What do workers’ compensation insurance companies do to attempt to show that an injured employee isn’t as injured as the employee says?
When a workers’ compensation insurance investigator is trying to disprove the extent of an employee’s injury, their investigation may be as simple as just knocking on your door and asking to speak with you.
If an injured worker claims that they are unable to work and an insurance investigator gets a video of them working, that would defeat the claim, and also may expose the injured employee to a claim of insurance fraud.
Most often when challenging workplace injury claims, when you’re in court, they’ll ask certain questions that they already have video of, to get the worker to say something that’s inconsistent with what’s on the video.
For example, in court, the insurance company lawyer may ask the employee is he or she uses their cane all the time. They try to get the employee to say that they do so that at the next hearing they can produce their video of the injured employee sometimes not sing the cane. That is an instance where insurance fraud may become an issue.
To prove insurance fraud, the workers’ comp insurer must show that the injured worker knew that he or she had made a material misrepresentation and that the benefits he or she received were as a result of that misrepresentation. That’s a difficult standard for insurance companies to meet.
Generally, if an injured employee is found to have committed fraud, he or she can be barred from receiving indemnity benefits. The employee’s medical treatment will still be covered, but they won’t be able to get wage loss benefits and they can refer the employee to a criminal investigation with New York State.
Q: Can a case that’s been resolved be reopened because information comes to light that the injured person was, for example, posting pictures of themselves dancing on social media?
Cases are usually never reopened. However, they may try to get you on record saying or doing something that is contrary to how you are living your life. If you’re out of work, you don’t have to stay in your house all day and become a shut-in.
However, if you go to court and say you’re a shut-in and they have videos of you doing stunts on a motorcycle, clearly that would be misrepresentation of the extent of your injuries.
Q: What if I’m found to be disabled for life, collect benefits, then get better?
If an injured employee is found to be permanently disabled, which is a difficult standard, someone may get payments for life, but the workers’ compensation law in New York changed in 2007 and most workplace injury claims no longer result in payments for life.
In most cases, where an injury victim is not able to go back to work, they’ll be found to have a permanent partial disability which will amount to a certain number of years based upon whatever percentage of disability they have.