Someone Is Watching: What To Know About Workers' Compensation Investigations

4 November 2020
 Categories: Law, Blog


The incidences of workers' compensation fraud are very low, but that may not prevent hurt workers from being watched. Studies show that 1 to 2% of workers' comp claims are submitted by workers faking injuries and trying to claim benefits. Those benefits range from payment of medical care and partial payment of lost wages to lump-sum payments for permanent injuries. Though the chances are small, insurers may still investigate certain claimants. Read on to find out more about how the specter of fraud can affect your claim.

Is it Fraud or Unjustified Denials?

The workers' compensation insurer is a for-profit business and like any other, they keep an eye on their bottom line. Your employer pays premiums to this insurer because it's a requirement. When a worker is hurt, everyone loses. The employee loses income and suffers from an injury. The employer loses an employee and their workers' comp premiums could rise as a result of filing a claim. Finally, the insurer might have to pay on a claim and that cuts into their bottom line. Unfortunately, this sets up a situation where the employer and the insurer may not be cooperative with the filing of claims. It can also mean the insurer scrutinizes everything the hurt worker does after they file a claim.

Hurt Workers May Have Good Days

As anyone knows, almost everyone suffering from an injury or illness has good days and bad days. Unfortunately, workers' comp investigators may record you during a good day and use that to deny your coverage. To prevent issues, take the following steps:

  1. Remember that if you are in public, you can be watched and recorded. That means parking lots, your driveway, the park, your child's soccer game, and more.
  2. Your doctor is likely a workers' comp doctor and they are bound to report everything to the insurer. The doctor, the nurse, the receptionist, and everyone else may be called to report on your movements. For example, they may want to know if you used a walker when entering the building or if you seemed to be walking without assistance.
  3. Not all workers' comp cases are equal. Serious and hard-to-prove injuries are more likely to garner more attention from the insurer. For example, if you are suffering from a potentially permanent injury, you may be under surveillance.

If your claim has been unjustly denied, you will need the help of a workers' comp attorney. Speak to one today if you think you have a permanent injury. You will need help to negotiate your settlement.