Getting hurt on the job can turn your life upside down. You count on workers’ compensation to help you recover, medically and financially. But if your claim gets flagged for fraud, everything changes fast. Suddenly, you’re facing a workers’ compensation fraud investigation
Fraud investigations are serious. Even if you’ve done nothing wrong, being under investigation can feel like you’re already being accused. That’s why knowing your rights and taking the proper steps is important.
Understand What Triggers an Investigation
Not every workers’ compensation claim gets investigated. But certain things raise red flags. Insurance companies may take a closer look if:
- Your injury lacks witnesses
- Your accident wasn’t reported right away
- Medical records don’t match your claim
- You have a history of claims
- Someone reported suspected fraud anonymously
Even something as simple as returning to physical activity too quickly (and posting it online) can bring attention. Insurance companies are trained to spot inconsistencies. Sometimes they’re wrong, but you still need to be prepared.
Don’t Ignore the Investigation
It might be tempting to hope it all blows over—but that’s a mistake. Investigators might already be watching you. They may review your social media, talk to coworkers, or even conduct surveillance outside your home. If they contact you directly, take it seriously. Stay calm, be polite, and don’t try to explain too much on your own.
You have the right not to speak with an investigator without legal guidance. Use that right.
Stick to the Facts
Honesty is critical. That doesn’t mean offering more information than necessary, but giving accurate, consistent answers. Don’t exaggerate your injury or try to “sell” your story. Just explain what happened as clearly as possible, the same way every time.
Talk to your doctor if something in your medical records is incorrect or unclear. Medical misstatements—like claiming you were injured at home—can derail your claim even if they were just a mistake.
Keep Detailed Records
When you’re under investigation, good documentation becomes your best friend. Keep copies of:
- Medical records
- Doctor’s notes
- Work incident reports
- Communications with your employer or insurance
- Any paperwork related to your claim
Write down everything you remember about the incident while it’s still fresh. If you get a call or visit from an investigator, note the time, date, and what was said.
Watch What You Post Online
Social media can hurt your claim more than you realize. Insurance companies regularly monitor platforms like Facebook, Instagram, and TikTok. A photo of you lifting groceries or attending a social event—no matter how innocent—can be used to argue that your injuries aren’t as bad as you claim.
While under investigation, it’s best to stay off social media altogether. At the very least, update your privacy settings and avoid posting about your health, work, or daily activities.
Don’t Face It Alone
Workers’ compensation fraud is a criminal charge. The process can affect your benefits and reputation even if you’re cleared. Having someone who understands the system is crucial.
A knowledgeable attorney can help protect your rights, guide you through the investigation, and speak on your behalf when needed. That’s not just about avoiding criminal charges—it’s also about making sure your claim stays on track and your medical needs are met.
Take Action Early
If you learn you’re being investigated for workers’ compensation fraud, don’t wait. The earlier you act, the more options you’ll have. Protecting your benefits and future starts with making smart decisions today.
If you’re facing a workers’ compensation fraud investigation or think one may be coming, contact Shugarman & Mehring. We can help you understand your situation and take steps to protect your rights.
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