Workers Compensation Investigations: What You Should Know

April 13, 2021
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Many employees are aware they are covered by workers compensation insurance in case of a workplace accident but hope never to need it. Unfortunately, work accidents happen in the blink of an eye, often leaving employees injured and needing financial assistance. The workers compensation process involves numerous steps, including an investigation. Some cases will require a more thorough investigation for suspicion of workers’ comp fraud. 

If your claim is under investigation, don’t hesitate to contact Rue & Ziffra right away for additional assistance.

What is Workers Compensation?

Workers compensation is a type of insurance most employers are required by law to carry for their employees. If you suffer an injury while at work, you may be entitled to file a workers’ compensation claim to receive benefits. Florida workmans' comp benefits include:

  • Medical Expenses
  • Lost Wages
  • Temporary Total Disability
  • Temporary Partial Disability
  • Permanent Total Disability

If an employee dies as a result of a workplace accident, workers’ compensation may pay death benefits. 

It is important to note that employees covered by workers compensation insurance are not entitled to sue their employers. Unless a third party was involved in your workplace accident, generally, the only way to recover from injuries is through a workers compensation claim. This elevates the importance of reporting your accident on time and consulting with a workers’ compensation attorney, as these steps will increase your chances of an approved claim.

Filing a Workers Compensation Claim

The first step after a workplace accident is seeking medical attention. Give the physician details of your accident. Then, whenever possible, notify your employer of what’s occurred. You have only 30 days to notify your employer. 

After your employer is aware of the work accident, they will file a claim with their workers’ compensation insurer. The insurer will then contact you directly regarding your workers’ compensation claim. From there, the insurer will review your claim and issue an approval or denial. While the workers’ comp process can be relatively quick and easy, it's common to encounter bumps along the way.

The Workers' Comp Investigation Process

Workers’ compensation insurers always investigate claims to determine an employee’s eligibility for benefits. The typical investigation can include:

  • Reviewing the details of the accident
  • Reviewing medical reports
  • Ordering further medical examination

The insurer will look for reasons to deny your claim, such as by claiming that your injury was preexisting or that it did not actually happen at work. If this occurs, you need a workers' compensation attorney to defend your rights.

Workers' Compensation Fraud

While the regular workers’ comp investigation process is straightforward, in certain circumstances, the insurer may suspect workers’ compensation fraud, and an additional investigation may occur. Many situations may lead an insurer to believe fraud is present, including:

  • The injuries are not consistent with the employer’s account of the accident
  • There were no witnesses to the work accident
  • The employee did not seek medical attention right away
  • The employee failed to report the accident on time
  • The employee is seen partaking in activities that would otherwise be difficult with their injuries
  • The employee is claiming a non-work-related injury as being work-related

Even the most minor detail or inconsistency can lead an insurer to believe workers’ compensation fraud is at issue. If you are suspected of workers’ comp fraud, the insurance company may take additional measures to investigate you and your claim, including:

  • Photo or video surveillance
  • Looking into your social media accounts
  • Speaking to those around you, including friends and family

Workers’ compensation fraud is not to be taken likely, as your benefits are dependent on the outcome of the investigation. A workers’ compensation attorney can help you combat these allegations and get the benefits you deserve.

Who to Help Prove Your Workers' Comp Claim

Even if your claim is under investigation, there are certain steps you can take to help move the process along. These include:

  • Ensuring all required forms and documents are correctly completed
  • Providing additional evidence or relevant information
  • Cooperating with the insurance company

It is also wise to consult with a qualified workers’ compensation lawyer. An attorney is thoroughly familiar with the workers’ compensation process and may provide helpful information or assistance to get you the benefits you seek. If you have any doubts or want additional help, a workers’ compensation attorney is your best resource.

Consult With a Workers' Compensation Attorney Today

Workers’ compensation can be challenging to navigate. Often claims run smoothly and are approved quickly, but in other cases, claims may require a lengthy investigation or be denied altogether. Don’t leave it up to chance. Consult with a Florida workers’ comp attorney as soon as possible. Rue & Ziffra has been serving Volusia, Seminole, and Flagler County communities for over 40 years. We started our firm with a desire to help those who were wronged and needed our assistance in seeking justice. We provide each client with the care and attention they deserve while fighting aggressively for their rights. Our firm offers free consultations. Contact us today, and let’s discuss your case

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