Workers Compensation Insurance Investigations

Workers Compensation Insurance Investigations

Workers’ Compensation is an important government-mandated program that mandates employer funded insurance in the case of employee injury. Unfortunately, some individuals decide to take advantage of the workers’ compensation system and falsify the severity of their injuries. Commonly called workers’ compensation fraud, this circumstance occurs when an insurance claimant, employer, or health care provider lies to the insurance system in order to fraudulently gain money or savings. Incredibly, worker’s compensation fraud accounts for 25% of all insurance fraud.*

A worker can commit worker’s compensation fraud in a variety of ways. Some examples are claiming an injury that happened while not at work, delaying treatment, or filing multiple claims. Examples of employer worker’s compensation fraud include denying valid claims, misclassifying employees to change their available benefits, or refusing to pay for workers’ compensation insurance. It is also considered worker’s compensation fraud to misclassify contractors, and it is similarly illegal to pay employees off the books to avoid paying worker’s compensation claims.

Insurance companies do investigate potential cases of fraud in a variety of ways:

  • Surveillance is used by insurance companies to verify that individuals were legitimately injured and are seeking treatment. Investigators might use audio, video, or other types of physical surveillance to check into claims of injury.

  • Interviews with co-workers, friends, and family are another way that insurance companies as well as checking in with the claimant. These might be conducted with individuals close to you to verify that you are receiving treatment. Relevant HIPPA laws, however, prevent individuals other than patients from gaining access to restricted health information.

  • Background checks are one avenue of investigation used by insurance companies. These checks can be conducted by checking credit history, employment records, and other public records. This can also mean checking on compensation claims from the past to see whether a company has been filed against multiple times.

If you file for worker’s compensation, do not be surprised if the insurance company hires a private investigator to verify your claim of injury. Do not, however, let this discourage you from filing a workers’ compensation claim if you have been injured on the job. These types of injuries are common, and worker’s compensation insurance exists for an important reason. Contact us at 803-252-4800 right away if you need help defending your right to the compensation you deserve.

Workers Compensation Insurance Investigations


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