A workers’ compensation case in theory should be easy, fast, and stress-free for an injured worker. You have the right to seek compensation after getting hurt at work, and you should be able to do so without being threatened, becoming the target of unfair workers’ compensation investigations, or being treated like a criminal.
However, this is how many workers’ compensation insurance companies protect their profit margins. They aggressively seek out fraud and perpetuate the idea that workers’ compensation scams are widespread, even though most workers’ compensation cases are legitimate. If you file a workers’ compensation claim and become the target of a fraud investigation, you need the help of an experienced workers’ compensation attorney.
It is important to note, most times an outright allegation of fraud does not occur, most often you can conclude if your claim has been denied or ?under investigation?, many elements of a fraud claim should be anticipated as defenses to your claim. Also, if such response has occurred from defendants, you need an experienced workers compensation attorney to review your claim and medical records to see what possible deficiencies or issues you have.
Do You Need a Lawyer if Your Company Suspects You of Workers’ Comp Fraud?
Finding out that your company or their insurance provider suspects you of filing a fraudulent workers’ compensation claim is extremely stressful. This is a common tactic used by insurance companies to pay out fewer claims. Many individuals, fearful of how long an investigation could take or what it might lead to, simply withdraw their claim. They are left either paying for medical care out of pocket or not getting the care they need.
It is essential that you hire a workers’ compensation lawyer if you are being investigated for fraud. An investigation could have serious consequences for you. If the investigator finds any evidence that your claim is not valid, they can deny your claim and refuse to pay for medical expenses or lost wages. If they believe that intentional fraud has been committed, they may even pursue charges against you.
Unfortunately, when not experienced in the realm of refuting allegations made against you, you may be doing more harm than good. It is easy to unintentionally weaken your workers’ compensation case. The information you provide to an investigator or insurance adjuster cannot help you; it can only hurt you. While you may think that you?ll be safe if you tell the truth, insurance companies are extremely skilled at manipulating information to suit their own interests. No matter how serious your injury is, the company will often try to claim you were not injured at work and have committed fraud. When you work with attorney Cerid Lugar, you can avoid common mistakes, provide necessary information without damaging your case, and improve your chances of an uneventful investigation that validates your claim.
When Does Workers’ Compensation Hire Private Investigators?
When you are targeted by an investigation, you may be confused and wonder what can trigger an investigation. Often you may not even know that they are investigating you for fraud. It is not as if they are required to disclose such information to you. Several situations or ?warning signs? can lead to a fraudulent workers’ compensation claim investigation:
- No one witnessed the accident in which an employee was injured,
- The employee has received multiple diagnoses or conflicting information after getting multiple medical opinions,
- The employee did not seek medical attention in a timely manner or did not report the incident to their manager immediately,
- There are inconsistencies in the workers’ story,
- The claim occurred right after a worker was terminated or disciplined for poor performance,
- The injuries suffered by an employee do not match the work they were hired to do,
- It is difficult to contact the employee while they are away from work,
- The medical record does not mention a work place injury, and
- The employee has been spotted engaging in activities that would be impossible with their injuries
While many of these ?warning signs? can effectively detect workers’ compensation fraud cases, they can also snare innocent workers who were hurt while on the job and not versed in the rules to follow when injured. For example, an employee who often works alone would likely not have anyone who could testify about their accident and subsequent injuries. Inconsistencies in a workers’ story could occur if they suffered a traumatic brain injury and had memory loss or confusion. Inconsistencies is one of the most manipulative tactics that is used for hearings and most often it is words pulled out of context. Proper rebuttal of evidence and designation of deposition testimony can assist in responding to an inconsistency claim as well.
How Workers’ Compensation Investigations Target Employees Unfairly
Many people believe that innocence is an absolute defense when it comes to workers’ compensation fraud. If they have done nothing wrong, then what can an investigator find out?
As it turns out, there is a lot that workers’ compensation investigations can do. Many times, the information they gather is inaccurate or irrelevant to the case. Consider, as an example, an employee who injured their lower back at work. Their doctor might recommend light exercise to stretch their back and start to build strength and mobility. The workers’ compensation investigator ?catches? them swimming or taking a long walk and uses it as evidence that they are not truly injured. An investigator could uncover positive social media posts and use them to claim that the employee is not in as much pain as they claim, even though social media posts are often not a true reflection of someone?s life.
The fact is workers’ compensation investigator surveillance can do significant damage to your case and your reputation at work ? they can investigate without you knowing it as well. The sooner you reach out to a Roanoke workers’ compensation rights attorney, the sooner you can protect your rights and your ability to receive compensation.
Let Us Help With Your Workers’ Comp Fraud Accusation
Workers’ compensation outright fraud allegation cases are uncommon, but that will not stop insurance companies from investigating injured employees nor alleging certain elements suggestive of fraud in the underlying workers compensation case. If your company?s insurance company has decided to investigate you (and you know it), reach out to a lawyer who can answer your questions, help you prepare for the workers’ compensation process, and limit your contact with the insurance company. If you have been accused of falsifying workers’ compensation claims, we can help you prove the validity of your case.