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Workers’ compensation: How insurers look for fraud

| Apr 23, 2018 | Firm News

Suffering a workplace injury is a risk for all Boston employees. The effects of such an injury can include loss of earning potential and job security as well as massive financial hardships. Even worse, victims must endure these negative effects on top of the physical pain and suffering caused by the injury.

You know that workers’ compensation is there to help you pay for your medical treatment and to replace a portion of your lost income when injured at work. Without these benefits, it is safe to assume that your losses would multiply significantly. Imagine the horror you would feel if you received notice that your workers’ compensation insurance carrier denied your claim.

Obviously, these insurance companies want to avoid paying when claims are fraudulent. However, the techniques they use to look for fraud may result in denials for valid cases as well as fraudulent ones. Below are a few examples of investigation techniques insurers use to look for fraud.

  • Interviews with co-workers, friends, neighbors and other people who might know about your injury
  • Background checks and research into your medical history — including how many workers’ compensation claims you have filed
  • Monitoring your activities after you file a claim via video and audio surveillance

The goal of such investigations is proving that no injury exists or that injuries are less severe than indicated. For example, an investigator sees the injured worker lift a bag into the back of a truck and concludes that the workers’ compensation claim is fraudulent. What the investigator cannot know is that the bag contains only a few pieces of paper and weighs next to nothing.

The takeaway here is not to give up when an insurer denies your valid workers’ compensation claim. Instead, consider finding someone to help you gather your own evidence so that you can appeal the denial and get the benefits you deserve.

Source: PInow.com, “Workers Compensation Investigation,” accessed April 23, 2018

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