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What does a workers’ compensation investigation involve?

On Behalf of | Sep 15, 2023 | Workers' Compensation |

Suffering a workplace injury can take a huge toll on your life. Aside from being unable to work, you might face high medical costs, lengthy treatments and a long road to recovery.

You can file a workers’ compensation claim in hopes of receiving benefits that cover your expenses until you can work again. Workers’ compensation benefits can sometimes amount to thousands of dollars.

The purpose of investigations

Employers and insurance companies know this, and they may initiate a workers’ compensation investigation of your claim.

When you are truly injured, this could seem unfair or spiteful, but unfortunately some people take advantage of the system and file fraudulent workers’ compensation claims. This is the reason behind these investigations.

Learning that your workers’ compensation claim is being investigated will likely cause you stress and anxiety, worrying that the slightest word or action could result in a denial of your benefits.

Common types of workers’ compensation fraud

The investigator is looking for evidence of fraud, which means you have intentionally lied to obtain workers’ compensation benefits. Some common examples of fraud include faking an injury or illness, secretly working while still collecting benefits, pretending you are still injured when you are not or claiming an injury is work-related when it is not.

A workers’ compensation investigation is launched when the claims administrator who reviews your claim suspects fraud. The insurance company then uses a private investigator or someone within the company to investigate.

What happens during the investigation

There are many different methods the investigator uses to find evidence of fraud. These include conducting video or online surveillance and/or interviewing you and your family, friends or co-workers.

Yes, this means they will look at your social media posts. It is best to simply stay off social media when you are receiving benefits, since many innocent posts could be misinterpreted and appear to be evidence of fraud.

Additionally, pay attention to your actions during the investigation. Assume that an investigator is always watching you. When you speak with the investigator, give consistent answers and act carefully.

If you do find yourself charged with workers’ compensation fraud, there are ways to refute the allegations and defend yourself.