What Do They Look for in Workers’ Compensation Investigations?

Posted April 5th, 2021 by .

Categories: Workers Compensation.

fall | Union City Attorney

According to the National Safety Council, the average workers’ compensation claim costs $40,000. This amount may explain why many employers and insurance companies conduct investigations before administering a claim. The main purpose is usually to prevent fraud by determining the eligibility of an employee to receive benefits.

As an employee, it is crucial that you understand workers’ compensation investigations and what they look for. Doing so will help you prepare the necessary evidence and documentation to protect your claim and secure an approval.

Have you been injured or fallen ill at work? Contact a North Bergen Personal Injury Attorney immediately to learn about your options for compensation.

Workers’ Compensation Fraud

Workers’ compensation fraud is not as uncommon as people would like to think. One perfect example includes a woman who claimed to have suffered severe shoulder injury that prevented her from standing or walking. Despite her claims, she was seen on the show “The Price is Right,” spinning the heavy wheel and running down the stage.

Other scenarios that may be considered workers’ compensation fraud include:

  • When a worker fakes their injury or illness
  • When a worker exaggerates their injury to receive more benefits
  • When a worker continues working while receiving benefits
  • When a worker falsely claims a previous injury to be work-related

When an employee defrauds the system, they waste resources that could be used to cover the losses of genuinely-injured workers and makes it more difficult for their claims to get approved. This is why investigations are an almost standard procedure in many states.

Workers’ Comp Investigations: The Procedure

Workers’ compensation investigations are not a standard part of the claims process. When an injured worker files a claim, it is usually evaluated and reviewed to determine eligibility. This often includes reviewing medical records, police reports, and other related documents. The claims adjuster or administrator then either approves or denies the claim, depending on their findings.

If an adjuster suspects fraud, they can launch an investigation into the injured employee. Investigations tend to be invasive and can include surveillance and interrogations. Many workers under investigation report feeling paranoid at being followed and frustrated at not being believed.

Techniques Used in Workers Compensation Investigations

As mentioned, workers’ compensation investigations can get invasive as the investigators try to find anything that suggests fraud. Some of the tactics might include:

  • Audio, photo, and video surveillance
  • Interviewing friends, families, colleagues, and other individuals known to the worker
  • Performing background checks to uncover any past filed claims
  • Reviewing medical records, past employment records, and police reports

If investigators uncover fraud, they may then collect evidence to prove their findings and justify denying the claim or taking legal action against the worker.

Talk to a North Bergen Personal Injury Attorney

If you are considering filing a workers’ comp claim, understanding workers’ compensation investigations and what they look for can help ensure you pass the eligibility test. You may also want to consult an attorney to prepare a strategy in case your claim is reduced or denied.

Attorney Anthony Carbone, an experienced North Bergen Personal Injury Attorney, has been fighting for the rights of injury victims in New Jersey for over 30 years. Contact the Law Offices of Anthony Carbone at 201-733-2230 to discuss your rights.

Call Today! (201) 963-6000

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