In 2019, insurance companies paid out of $48 million in workers’ compensation insurance claims to over 625,000 filings. That number represents a steady decline in workplace injuries as employers become more conscientious about workplace safety.

What do they look for in workers compensation investigations?Thanks to federal and state regulations, workers in New York enjoy not only the safest working conditions ever but also a promise of a fair, complete workers’ compensation package in case they are injured.


However, the lowering of coverage may also be in part to one disturbing trend: insurers’ increasing commitment to reducing and denying claims. One of the unpleasant facts of life is that insurance companies seek to make a profit by not paying out on claims. 


While workers’ comp fraud does happen, these cases make for only one or two percent of all claims. More often than not, claims are rejected due to avoidable mistakes made when filing. That’s why a New York workers’ compensation attorney should assist you during the claims process, especially if you are being investigated by the insurance company.


Our attorneys at The Weinstein Law Group have over 35 years of experience successfully winning workers’ comp claims for their clients. Give us a call at 212-741-3800 or contact us online to set up a free, no-risk consultation today.


To help you understand what you might be up against, here’s some information regarding workers’ compensation investigations and what they look for.


Investigating workers’ compensation fraud


The popular image of a private investigator as a hard-boiled gumshoe solving cases the police cannot is largely fiction. Most private investigation is done by teams of thorough administrative types at the behest of insurance companies. While some private investigators work with attorneys and some insurance companies employ their own investigators, the bulk of cases are contracted out to private agencies, not individuals.


For the most part, this need for resources means insurance companies would rather pay a small claim than hire an investigator, especially if the injured party gets back to work quickly. However, for a severe injury that will require a large or ongoing payout, insurance companies will make sure every i is dotted and t is crossed before paying out a penny. Investigators must follow the law and what they can observe is limited, but they can use the following sources of information to aid in their research:


Security video surveillance

Most medical offices have video cameras watching their parking lots. Since healthcare providers are chosen by the insurance companies paying the compensation, investigators will have access to the surveillance video. They’ll scrutinize these videos trying to catch a claimant who is faking injuries the moment they approach the doctor’s waiting room.


Non-video surveillance

Investigators are not allowed to break the law with the illegal observation of a private residence, since this would impede the company’s case against paying a claim. That being said, once you leave your home, they can observe you wherever you go in public spaces. So long as they remain discreet, they can follow a mark anywhere. 


Even if your claim is legitimate, it’s a point in the company’s favor if the investigator reports you were moving without pain when you reported a knee injury on the job. 


To spot investigators, be aware of your surroundings and trust your instincts. Look for people wearing obvious obscuring accessories like glasses or ball caps who continue to show up where you go. Better yet, obey doctor’s orders by minimizing public trips and by using any prescribed medical devices, such as a brace or cane.


Standard investigative techniques

Investigators cannot break the law to get information. They can’t break into your house or misrepresent themselves in person or on the phone. They can, however, interview your friends, family, or even anyone who leaves your house, like someone delivering a package or a visit from a medical professional. Piecing together this information, an investigator can look for inconsistencies in your statements or possible evidence of fraud.


Social media surveillance

Along with everything else, the ubiquity of social media has had a massive, lasting impact on workers’ compensation claims. Investigators will check any public social media postings available, so use common sense when posting online. Avoid discussing your injury or claim in any form. It’s smart to say very little on social media, and best to say nothing at all. Consider a complete social media hiatus until your claim is resolved.


How to help yourself

Apart from being aware of insurance investigators, there are several ways a claim can be denied on technicalities. For example, the most important thing you can do is follow the doctor’s orders to the letter. If you’re told to not walk on a wrenched knee, for instance, don’t walk on a wrenched knee even if on crutches or a walker. 


Be clear on the details of your accident, and don’t speculate if you aren’t sure about specifics. Investigators look for discrepancies in the story and forgetting details can scuttle the claim. Any time you have to discuss your accident, keep the details concise and simple.


If you file your claim in writing, make sure it’s clearly written and isn’t covered with corrections. Like with verbal evidence, keep the story concise and uncomplicated, only reporting the basic facts. Fill out all forms completely, neatly, and on time. Don’t wait to file a claim. Cooperate with the claims administrator handling your case, and always keep your cool any time you are responding to questions.


And while the day you file your claim isn’t something you can control in many circumstances, do know that insurance investigators often look at the timing of a claim when searching for fraud. For example, claims filed on the weekend or before a vacation often raise a red flag. 


Furthermore, if a worker has a poor attendance record or has been written up at work, they may draw more scrutiny. Insurance companies will look for any crack in a claimant’s story to keep from paying a claim, such as a motivation to avoid work while collecting benefits, so don’t give them one.


The best thing you can do when dealing with investigators? Call a New York workers’ compensation lawyer

Knowing about workers’ compensation investigations and what they look for is just part of the equation.


Pursuing a workers’ compensation claim is a complicated, trying experience. Filing a claim is usually done after you’ve been injured seriously and are receiving medical care or worrying about losing income. 


It’s something that any typical person would need help with, and that’s where The Weinstein Law Group comes in. Our New York workers’ compensation attorneys have the experience and determination to help you seek a favorable resolution to your claim, and they will always treat your case as a high priority. 


Our attorneys are waiting to get started on your case. Call us at 212-741-3800 to set up a risk-free consultation today. The longer your wait, the harder it is to get the compensation you need.

Looking for more information? Here are some related articles :

What does workers compensation cover?

What is workers’ compensation benefits?

What does a workers’ compensation defense attorney do?