Workers' Compensation Surveillance: Who Is Watching You?

When you file a workers' compensation claim, you might be under more scrutiny than you think. Insurance companies often use surveillance, including hiring private investigators, to identify fraudulent claims and avoid paying even legitimate ones. Understanding how this surveillance works and knowing how to avoid giving them evidence against you is crucial.

When Does Surveillance Happen?

Surveillance can occur at any point in your case but is most common as your claim approaches or after you reach Maximum Medical Improvement (MMI). At this stage, the insurance company typically looks to settle your claim and will gather as much evidence as possible to reduce or deny your benefits. It’s important to note that hiring a private investigator costs the insurance company money, so not every case will be scrutinized this way. However, the likelihood increases for certain types of cases, such as:

• Claims that are allegedly not work-related
• Large and expensive claims
• Long-term wage benefit claims
• Claims for permanent total disability or high levels of permanent disability
• Cases with little improvement after ongoing treatment
• Claims without objective evidence of injury
• Suspected fraudulent claims

Signs of Fraudulent Claims

Insurance companies look for specific red flags that might indicate a fraudulent claim, including:

• New employees
• No witnesses to the injury
• Inconsistent statements
• Refusal of treatment
• History of filing workers' compensation claims

Even if none of these apply to you, random surveillance can still happen. Investigators might monitor you for several days, particularly when you’re likely to be in public, such as during a doctor's visit. However, surveillance can occur at any time of day or night, not just during typical working hours.

How Do They Conduct Surveillance?

Insurance investigations are tailored to the specific issues at hand. Methods include:

• Conducting background checks
• Comparing notes between doctors and other cases
• Setting up cameras to record you
• Following you in public
• Interviewing people who know you

With the prevalence of social media, investigators also collect evidence from your online activity. They’ll scrutinize your posts and those of your family and friends to find any contradictions to your claim. Remember, while investigators can use any legal means to gather evidence, they cannot break the law. This means no illegal recordings, hacking, or tracking devices.

What Is the Investigator Looking For?

Investigators are not necessarily trying to prove you’re not injured, but rather that you’re not as injured as you claim. They look for evidence of you violating medical restrictions set by your doctor. For example, if you’re not supposed to lift more than 10 pounds but are seen picking up your toddler, it can damage your case. Similarly, if you’re restricted from driving but are caught driving, it won’t bode well for your claim.

They also look for inconsistencies. If you limp into a doctor's appointment but are seen walking normally later, that’s a red flag. Inconsistencies between what you tell your doctor and the insurance company’s doctor can also be detrimental. Always be honest and consistent with everyone involved in your case.

What Should You Do?

To protect your workers' compensation claim, assume you are always under surveillance:

1. Follow your doctor’s orders: Adhere strictly to the medical restrictions imposed by your doctor.
2. Be mindful of your actions: Avoid doing anything that contradicts your injury claims, even out of habit.
3. Maintain honesty: Don’t overstate your restrictions to your doctor to ensure consistency with reality.
4. Manage appearances: Even if something seems harmless, like using a self-propelled lawnmower, it can be used against you if it contradicts your restrictions.
5. Communicate proactively: If you foresee situations where you might need to violate medical orders, discuss these upfront with the insurance company’s doctor. This transparency can reduce the need for surveillance.

Conclusion

Surveillance is a common tactic used by insurance companies to scrutinize workers' compensation claims. By understanding when and how it happens, and what investigators are looking for, you can better protect yourself and ensure your claim remains valid.

If you or a loved one have been injured on the job and need expert legal advice, contact Rex Zachofsky, a seasoned workers' comp attorney in New York, at 212-406-8989 for a free consultation. This conversation is confidential, costs you nothing, and can potentially secure you significantly more benefits than you might otherwise receive.

For more insights on workers' compensation, check out our other resources, including a video on the optimal time to settle your case for the highest possible amount and arm yourself with the knowledge to maximize your benefits.

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