Investigations are an essential part of the workers’ compensation process. Insurance companies or the state might conduct investigations to determine the validity of claims and the extent of workers’ injuries. Most workers’ compensation cases involve some investigation, affecting how long a case takes to resolve and whether a worker receives benefits.
Here are the top five things to know about New York workers’ compensation investigations to give insight into how the system works and help you avoid the common pitfalls. Understanding investigations and other parts of claims can also tell you when you need an experienced attorney to protect your interests.
1. What Workers' Compensation Investigators Are Allowed To Do
There are several things that workers’ compensation investigators are allowed to do to determine whether your claim is valid. Some of the steps they may take include the following:
- Review any videotape of your accident
- Talk to witnesses
- Observe you in public places, conduct surveillance, and take pictures and video
- Scan your social media
- Talk to neighbors, family, and friends
- Call you or knock on your door to ask for information
- Review your medical history for pre-existing conditions
There are limits to what’s allowed in New York workers’ comp investigations. Investigators cannot hack your social media accounts, trespass on your property, or pose as someone else to collect information.
If you are an undocumented worker, an investigator or other party may falsely tell you that you cannot collect workers’ compensation. Your immigration status does not bar you from workers’ compensation in New York.
If you think that an investigator is breaking the rules, contact our experienced NYC workers’ compensation lawyers so we can advise you on the next steps.
2. Are All Workers' Compensation Cases Investigated?
Your employer’s insurance company will most certainly do some kind of investigation when evaluating your claim. The extent of that investigation will depend on the particular circumstances of your claim. However, if the insurer suspects fraud, it usually will conduct a more extensive investigation.
The New York Workers’ Compensation Fraud Inspector General might investigate your claim if someone files a fraud complaint. A state investigation could result in the recovery of payments and criminal charges.
An investigation won’t necessarily harm your chances of getting benefits. Investigations by insurance companies may just be the result of one or two red flags that are easily explainable.
If you are honest about your injury and how it occurred but are still under investigation, contact our attorneys for a free consultation. We can contact investigators on your behalf when appropriate, gather evidence supporting your claim, and fight for the benefits you deserve.
3. When Workers' Compensation Claims May Be More Likely To Be Investigated
Some circumstances increase the chances that you’ll face an investigation of your workers’ comp claim or that the investigation will be more thorough. Some problems in your case that can lead to further scrutiny include the following:
- There are inconsistent statements about how your accident occurred.
- You filed your claim after a negative performance review, denial of time off, termination, or other action.
- There were no witnesses to the accident.
- You are difficult to reach.
- You have a history of workers’ comp claims.
- You delayed filing your worker’s compensation claim.
None of these factors mean you filed a false claim. They simply indicate to the insurance company that your case needs further investigation. Even with these potential red flags, the investigator still needs objective evidence that you filed a false claim.
If the insurance company denies your claim or you feel an investigation will result in a denial, contact our workers’ compensation law firm immediately so we can answer any questions you may have.
4. How Long a Workers' Compensation Investigation Takes
Every workers’ compensation investigation has unique circumstances, and there is no fixed workers’ comp investigation timeline. Some things can complicate an investigation and your case, such as a dispute over how your accident happened or the severity of your injuries and their impact on your ability to work.
A delay in your final diagnosis may also complicate a workers’ comp investigation and the resolution of your claim. A doctor can’t decide on permanent disability, for example, until you have reached maximum medical improvement. This determination can take months or years, depending on your injury.
The number of circumstances that an investigator or insurance company considers suspect can also impact the length of a New York workers’ comp investigation. Takes these four steps after a work accident to help prevent potential problems. If you seek medical help immediately, report your accident right away to your employer, file your claim quickly, and hire a skilled workers’ compensation attorney, your claim should go more smoothly.
Your workers’ compensation may overlap with a personal injury case against a third party, impacting the time it takes to investigate and settle your claim. Our experienced attorneys can handle both of your claims to keep things running smoothly and help you negotiate with multiple insurance companies and other parties.
5. What Workers' Compensation Investigators Look For
Workers’ compensation investigators may take several steps to pick apart your case and look for signs your claim isn’t valid. They’ll look for signs that your claim doesn’t match your day-to-day activities by talking to people, observing you, and canvassing your medical record to determine if your claim aligns with your diagnosis and treatment.
Some things that an investigator may specifically look for include the following:
- Social media posts showing you engaging in activities that your injury should preclude
- Conversations with neighbors or friends that indicate your injury isn’t as serious as you claim
- Video or photo surveillance showing you doing things your injury should prevent
- Visits to a doctor not approved by workers’ comp, indicating you have a pre-existing condition
- Fellow employee testimony suggesting you contributed to your accident
Investigators can easily misinterpret evidence, which the insurance company can use to deny your claim. You need an experienced workers’ compensation attorney with the skill and knowledge to investigate your claim thoroughly. Our attorneys will meet the deadlines for filing your claim, deal with the insurance company, and fight for a fair claims resolution. If necessary, we will file an appeal and vigorously represent you during the complicated process.
Shulman & Hill Is Here To Help You Throughout Your Workers' Compensation Investigation
Our award-winning workers’ compensation attorneys can advise you at every step of your workers’ compensation claim, even if your claim was originally denied. We have over a decade of experience helping New Yorkers deal with insurance companies and the complex New York workers’ compensation investigation and claims processes.
Partner Alex Shulman is a member of the NY Injured Workers’ Bar Association, and our attorneys have won recognition from several respected organizations and publications, including the following:
- National Trial Lawyers Top 40 Under 40
- Super Lawyers Rising Stars
- Attorney and Practice Magazine Top 10 Plaintiff’s Personal Injury Award
- American Institute of Legal Counsel 10 Best Workers’ Compensation Law Firms for Client Satisfaction
Testimonials and Results
We pride ourselves on our client-centric approach to the law and are honored by testimonials praising our communication, hard work, and ability to get results. We’ve recovered over $500 million for thousands of deserving clients. Some of our notable settlements include $2.5 million for a non-union laborer seriously injured by improperly secured rebar and $1.5 million for an undocumented day laborer severely injured during the uncontrolled descent of a steel beam.
If you are concerned about a workers’ compensation investigation or have other questions about a claim, call us at 212-221-1000 or complete our online form to schedule a free consultation.
