Workers’ compensation insurance companies sometimes initiate an investigation after a worker files a claim for an on-the-job injury. These inquiries occur for a variety of reasons, including issues relating to potential fraud by the employer or employee. Workers who file a claim need to be aware of what happens if the insurance company starts a workers’ compensation investigation and know what to do during the investigation.
Some insurance companies use investigations to attempt to reduce, deny, or delay payment of a claim. While an investigation may be initiated at any stage of a claim, they most frequently start soon after the claim is filed or shortly after the injury report.
A workers’ compensation investigation may indicate that the company suspects fraud by the employer or by the employee. The potential fraud may relate to the nature of the accident or the extent of the injury, or to employer actions taken after report of the accident. Initiating an investigation enables the insurance company to gather information about all aspects of the claim.
In some cases, insurance company representatives conduct the investigation themselves. In other cases, the company hires a private investigator specializing in workers’ comp investigations.
While an investigation can sometimes undermine a worker’s claim, there also are cases where the results of the investigation support and reinforce the claim. In some circumstances, the worker may end up with more benefits as the result of an investigation.
If you discover your workers’ comp claim is under investigation, your first step should be contacting an experienced workers’ compensation attorney, like our lawyers at Renfro & Renfro. Getting assistance from legal counsel ensures that your rights are fully protected and that you receive the compensation you deserve.
A workers’ comp investigation may involve a wide range of techniques to gather evidence about the accident, injury, nature of the workers’ employment, and actions by the employer and employee relating to the accident. The investigator gathers documents relating to the worker’s responsibilities, the accident, and treatment of the injury itself. They also may conduct a background check and gather employment records, medical records, and other documentary evidence relating to the injury claim. If the worker filed previous claims, documents relating to those claims are secured as well.
An investigator may use audio, video, and other types of surveillance, particularly relating to the worker’s activities following the injury. One goal of surveillance is to determine whether the actual injury is as severe as the worker claims. Photos, including social media posts, that show the worker engaging in activities inconsistent with the claimed injury may be used to dispute the truthfulness of the claim.
The investigator may interview the employer, worker, fellow employees, and even the worker’s friends and family. The purpose is to learn as much as possible about the worker and their employment circumstances as well as gather detailed information about the facts relating to the claim and the extent of the injury.
If you learn that your workers’ comp claim is under investigation, you should immediately contact a knowledgeable lawyer if you do not already have legal representation. Your lawyer will explain what happens during a workers’ compensation investigation and advise you of what to do during the process.
Throughout the investigation, it is essential to be accurate and truthful in providing information, including to your doctor and medical professionals. Exaggerating your injuries will not help your claim and can be detrimental to your case.
When an investigation is underway, you should assume that everything you do is being monitored by the investigator. That includes your conduct at work (if you are still working), in public, and even in private. Staying away from social media altogether is advisable. You should also ask your friends and family to avoid mentioning you or including photos of you on their social media posts.
It’s important to continue to update your doctor and other medical professionals about your physical condition and activities, including pain you experience as the result of your activities. Documenting the extent of your injury in medical records is the best way to ensure that there is full evidence of the nature of your injury to support your claim.
Above all, follow the advice of your legal counsel without exception during the course of the investigation. Your lawyer knows how to navigate through a workers’ compensation investigation — but doing so requires that you strictly abide by the advice your lawyer provides.
If you received injuries in an on-the-job motor accident, it’s important to reach out to a lawyer as soon as possible. It’s especially essential to talk with an experienced workers’ comp attorney if you learn that the insurance company is investigating your claim. Our Richmond injury lawyers at Renfro & Renfro are here to help with your claim and work with you closely during an investigation of the claim. Our injury lawyers welcome you to contact us for a free consultation.