Workers’ compensation benefits employees who are injured or fall ill on the job. In cases where a claim’s legitimacy is in doubt, insurers may hire a workers’ comp private investigator, often in an attempt to refuse workers’ comp benefits. This practice is particularly relevant in places with a dense workforce and high claim rates, such as New York City. Understanding when and why a workers’ comp private investigator might be involved in a claim can help employers and employees navigate the complexities of workers’ compensation laws in New York State.

Keep reading for more from a New York workers’ compensation lawyer at The Weinstein Law Group.

workers comp private investigator

Why do insurance companies hire private investigators in New York City?

The primary reason for hiring a private investigator in the context of workers’ compensation is to prevent fraud. Fraudulent claims can significantly impact the financial health of the workers’ compensation system, leading to higher premiums for employers and undermining the resources available for legitimate claims.

Investigators are hired to ensure that the claim is valid, that the injury occurred as stated and is as severe as claimed, and that the employee is not engaging in activities that contradict their injury claim.



Office of the Workers’ Compensation Fraud Inspector General – Learn about types of workers’ comp fraud or file a complaint.

What situations trigger investigation?

Several scenarios might trigger hiring a workers’ comp private investigator in New York City.

Discrepancies in the claim

If there are inconsistencies in the employee’s account of the incident or discrepancies between the medical report and the claim, an insurer might find it necessary to investigate the claim further.

Lack of witnesses

Injuries occurring in areas without witnesses or surveillance footage may raise suspicions, especially in a bustling urban environment like New York City, where many areas are typically crowded.

Delayed reporting of the injury

Delays in reporting an injury can sometimes indicate that the claim might not be legitimate, prompting further investigation.

Previous fraudulent claims

If an employee has a history of filing suspicious or fraudulent workers’ compensation claims, insurers might be more inclined to conduct a thorough investigation for subsequent claims.

High-risk industries

Certain sectors with higher incidences of workers’ comp claims may be under more scrutiny. In NYC, industries like construction, delivery services, and public transportation might see a higher investigation rate due to the inherent risk associated with their work.

Legal boundaries in New York

It’s crucial to understand that while workers’ comp private investigators operate to uncover potential fraud, their activities are bound by legal and ethical guidelines. In New York, investigators must adhere to privacy laws and cannot engage in harassment, trespassing, or illegal surveillance. Their investigations typically involve observing the claimant in public places, verifying the severity of the injury, and ensuring the claimant’s activities align with the limitations reported.

The impact of surveillance evidence

Evidence gathered by private investigators can significantly impact a workers’ compensation claim in New York City. Surveillance footage or photographs showing a claimant engaging in activities contradicting their reported injuries can lead to a denial of benefits. However, this evidence must be obtained legally and presented appropriately within the workers’ compensation claim process.

Common workers’ comp private investigator tactics

The process involves several key steps and methodologies, which are tailored to gather evidence about the claim, the circumstances of the injury, and the claimant’s condition post-injury. Common tactics include:

  • Surveillance in public areas
  • Social media and online activity checks
  • Background checks for former records of fraud
  • Medical records review
  • Co-worker and witness interviews
  • Workplace investigation

Hurt at work? Let us protect your rights.

It’s important to note that while workers’ comp investigations aim to identify fraud and protect the system’s integrity, they must also ensure fairness and due process for the claimant. In New York, the Workers’ Compensation Board provides guidelines and oversight to balance these objectives, ensuring that investigations are conducted ethically and legally.

If you’ve been hurt at work and are concerned you may be under investigation, contact The Weinstein Law Group, PLLC to speak with a lawyer and understand your rights.

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