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How Does an Insurance Company investigate my Workers Compensation Claim?

What Does it Mean When Your Connecticut Workers' Compensation Claim is Under Investigation?

When employees are injured at work in Connecticut , they should have the right to receive workers’ compensation benefits. However, obtaining these benefits is not always easy. Insurance companies are in the business of making money. They often try to reduce, delay or deny claims. One way they do this is by telling injured workers that their claims are “under investigation.”

If a claim is under investigation, the workers compensation insurance company for you employer will file a Form 43 .  This means that the insurance company will not pay for medical care or pay only a limited amount for medical care until a decision has been reached on the validity of your worker's compensation claim  A seasoned Connecticut work comp lawyer at the law offices of James F. Aspell, P.c. can help those hurt on the job while their Connecticut work injury claim is under investigation and work hard to challenge the insurance company's efforts to deny compensation.

Why Are Some Connecticut Workers' Compensation Claims Investigated?

A workers' compensation claim can be investigated at any point during the claims process. However, an investigation is most likely to happen at the beginning of a claim, or shortly after the worker reports the accident and injury to his or her employer. Typically, an insurance company will launch the investigation if it suspects that the worker is trying to commit workers' compensation fraud.

In some cases, an insurance company may suspect fraud on the part of the employer. For instance, the employer may wrongfully refuse to pay disability benefits, or it may retaliate against employees because they have filed a workers' compensation claim or provided a statement or testimony in support of a co-worker's claim.

What Happens During Workers' Compensation Claim Investigations?

An insurance company may take many steps when it investigates a workers' compensation claim. The insurer may hire a private investigator, or it may have one of its own adjusters follow the injured work in order to surveil them. During this phase, the insurance company wants to find evidence that the hurt worker is not as injured as the worker claims.

For example, an injured worker may claim that he suffered a severe leg injury from an accident that occurred on the job. The insurance company may look for evidence that the worker is engaged in physical activity. If the insurer obtains video footage of the worker playing basketball at the gym, it would greatly undermine the worker's claim for medical and/or disability benefits.

The insurance company may also work with accident reconstruction specialists. These professionals can examine all available evidence, recreate an accident scene and determine if the alleged accident would have resulted in the same type of injuries which a worker claims to have suffered.

An insurance company may also perform a background check. This type of background check is different from the type which employers may conduct before they hire someone. Instead, the insurance company will look at the worker's prior workplaces and employers and see if the worker has a history or pattern of filing workers' compensation claims. If so, the insurance company may use the worker's background against him or her and argue that the worker is trying to “game the system” and collect benefits which the worker does not deserve.

What Should You Do If Your Workers' Comp Claim Is Under Investigation?

Learning that your workers' compensation claim is under investigation can be scary. You know that you have a valid claim. However, you may feel like the insurance company is questioning your honesty and integrity. Here are a few tips which you can follow in order to get through the process as smoothly as possible:

  • Communicate with the insurance company – If the insurance company makes requests for information in order to process your workers' compensation claim, then you should cooperate while, at the same time, avoiding steps that would compromise your rights. This can be a difficult balancing act. For that reason, you should allow your lawyer to handle these communications. If you ignore the insurance company, it won't help you.
  • Collect all documents – You should collect and keep any documents that will help you to prove your work-related injuries such as medical records. Also, you should keep copies of any documents, including e-mails, which your employer, the insurance company or the Virginia Workers' Compensation Commission sends to you. Make sure to forward these documents to your attorney as the investigation of your claim moves on.
  • Continue to see your doctor – You should also continue to see your doctor for any treatment you need. If you do not, your injuries could become worse. It could also provide the insurance company with additional reasons to deny your claim. The insurance company may assert that you cannot be as injured as you claim because you have stopped getting medical treatment. Too many applicants stop treatment because they cannot afford them without workers' compensation benefits. However, you can work out those issues at a later time.
  • Communicate with your employer – Finally, you (or your lawyer) should try to stay in regular contact with your employer. You should keep the employer advised of the status of your injuries and of your expected return to work (if you have reason to believe that a return will be possible).

Is Your Claim Under Investigation? Our Hartford, Connecticut Workers Compensation Lawyers Can Help

It can be intimidating and discouraging to learn that your workers' compensation claim is under investigation by the insurance company. If this has happened to you, it is crucial that you speak to one of our experienced workers' compensation lawyers at James F. Aspell, P.C. We will know how to collect evidence to establish your right to benefits and counter any attempts by the insurance company to deny or delay your claim. Additionally, we can handle all communications with the insurance company, which allows you to focus on what's most important: your health and recovery.

If you have been hurt on the job in Connecticut, please call us any time  to discuss your case. We can provide a free consultation through our Farmington, Ct workers compensation office.


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