Workers’ Compensation Investigations and What They Look For

Why Do Workers’ Compensation Claims Get Investigated?

Workers’ compensation is designed to provide injured employees with medical care, wage replacement, and vocational rehab when needed. Unfortunately, not every claim sails through unchallenged. Insurance carriers and self-insured employers have a financial interest in limiting payouts, and they often launch investigations if they suspect fraud, exaggeration, or any deviation from a textbook claim.

Common triggers for an investigation include:

• Delayed reporting of the injury
  
• Conflicting medical records
  
• Lack of witnesses
  
• Prior injury history
  
• Anonymous tips from coworkers
  
• Social media red flags

Not all investigations are aggressive or intrusive, but some can feel overly invasive—especially when the insurer is actively looking for reasons to deny your claim. If your case involves high medical costs, conflicting details, or a history of prior injuries, you may be scrutinized more closely. Understanding what investigators look for and how the process works can help you avoid missteps that could jeopardize your right to benefits.

What Counts as Workers’ Compensation Fraud?

Workers’ compensation fraud isn’t just about faking an injury. It covers a broad spectrum of deceptive practices. While employers, providers, and insurers can all commit fraud, investigations typically focus on employee behavior.

Here are examples of actions that may be classified as workers’ compensation fraud:

• Faking or staging an injury or illness
  
• Exaggerating the severity of symptoms to prolong time off work
  
• Claiming a pre-existing or personal injury as work-related
  
• Working a side job while receiving total disability benefits
  
• Filing false mileage reimbursements or medication receipts
  
• Misrepresenting your employment status or income

These aren’t just grounds for denial—they can lead to criminal charges, benefit forfeiture, and steep financial penalties. Even unintentional misstatements can raise red flags, so accuracy and transparency are essential.

What They Look for in a Workers’ Compensation Investigation

Investigators are trained to scrutinize every angle of a claim. Whether hired through the insurance company or working in-house, their mission is to verify (or disprove) the injury, the cause, and your level of disability.

Key areas they focus on include:

1. Is Your Injury Fake or Exaggerated?

Surveillance footage, social media posts, or gym visits can be used to contradict your claim. For instance, if you say you can’t bend or lift, but investigators capture you unloading groceries or coaching soccer, they’ll argue your injury isn’t as severe as claimed.

2. Was the Injury Job-Related?

If you reported that you were hurt lifting boxes at work, but coworkers say they saw you limp in from your morning run, investigators will challenge the “work-related” nature of your claim.

3. Are You Working While on Disability?

Collecting total disability while secretly driving for Uber, bartending, or doing cash construction work is a fast track to fraud allegations. Investigators look for employment records, business licenses, and online ads that tie you to active employment.

Methods Used by Workers’ Compensation Investigators

Workers’ compensation investigations in Illinois rely on multiple surveillance and intelligence-gathering tools. Here’s how they build a case:

Video Surveillance

Investigators may stake out your home, follow your car, or film you entering medical clinics. This isn’t paranoia—it’s standard practice. They’re looking for inconsistencies between your behavior and your claimed limitations.

Pro tip: Assume you’re being recorded anytime you leave the house. Walking your dog, shoveling snow, or helping a neighbor move furniture can all be weaponized against your claim.

Online Monitoring

Social media is fertile ground for investigators. Facebook, Instagram, TikTok, and LinkedIn are all combed for posts that suggest you’re not as injured as claimed. Birthday parties, vacations, sports games, and even emojis or hashtags can become part of the case against you.

Pro tip: Don’t post anything on social media, even if you think your account is set to private. Ask your friends not to tag you in any posts, either.

Interviews

Investigators may try to interview you, but you’re not legally obligated to comply. Anything you say can and will be used to evaluate (or dismantle) your claim. They may also interview coworkers, neighbors, and relatives, looking for statements that contradict your report or timelines.

Best practice: Don’t speak to an investigator without legal counsel. Politely refer them to your attorney.

What to Do if Your Workers’ Comp Claim Is Under Investigation

Being under investigation doesn’t automatically mean you’ve done anything wrong—but how you handle it can make or break your claim. Here’s how to stay out of trouble:

Act Like You're Being Watched 24/7

This doesn’t mean you have to hide in your house—but don’t do anything your doctor hasn’t cleared you for. Be mindful of body movements, public appearances, and anything that could cast doubt on your injury.

Limit Social Media Activity

When in doubt, log out. Even an innocent post like “Feeling better every day!” can be spun to imply that you’re ready to return to work.

Stick to the Facts

When reporting your injury, be honest and consistent. Don’t guess or embellish. If you don’t remember something, say so. Inconsistent statements are often used to question a claimant’s credibility.

Follow All Medical Advice and Keep Appointments

Missing therapy sessions or ignoring doctor recommendations can be interpreted as a sign your injury isn’t serious.

Meet All Deadlines

In Illinois, you must report your injury to your employer within 45 days of the incident. Failing to do so could disqualify you from benefits entirely.

Should You Call an Attorney If Your Workers’ Compensation Claim Is Under Investigation?

The second you learn you’re being investigated—or even before—get a workers’ comp lawyer involved. An experienced attorney can help you:

• Avoid statements that could be misinterpreted
  
• Ensure compliance with all legal requirements
  
• Push back against unfair surveillance tactics
  
• Preserve your medical and wage loss benefits
  
• File an appeal if your claim is denied

Don’t wait until it’s too late. The earlier you get legal guidance, the better your chances of keeping your benefits and avoiding an unnecessary fight. Contact Strong Law Offices in Bloomington or Peoria at 309-393-2928 for a free, no-obligation consultation.