What You Need to Know About Workers' Comp Investigations

A Dive Into Workers’ Compensation Investigations and What They Look For

​A large number of fraudulent workers’ compensation claims are filed each year throughout the U.S. This not only bogs down the workers’ compensation system, but also costs tax-payers thousands of dollars. As a result, most insurance companies have resorted to using private investigators to conduct investigations into the claims and behaviors of injured workers both during the claim filing process and even after they have already received a workers’ compensation settlement. While catching fraudulent claims is beneficial for the entire system, there are times when insurance companies abuse this process by using investigations as a means to disprove legitimate claims so that they don’t have to pay. The purpose of this blog is to answer your workers’ comp investigation questions and provide you with some insight on how you can protect your own claim when under investigation.

Has your legitimate claim been denied because the insurance company thinks it’s fraudulent? Our work injury lawyers at McHargue & Jones can help. Call (312) 487-2461 for skilled legal representation.

What Is a Workers’ Compensation Investigation?

A workers’ comp investigation refers to the steps that the workers’ compensation insurance company will take to ensure that the person filing the claim is actually as injured as they are claiming to be and that they actually qualify to receive workers’ compensation benefits. In some cases the company will hire a workers’ comp private investigator to dig into the details of your claim and in some cases monitor your behavior after you file your claim. The purpose of this investigation is to prevent workers’ compensation fraud. The private investigator will then provide the company with their investigation report and the company will use that to inform their decision on whether or not to approve your claim or to continue providing you with workers’ compensation benefits.

Common Workers’ Comp Investigator Tactics

Workers’ comp investigators will go to great lengths to disprove a workers’ claim. The majority of their evidence is gathered when following or monitoring the worker while they are in public running errands, going to appointments, etc. after their injury. This can include any of the following tactics:

  • The use of video or photo surveillance - For example, if you are seen to be lifting a heavy object after filing a claim based on a severe back injury that prevents you from lifting anything over 10 lbs, a photo of you lifting a 30lb object could be grounds to disprove your claim

  • Monitoring your social media accounts - An investigator will typically monitor any public social media accounts you have; this can include Facebook, Instagram, TikTok, and more. If you are found to be posting photos of you doing something that would exacerbate a work-related injury, this could have an impact on your claim.

  • Talking to your family or friends - A workers’ comp investigator may talk to your close family or friends to try to gather information about your injuries. If someone close to you says something that contradicts an element of your claim, this could hurt your workers’ comp claim.

  • Conducting background checks - An investigator may also take steps to determine if you have accepted employment while still receiving workers’ compensation from another job. In many cases this would violate the grounds for receiving workers’ compensation.

What Can’t Workers’ Comp Investigators Do?

While it’s true that private investigators will often go to great lengths to disprove a workers’ comp claim, there are still rules that they must follow when surveilling a worker. For example, workers’ comp cannot tap your phone, hack into your private email or phone accounts, or impersonate a police officer in an attempt to get information from you. They also may not enter your home without permission. Essentially, an investigator can use any method available to them as long as they don’t break the law or violate your right to privacy.

How Long Does a Workers’ Comp Investigation Take?

The workers’ comp investigation process can vary from one case to the next. In some cases you may not even have to worry about being investigated, although you should always be careful about what you post on social media when handling a workers’ comp claim. It often depends on how confident the insurance company is in the validity of your claim. If there is doubt, the company may have you under surveillance for months or even years.

Will You Have to Worry About Surveillance After You Get Your Settlement?

In some cases, yes. Even after your claim has been settled and you’ve been awarded workers’ compensation benefits, some companies will continue to surveille workers to ensure that they are not employed elsewhere or doing tasks that contradict the type of injury they have claimed to have. If they find that you are not living your daily life in accordance with the injuries you have claimed, there’s a chance you could lose your benefits.

Get Help Filing Your Claim Today!

If your claim is legitimate and you have genuinely been injured on the job, you shouldn’t have too much to worry about when being subjected to surveillance. However, there are times where insurance companies act selfishly and attempt to “disprove” a claim just so that they don’t have to pay the injured worker. In cases like this, it’s imperative that you hire an experienced workers’ compensation attorney to represent you and ensure that your benefits are protected.

Don’t wait! Call the work injury lawyers at McHargue & Jones, LLC today: (312) 487-2461. Our team offers free initial consultations to prospective clients.