Workers' compensation insurance is a critical safety net for employees injured on the job. Unfortunately, however, it can also be subject to fraud. As an employer, it's essential to understand how workers' compensation investigations work. At Peterson White, we're here to guide you through this process.
The Investigation Process: What Does It Involve?
Whenever an employee files a workers’ compensation claim, a claims administrator must review it, paying particular attention to the evidence presented and the circumstances of the injury. At that point, the claim may be approved or denied, or an investigation will begin.
A workers' compensation investigation starts when an employer or insurance carrier suspects that a claim may be fraudulent. This could be due to inconsistencies in the employee's report, a lack of witnesses, or a history of similar claims from the same employee.
The investigation aims to determine the validity of the claim. This involves gathering evidence, interviewing all parties involved, reviewing medical records, and sometimes surveillance.
Key Areas Investigators Focus On
Investigators look at several areas during a workers' compensation investigation. These can include:
1: Employee Statements
Investigators will review the employee's account of the incident. They'll look for inconsistencies in the story or discrepancies between the employee's version of events and medical reports.
2: Witness Interviews
If there were witnesses to the accident, investigators would interview them to verify the employee's account. They'll ask questions about what they saw and whether it aligns with the reported injury.
3: Medical Record Review
Investigators will scrutinize medical records to confirm that the injury is consistent with the reported accident. They'll also check if the employee sought immediate medical attention after the incident.
In some cases, investigators might use surveillance to observe the claimant. This step is taken if there are serious doubts about the legitimacy of the claim.
Identifying Workers' Compensation Fraud
Workers' compensation fraud occurs when someone knowingly makes false statements or conceals information to receive benefits. Examples include:
- Exaggerating the extent of an injury
- Claiming a non-work-related injury occurred on the job
- Working while receiving benefits without reporting income
How Peterson White, LLP Can Help: (855) 919-4124
At Peterson White, LLP, we understand the complexities of workers' comp investigations. Our experienced team of Knoxville workers' compensation attorneys can help employers navigate these processes, ensuring that legitimate claims are honored while preventing fraudulent ones.
We offer cost-saving representation that benefits employers, carriers, and self-insureds. Our firm has a proven track record in providing expert guidance throughout workers' compensation investigations, ensuring compliance with all legal requirements while safeguarding your business interests.
Knoxville Workers' Compensation Attorneys
Don't let the complexities of workers' compensation investigations overwhelm you. Reach out to Peterson White, LLP today for professional, knowledgeable assistance that puts your business first: (855) 919-4124.