Workers compensation, or simply workers comp, is a program mandated by the government that aims to give benefits to workers who have been injured or fallen ill due to their work. Workers comp typically provides an employee with medical benefits and lost wages due to the injury or illness, however, it varies by each state. In the event you file for workers compensation, you can expect for an investigation to also occur. The workers comp investigation is done by insurance companies to check whether your claim is legitimate or not and to determine what your benefits include. While the main aim for the investigation is to seek out any potential workers comp fraudulent claims, they can also be used by insurance companies to reduce or even deny your claim.
What the Investigation Process Looks Like
Insurance companies will send out an investigator on their behalf to gather information and evidence on your injury with the purpose of determining your claim’s validity. The investigation period usually lasts 2-4 weeks. During this process, the investigator will collect information from a variety of sources, including security cameras, interviews, and online social platforms.
Video footage from security cameras at your workplace may be used by the investigator to observe if the injury occurred as you described it on file. This can be a number of aspects like the timing of the incident, the equipment by which you claim to have gotten hurt, the severity of the injury at the time of the incident, etc. The insurance companies may also gain access to other security cameras around your workplace or even your residence to watch how you have been going about your day with the claimed injury. For example, if you have a leg injury and require the use of a walking cane, but the investigator acquires video footage of you walking without the cane, this point would be brought up by the insurance company.
Another component of the investigation process is conducting interviews. The investigator may not only interview you but also your co-workers, friends, and family members about your injury. You are not legally required to answer any of the investigator’s questions, but avoiding them could result in further suspicion towards your claim. Therefore, if you choose to agree to an interview, be exact and concise with your words and have a planned frame of answers ahead of time.
Friends and family members could be asked questions in the attempt to figure out if the injury even occurred on the job or if it is the result of something outside of work. They could also be questioned about the incident itself to find any holes to the story they know versus what you claimed on file. Co-workers would also be interviewed to have their stories all cross-examined, paying attention to the sequence of events leading up to the incident and immediately following it. It’s important that you discuss the details of your incident with anyone close to you that you believe may be interviewed, this will ensure the same answers are provided to the investigator each time.
Believe it or not, your social media accounts may also be used by the investigator to further collect information. Any posts you publish will be run through the microscope by the investigator to verify your current situation. For example, if you claim to have a severe back injury, but then you post a video of you lifting weights, this very well could be enough evidence for the insurance company to refuse you compensation. Keep in mind that even if pictures and videos you post now had been taken prior to the incident, it can present the narrative of you faking your injury. Also, know that the investigator may look through any posts you are tagged in as well. So even if you never post anything that could be seen as contradicting your claim, your friend could easily post a picture or video with you that brings doubt to your claim’s validity.
Things to Keep In Mind
If you find yourself injured or ill due to your job, immediately seek medical attention. Do not prolong getting help after you’ve realized the health issue, as things like this can be used against you if discovered in the investigation. Once you file your claim, remember to be mindful of your conduct at all times because an investigator may see you doing or saying something and conclude that you are lying about or exaggerating your injuries/illness. Imagine that you’re constantly being watched because you never want to let your guard down right as an investigator is observing you. Even activities such as posting to social media should be done with precaution during the process as any pictures or videos could be pulled as reasoning to lower or deny your claim.
Workers compensation can be a complicated and stressful process, which is why it’s best to contact a workers compensation attorney to help you avoid making mistakes and to support you and your loved ones through it all.
