If you have been involved in an accident at work, you’ve probably filed for a workers’ compensation claim. However, your employer or the insurance company may decide to investigate your claim for fraud. There is no need to panic as this is standard procedure in some situations.
However, it’s important to note that workers’ compensation claims are investigated when the insurance company suspects that you might be faking your injuries or you took another job while collecting benefits. It is a criminal offense to give false statements about a workplace injury because this is considered workers’ compensation fraud in every state.
You should contact a Fall River workers’ compensation lawyer as soon as possible if you believe your claim might be under investigation. This is a necessary step if you want to protect yourself from an intrusive investigation.
Why is your workers’ compensation claim being investigated?
Your claim will be investigated because the insurer or your employer doesn’t believe that your injuries are work-related or believes they occurred outside of work. If your claims are not fraudulent then you have nothing to worry about but it’s important to note some of the acts that might raise suspicion:
- Exaggerating your injuries
- Purposely lying to collect workers compensation benefits
- Working another job while collecting benefits
- Claiming you were injured while on the job when you really weren’t
Collecting workers’ compensation benefits for an extended period of time doesn’t equate to fraud. You also do not need to return to work until your doctor authorizes you to do so. However, an insurance adjuster might launch an investigation to see if they can find a reason to terminate your benefits.
Red flags that suggest your workers’ compensation claim is fraudulent
There are some situations where your employer might suspect that you’re collecting benefits fraudulently. For instance, your employer might spot you lifting heavy objects after returning to work on a restricted basis for a back injury. Other ways that your claim might seem suspicious include:
- You were a disgruntled worker
- You are a new employee
- No one witnessed your accident
- The story of how you were injured keeps changing every time you narrate it
- Witness statements and your version of how the accident occurred differ significantly
How do investigations into workers’ compensation fraud work?
Once you file a workers’ compensation claim your employer will send it out to the insurance company for evaluation. The aim of the investigation is to determine whether you deserve to receive workers’ compensation benefits.
How long does the investigation last?
It’s difficult to establish how much time a fraud investigation takes. It might take a few days to a year to complete. The length of the investigation depends on how experienced and skilled the investigator is and how much detail needs to be investigated.
Which tactics do workers compensation investigators use?
Some of the tactics they use include:
- Video evidence of your claim
- A background check
- Electronic surveillance
- Reviewing your medical records
- Interviewing you, your co-workers, friends, and family members
Electronic surveillance includes monitoring your social media accounts. The investigator will be looking to find out whether you exaggerated your injuries or if they are non-existent by looking for comments or pictures that suggest so. If for example, you post a picture of yourself going hiking yet you reported that you had injured your ankle, there’s a good chance your claim will be considered fraudulent.
If you have work-issued devices and you decide to go home with them, your employer might decide to monitor them to track your movements. If you’re moving around a lot yet you’re supposed to be on bed rest then it could raise some red flags.
The investigator might also film you while you are in public to see if your movements indicate that you have an injury. This is completely legal since you are not at a private location.
How to get through your workers claim investigation
The best way to get through it is to avoid it altogether. This means being honest about your injuries and supporting your claim with reliable evidence. You should also stay away from social media and avoid activities that may raise suspicion.
Consult a Fall River workers compensation lawyer
If you think your claim might be under investigation you should contact a workers compensation lawyer in Fall River for legal help. We can help you collect evidence that supports your claim and speak to insurance investigators on your behalf. Contact us today at 508-676-0001 to schedule your free initial consultation.
