Workers’ Compensation Investigations and What They Look For

If you have been injured at work, you may need to know about workers' compensation investigations and what they look for. Workers’ compensation investigations seek to confirm or deny the legitimacy of workers’ comp claims. Insurance companies and employers investigate to ensure people collecting workers’ comp payments have legitimate injuries and qualify for the benefits. The main goal of these investigations is to prevent fraud. Some insurance companies may, however, investigate to lower or deny claims. 

Workers’ comp investigations are designed to determine whether you are fabricating or exaggerating a work-related injury or illness. They look for misrepresentation of an injury or illness. They will also try to find out whether you are working while receiving workers’ comp benefits. 

What Counts as Workers’ Compensation Fraud?

Workers’ compensation fraud happens when a person obtains financial benefits through lies. Employers, employees, medical providers, and insurance companies can commit workers’ comp fraud. This article will focus on workers’ compensation fraud committed by employees. The following may count as workers’ comp fraud: 

• Fabricating an injury or illness 
• Claiming a non-job-related injury as job-related 
• Working while receiving total disability benefits 
• Exaggerating injuries or illnesses to receive more money or extend the duration of benefits payments 
• Misrepresenting your income 
• Seeking compensation for medications or medical treatment you did not obtain

Understanding what qualifies as workers’ compensation fraud can help you avoid mistakes that can get an otherwise valid workers’ comp claim denied. You will also avoid getting trapped in the net designed for fraudsters.

What They Look for in a Workers’ Compensation Investigation

If you have a valid work injury claim in Chicago, Illinois, you might want to know more about workers’ compensation investigations and what they look for. A workers’ comp investigation involves compiling information and evidence regarding an injury to verify or deny the claim's validity. 

Most insurance companies assign this job to private investigators who are skilled in workers’ comp investigations. Other insurers have an in-house team of investigators committed to investigating potential fraud. Here are some things a workers’ compensation investigator looks for:

Is Your Injury Fake or Exaggerated? 

An investigator may assemble information and evidence that implies you are not actually injured. The investigator may also try to show that your injury is not as severe as you claim. Workplace surveillance footage may, for instance, show that you did not suffer any injuries during the alleged accident. Surveillance footage at the gym may also show you performing strenuous workouts while you claim to have a severe back injury. 

Is Your Injury Job-Related?      

Investigators also try to find evidence that your injury is not job-related. Let us assume you claim your leg was injured at your construction job. An investigator will interview several witnesses to see if anyone contradicts your account. If multiple witnesses claim you injured your leg in a bicycle accident, the investigator will deem your injury non-work-related. 

Are You Still Working? 

Investigators will search for proof that you are still working. If so, they will investigate whether you are correctly reporting your income. 

Methods Used by Workers’ Comp Investigators to Obtain Evidence 

Video Surveillance 

Investigators use video surveillance to catch employees faking or exaggerating their injuries. They may hide a camera near your home. They may follow you around and watch you constantly. If you do something to put your injury into question, investigators will be at the scene to capture the action in real-time. 

Most health care facilities have video cameras near their parking lots. Investigators can obtain footage of these cameras effortlessly, as workers’ comp insurance companies are usually responsible for choosing medical providers for injured workers. They will then review this footage to identify a claimant who shows signs of faking their injuries. 

Online Surveillance  

Investigators can monitor your activities on social media channels and other online platforms. They will check your status updates, posts, tagged pictures, and other online activities. They will then submit proof of illegitimate injuries to the insurance company or your employer. 

Interviews 

Investigators may also interview you in person or over the phone. The law does not require you to grant them an interview. Accepting their interview, however, can help your case if you have valid work-related injuries. 

Your friends and family members are also a great source of information regarding your injury. Investigators might interview your relatives, close friends, neighbors, and workmates. An investigator can compile this information and try to identify inconsistencies or potential proof of fraud. 

What Should You Do if Your Claim Is Investigated?

Be conscious of your actions at all times when your claim is under investigation. Conduct yourself as if you are under 24-hour video surveillance. Avoid making social media posts that may suggest you are faking or exaggerating your injuries. If you are claiming a severe knee injury, for instance, avoid uploading images and videos of you while jogging. 

Keep specifics of your accident as clear and concise as possible. Avoid speculating, even if you have forgotten some details of your workplace accident. Remember, a discrepancy in the specifics of your accident can compromise your claim. 

Ensure you know how to report a work injury. Your written report, for instance, should be error-free. It should clearly outline only the facts. Submit the report to your employer on time. In Illinois, you have 45 days to report your work-related injury or illness to your employer. 

File your worker’s comp claim as soon as possible. Complete all the paperwork neatly and within the deadline.  Give the claims administrator overseeing your case maximum cooperation. Always stay calm when engaging the administrator and provide concise answers. 

Involve a workers’ compensation lawyer immediately after you are injured at work or discover you are facing a workers’ comp investigation. The lawyer can help you navigate the workers’ comp investigation process smoothly. The lawyer can also help you avoid common pitfalls, offer required information without sabotaging your case, and increase your odds of an uneventful investigation that corroborates your claim.