How Do Insurers Investigate a Workers’ Compensation Claim?

Though the vast majority of workers’ compensation claims are filed by people who have suffered legitimate injury or illness on the job, there is a small percentage of people who file fraudulent claims. As a result, workers’ compensation insurers need to investigate suspicious filings to make sure that they are valid. Though it may feel intrusive to those who simply want to get better or get the compensation they deserve, the work is also necessary: workers’ compensation fraud perpetrated by both employers and employees account for 25 percent of all insurance fraud. The news media has covered some of the most notorious of these crimes, including a woman who claimed to have been disabled and then appeared doing something strenuous on a daytime television game show, and another employee who was videotaped water skiing.

To rout out this type of crime, investigators use several different investigative techniques, including:

• Video and audio surveillance – Investigators can follow an individual worker around and record evidence that shows that they are not as disabled as they claim to be.
• Social media surveillance – Investigators can review social media postings that provide contradictory evidence of disability.
• Interviews with colleagues and others – Investigators are able to question friends and family members, co-workers, and others in a claimant’s community to determine whether their claims are legitimate.
• Background checks and medical records research – Investigators can look into a claimant’s medical records to determine whether their reported illness or injury was actually a pre-existing condition. They can also pull records on previous insurance claims.

Though workers’ compensation insurance investigators may seem like the enemy, it is important to understand that workers’ compensation attorneys also investigate insurers and employers to make sure that claims are being appropriately paid. It is also important to note that there are limits to how far investigators for workers’ compensation insurance companies are allowed to go while pursuing their investigations. They are not permitted to be deceptive in their approach, and those that have used deceptive tactics have faced successful legal action.

Workers’ compensation insurance fraud is a crime that costs all of us. It drives up the rates of workers’ compensation insurance premiums and makes it more challenging for those who have been legitimately hurt on the job to get the compensation and benefits that they deserve. If you have been hurt on the job, contact us today to set up a consultation to discuss your case.