Let's pull back the curtain and reveal the dirty tricks insurance companies use to undermine workers’ comp claims, based on firsthand experience and real cases.
One of the biggest tricks insurance companies pull is surveillance—and not just snapping a photo or two. We're talking full-on tailing you, recording your day-to-day, and hoping to catch you doing something they can twist to hurt your case.
Here’s how it usually goes: after your Independent Medical Exam (IME), they know your name, your car, and where you’ll be. From there, they might send a private investigator—often a retired cop—to follow you around. Grocery store runs, hanging with your kids, even answering the door for a fake apartment showing—they’ll use any of it to try and prove you’re not really injured.
And it gets sneakier. Sometimes they won’t even show the footage—they’ll just say they have it to freak you out and pressure you into settling. The moment they toss out the word “fraud,” it puts doubt in people’s minds—judges included.
In a perfect world, your recovery would come first. But in workers’ comp, insurance companies are more focused on saving money—so your medical care turns into a fight.
One of their go-to moves is the IME—Independent Medical Exam. Sounds fair, right? It’s not. These doctors are paid by the insurance company, and their job is often to say you're fine when you’re not. They'll say you don’t need more treatment or that you've hit “maximum medical improvement” even if you're still in pain.
Then there’s the paperwork. They’ll hit you with HIPAA forms and medical releases so they can dig through your history and blame your injury on something from years ago. Hurt your back at work? If you had a strain five years ago moving a couch, they’ll call it a “pre-existing condition” and try to reduce what they owe.
They also love to stall—slow approvals, picky paperwork demands, and bogus denials. Even if your doctor says you need surgery, they’ll find a reason to delay it. They’re hoping you’ll get tired, broke, or desperate enough to settle for less.
And even when they do approve treatment, watch for the “without prejudice” label. That means later on, they might argue they never should’ve paid—and stick you or your doctor with the bill.
Insurance companies know that dragging out your case puts the pressure on you—not them. The longer things take, the more likely you are to settle for less just to get it over with. And they use that to their advantage.
Let’s say your doctor requests surgery. The insurance company has a deadline to respond—but they’ll take every single day they’re allowed. Then they’ll ask for “more info” just to restart the clock. Meanwhile, you’re stuck waiting and in pain.
They pull the same stunt in court—claiming they need more documents or testimony, just to stall. It’s all meant to wear you down.
There’s even a name for it: “starving you back to work.” They hold off on paying as long as possible, hoping you’ll give up and go back before you’re ready.
And be careful with approvals that come “without prejudice.” That means they might pay for something now, like a surgery, but later say it was never their responsibility—leaving you or your doctor stuck with the bill.
If there’s one place insurance companies get sneaky, it’s with the math—specifically, your Average Weekly Wage (AWW). That number sets how much you get paid, and they’ll do everything they can to keep it low.
Your AWW should include everything you earned in the 52 weeks before your injury—overtime, bonuses, housing, even stuff like a free apartment or work car. But employers and insurers often leave things out, whether it’s a mistake or totally on purpose.
One trick? They ignore income from side jobs or only report what you made at one site when you worked at several. We’ve even seen employers submit fake numbers or use someone else’s lower pay—like a worker who’s also out hurt—to set your rate.
And of course, there’s the lowball settlement offer. They’ll throw out quick cash early on, hoping you’re stressed enough to bite—way before you know what your case is really worth.
Getting hurt at work can feel like a total mess—pain, paperwork, and not knowing what’s next. But the good news is, there are simple ways to protect yourself right from the start.
First: document everything. Text your boss, email HR, save voicemails—anything that shows you reported the injury. One quick message like “Hey, I just fell off the ladder—heading to urgent care” can make or break your case.
Not into paperwork? Use your phone. Record a voice memo with what happened, who you told, and where you went for treatment. Done.
Next, talk to your doctor—and don’t hold back. Mention every issue, even the ones that pop up later. Limping from a knee injury and now your back hurts? Using crutches and now your shoulder’s shot? That’s called a consequential injury, and it only counts if it’s in your medical records.
Also, be upfront about past injuries. If you had a similar issue years ago, say so. Hiding it can tank your case fast.
And make sure you know what your pay really includes. Your average weekly wage isn’t just your base pay—it should count overtime, tips, housing, second jobs, all of it. If you earned it, your lawyer can fight for it—but only if you speak up and share the proof.
Biggest tip of all? Call a lawyer early. Not after your claim gets denied. Not when you’re desperate. Call right away—before anything snowballs.
If you’ve got questions about your case, something doesn’t feel right, or you’re just not sure what to do next, give me, Rex Zachofsky, a call at 212-406-8989. I’ll do everything I can to point you in the right direction, whether you end up hiring me or not.
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