo was taken. But it wouldn’t matter to a workers comp investigator. If they see you doing things you shouldn’t be able to, your claim might be labeled as fraudulent.

Do You Need a Lawyer?

Many insurance companies are known to use workers comp investigations to scare off claimants. Since investigations can take time, many tend to just drop their claim or settle for a much lesser amount.

If you got charged with workers comp fraud,  they may also pursue a case against you. This is why you need an experienced workers comp lawyer like Victor Malca fighting for your rights. He has been helping injured workers in Florida for almost three decades. He can help refute fraud allegations and defend your claim in court too. Call us now for a free consultation.

VICTOR MALCA LAW – A TRUSTED NAME IN FLORIDA

Victor Malca P.A. has over 25 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success in fighting for his clients puts among the most trusted workers’ compensation lawyers in Florida. Our area of expertise is in representing injured workers on compensation benefit cases and disabled individuals claim social security disability benefits.

Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida. Book a free consultation today.

Judy Ponio is a writer for Victor Malca LawAbout The Author

Judy Ponio is a writer for Victor Malca Law P.A. and enjoys helping people with questions about social security, workers compensation, and other serious matters involving people’s livelihood. She is not an attorney and her writing should not be considered legal advice.

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