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Florida Keys Injury Lawyers > Blog > Workers Compensation > Florida’s Workers’ Compensation Investigation Process

Florida’s Workers’ Compensation Investigation Process


In Florida, employees can recover workers compensation benefits after suffering an injury while on the job. Often, workers compensation benefits can amount to thousands of dollars. Unfortunately, some workers take advantage of the system because of the huge payout that an employee can recover after filing a workers compensation claim. Some employees file fraudulent claims. In order to try and prevent fraud, insurance companies often conduct workers compensation investigations.

Even if yours is a genuine workers compensation claim, you may find yourself under investigation. If you have a Florida workers compensation claim that is under investigation, it is vital that you retain the services of a qualified workers compensation attorney. Although insurance companies conduct workers compensation investigations to identify fraud, insurance companies are known to deny even genuine claims at the slightest doubt. Also, one mistake during the investigation process could lead to you not recovering benefits.

Florida’s Workers Compensation Investigation Process

Usually, insurers will investigate a workers compensation claim to determine if an employee is eligible for workers compensation benefits. Often, this investigation includes;

  • Reviewing the accident details
  • Reviewing medical reports
  • Conducting further medical examination

If during the process of investigating the claims administrator suspects fraud, a further investigation will be launched, and investigators will use several methods to look for evidence of fraud. Below are some of these methods;

  • Video surveillance
  • Online surveillance
  • Interviews

If an investigator determines a claim is fraudulent, they will deny it. However, it is possible to file an appeal.

What Is Workers Compensation Fraud?

A worker commits workers compensation fraud when they willfully lie in order to recover workers compensation benefits. Below are some examples of acts that constitute workers compensation fraud;

  • Faking an injury or illness
  • Claiming that an injury that is not work-related is work-related
  • Exaggerating the severity of injuries to collect more money or prolong benefit payments
  • Claiming reimbursement for medical treatment never received

The following are some of the situations that may lead an insurer to believe that a worker has filed a fraudulent workers’ compensation claim;

  • Failure to seek medical help immediately after an accident
  • Injuries not being constituent with an employee’s version of the accident
  • No witnesses to the incident
  • Failure to report the accident within thirty days as per Florida law
  • An employee engaging in activities that they should not be participating in, given their injury

Even if you have a legitimate worker’s compensation claim,  delays in seeking medical help might give the insurance company the impression of fraud. Additionally, even minor inconsistencies in your version/timeline of events might result in you being suspected of fraud.

Being suspected of workers compensation fraud is not something you should take lightly. Even if your claim is legit, you need to hire an attorney if you are being suspected of fraud. Investigators are known to be intimidating, especially during interviews. So even if you are innocent, you may be intimidated to the point of making inconsistent statements that could affect the outcome of the investigation. With the help of an attorney, you can avoid this. An attorney can help you get the benefits you deserve.

Contact a Key West & Marathon Workers Compensation Lawyer

If you have a pending Florida workers compensation claim and are worried that your claim may be denied, contact our Key West & Marathon workers compensation lawyers at Florida Keys Injury. We can help you recover the benefits you deserve.


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