Let’s be clear about something from the start: No employer likes to hear that an employee is injured and needs workers’ compensation. In addition, no insurance company likes to pay out even $1 more than necessary on a claim.
So, despite the fact that the majority of workers’ comp claims are legitimate, that doesn’t stop claims adjusters and investigators from “digging through dirt” to try to deny your injury claim.
What kind of dirt will an investigator try to dig up? It all depends on your case, but they may use:
- Recorded statements
- Doctor’s notes
- Depositions from co-workers
- Depositions from witnesses
- Your social media posts
- Background checks
- Covert surveillance
It all depends on what goals the insurance company has for your case.
So, what sets off an investigation into a workers’ comp claim? Here are some of the “red flags” that insurance companies typically look for that they claim signal a problem:
1. Late reports
Maybe you thought you just twisted your ankle but actually tore a ligament. You waited a week to see if it would heal before you found out how bad the damage was. That late report is a red flag.
2. Monday claims
You were tired, and you didn’t notice a spill on the shop floor, so you slipped and fell. However, the insurance company may decide that you were really attempting to blame a weekend injury on a workplace accident to milk the system.
3. No witnesses
You were alone when the accident happened. You realize that wasn’t convenient, but the insurer sees that as a huge sign you may be faking.
4. Changing details
Maybe you weren’t sure when you actually slipped a disc in your back, and you gave inconsistent answers when asked. You didn’t mean to be inconsistent, your memory just wasn’t clear. Well, to the insurance company, that’s clear proof you’re lying.
5. You’re a malcontent
Have you mouthed off to your boss? Complained about working conditions? Well, naturally, the insurance company believes you’re just faking that back injury to get even.
The reality is that accidents at work happen, and they usually aren’t convenient, tidy and easy to prove. If you’re having trouble with your workers’ comp claim because circumstances threw up a “red flag” to the insurer, protect your rights with legal advice.