What Happens During a South Carolina Workers’ Compensation Investigation?

After an on-the-job injury, you need time to rest and heal. Worrying about what other people think of you and your injuries should be the last thing on your mind.

Unfortunately, many South Carolina workers don’t get the respite they need from other people’s opinions. Instead, they find themselves the subject of a workers’ compensation investigation. 

If an investigation leaves you feeling like you’re under a microscope, you’re not alone. Investigators seek to uncover evidence of workers’ compensation fraud一signs that your injuries aren’t as severe as you claim or don’t require the kind of compensation and support you’ve requested. 

If you’re under investigation or you suspect an investigation is coming, talk to an experienced South Carolina workers’ compensation lawyer today. 

Understanding Different Types of Workers’ Compensation Benefits

An investigation may focus on medical benefits if an insurer believes your medical costs don’t match your actual injuries or the medical treatment you’ve actually received. 

Investigators may look into lost wages if they believe you have misrepresented your income or that you could have returned to work sooner than you stated. 

Finally, investigators may examine permanent disability benefits if they believe you’re capable of working一that is that you aren’t permanently disabled. 

What to Expect During a South Carolina Workers’ Compensation Investigation

An investigation can cause additional headaches for you and your family. You can help manage these things during an investigation by:

• Being as honest as you can. Anytime you talk to your employer, the insurance adjuster, or your doctors, be as honest as you can. Don’t exaggerate your symptoms, but don’t hide any of them either. If new symptoms appear or symptoms aren’t getting better with treatment, talk to your doctor as soon as possible.
• Don’t push yourself. Pushing yourself can delay your healing. It can also produce evidence that an insurance company may try to use against you. For instance, if you push yourself to go to a water park with your kids, a photo or video of you may appear as evidence that you’re faking your injuries一when what you learned from that day is that you actually can’t handle a full day on your feet in the sun. Take the time you need to rest and accept help when it’s offered.
• Review your social media privacy settings – or stay off social media altogether. Before social media, investigators had to follow you to gather evidence of your daily activities. Today, they can often find everything they need to undermine your case on your Facebook or other social media feeds. Turn your privacy settings up or take a social media break altogether so investigators can’t use your posts against you. 

Balancing the fact of an investigation against the needs of daily life can be tough. Your injury didn’t stop the world from turning around you: The kids still need to go to school, the grass still needs cutting, and you still need to buy groceries. Family members may get married, have a new baby, or hold a funeral you need to attend. 

You’re doing your best to meet these obligations despite your injuries. You don’t want these tasks taken out of context: You’re still in pain and still struggling. Yet, workers’ compensation investigators may do just that. 

In the event of an investigation on medical causation, an adjuster will attempt to get a recorded statement and signed medical authorization that allows them to get any and all of the claimant’s medical records. If there’s a remote complaint of back pain fifteen years before, The South Carolina Workers’ Compensation Commission could deny it on medical causation grounds and a pre-existing condition.

What Does a Private Investigator Do? 

In South Carolina, a workers’ compensation insurer may hire a private investigator to gather information about a worker’s daily life. When a claim involves high costs or a long-term need for benefits, insurance companies have more incentive to cut costs. And cutting costs may mean attempting to prove your injuries are not as bad as you claim. 

Private investigators look for evidence of workers’ compensation fraud. Evidence includes photos, videos, documents, social media posts, and other items that support an argument that:

• You’re not as injured as you claim.
• Your injury or illness isn’t job-related.
• You’re working for pay while also receiving total disability benefits.
• You’ve misrepresented your income. 
• You’ve asked to be repaid for medical costs you didn’t pay out of pocket. 

To gather this evidence, a private investigator may interview you or those close to you, such as family, friends, co-workers, or neighbors. They may review your social media posts. They may even capture photos or videos of you while you’re working in your yard or out in public. 

You don’t have to deal with an investigation alone. Talk to an experienced South Carolina workers’ compensation attorney. The team at the Steinberg Law Firm is here to help.