Understanding Florida’s Workers’ Compensation Investigation Process

workers' compensation investigation

As an employee, you may know that you can receive workers’ compensation benefits if you are injured in a workplace accident. However, you probably also hope that you never have to use it. 

Unfortunately, work-related accidents occur every day in Florida. In some situations, the injured party is left unable to work and provide for their family. This is when workers’ compensation benefits should kick in. 

However, it’s not always that simple or easy. There is a process that includes multiple steps to receive these benefits, including a workers’ compensation investigation. In some cases, a more comprehensive investigation is required – especially if there is a suspicion of fraud. 

If you have a workers’ compensation claim in Florida that is under investigation; it’s in your best interest to contact our team at Sternberg Forsythe, P.A. for help. Along with seeking our assistance with your case, learn more about the investigation process and what to expect. 

Workers’ Compensation Defined 

Most employers in Florida are required to carry workers’ compensation insurance for employees. If you are injured on the job, you can file a workers’ compensation claim to receive the benefits you are entitled to. The benefits you can receive in Florida include:

  • Medical costs related to your injury
  • Lost wages
  • Temporary partial disability or temporary total disability
  • Permanent total disability

If a worker dies due to the injuries caused during a workplace accident, then the workers’ compensation insurance may provide death benefits. 

It’s worth understanding that if workers’ compensation insurance covers you, you don’t have the right to sue your employer. Unless there was a third party involved in the injury, the only way that you can recover for the injuries you experienced is by filing a workers’ compensation claim. This explains why it is essential that you report the accident right away and get in touch with an attorney. Doing these things will increase your likelihood of having your claim approved. 

How to File a Workers’ Compensation Claim in Florida 

After you seek medical attention for your work-related injury, you need to let your employer know what happened. You have just 30 days to let your employer know about the accident. 

Once your employer knows about the work accident, they will file a claim with their insurer. At this point, the insurer will get in touch with the accident victim regarding their claim and then approve or deny it. Even though there are some situations where the process to receive compensation is fast and easy, this isn’t always the case. 

What Happens During a Workers’ Compensation Investigation?

Most times, workers’ compensation insurers will investigate a claim to figure out if an employee is eligible for the benefits. In most cases, the investigation will include:

  • A review of the accident details
  • A review of all related medical reports
  • Further medical examination

Usually, the insurer is looking for a reason to deny a claim. This is done by claiming that the injury was a preexisting condition or that it did not occur at work. If this happens, you will need to hire an experienced Florida workers’ compensation attorney to help defend your rights and get you the benefits you deserve. 

What Is Workers’ Compensation Fraud?

While most workers’ compensation investigations are simple and straightforward, insurers may believe fraud is involved in some situations. At this point, an additional investigation will be done. A few situations may result in an insurer believing that fraud is involved. These include:

  • Injuries that aren’t consistent with the employer’s version of the accident
  • Failure to seek medical attention right away
  • No witnesses for the accident
  • The employee is seen participating in activities they should not be able to do with the injury reported
  • Failure to report the accident within 30 days
  • Claims of a non-work-related injury happening at work

Even what may seem like a minor inconsistency or detail can result in insurers believing that workers’ compensation fraud is present. If you are in a situation where fraud is suspected, they will likely take even more steps to investigate your claim, such as video surveillance, looking at your social media accounts, and speaking to people you know. 

Cases of workers’ compensation fraud aren’t something you should ignore or wait to see what happens. This is because the benefits you receive depend on the outcome of this investigation. Hiring an experienced attorney will help you get the benefits that you deserve. 

Hire an Attorney for Help with Your Florida Workers’ Compensation Claim

If you are worried your workers’ compensation claim may be denied, contact our legal team right away. WE can investigate the case and help ensure you get the benefits you deserve. Our team has years of experience and will fight hard for your rights. 

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