Workers’ Compensation Investigations: What Insurance Companies Look For

Workers’ Compensation Investigations: What Insurance Companies Look For

When you file a workers’ compensation claim, you should not expect your employer’s insurance company to simply provide benefits without any questions. Incidents of workers’ comp fraud happen all the time, and insurance companies work to prevent unwarranted payouts. This means that insurers investigate claims to confirm they are valid before providing benefits. The Kansas Department of Labor also has a Fraud and Abuse Unit that investigates claims for possible inconsistencies.

If your claim is undergoing an investigation, you should understand what the insurer is looking for. Even someone with valid injuries can say or do the wrong thing to cast doubt on their claim. The best thing to do in this situation is to seek help from a workers’ compensation lawyer in Kansas.

What Might be Investigated?

Workers’ comp insurers might investigate a claim if there are one or more red flags, or the investigation might be random. Some things investigators might focus on include the following:

• Emails, texts, and other messages.
• GPS or cell phone data.
• Social media pages, including status updates, photos, videos, check-ins, and even tags from other people.
• Surveillance video from the employee’s workplace.
• In-person surveillance by investigators.
• Witness interviews.

What are Investigators Targeting?

Investigators know what to look for when seeking potential fraud or an otherwise invalid claim. The following are some examples of things investigators might be targeting.

The injury is fabricated or exaggerated.

First and foremost, insurance companies want to ensure that you suffered a real injury that requires medical attention and potentially time off of work. Some employees might try to falsify an injury for different reasons, including seeking medication that they plan to give or sell to someone else.

Other people might have real injuries, but they exaggerate the severity of the injury. Some people might claim their injuries are worse than they really are to justify being out of work longer and getting wage replacement benefits. Exaggerating an injury to obtain disability benefits is still considered fraud – even if the initial injury was legitimate.

The injury did not happen on the job.

Sometimes, a claimant might have a real injury, but there are doubts about how it happened. An injury is only eligible for workers’ compensation if it happened in the course of the person’s employment.

Investigators will do what they can to determine whether a back injury happened while lifting something at work – or while lifting something at home. Someone might hurt themselves outside of work and then fabricate a workplace incident to try to get benefits.

The employee can still work.

Some injured workers cannot work for weeks, months, or years following a job-related injury, and they deserve disability benefits. However, some people might try to game the system by claiming they are disabled, but, in reality, they are earning money working for another enterprise. Investigators can examine whether an employee is disabled or is working while receiving disability benefits.

A Kansas Workers’ Compensation Lawyer Can Help

Workers’ compensation investigations do not have to be stressful, and having guidance from Pyle Law can help ensure that investigators do not get the wrong idea about your situation. Contact us for assistance with a claim today.