When one gets injured at work, it is easy for them to assume that the insurance company will immediately pay for the medical expenses and lost wages. In most cases, this is what happens, and most employees don't have to drag the insurance company to court. However, there are instances when the insurance company will ask for an investigation into the claims before settling the matter. They assign a private investigator or one from their firm to look into the claim and ascertain whether it is valid. When this happens, you should know what to expect and how the investigations will affect your case. Read on to find out.
Why is an investigation necessary?
Why did your employer's insurer need to make an investigation into your claim? Should you be worried about getting your claim denied? Well, there are various instances when the insurance company's claims department will ask for an investigation, and they include the following:
- Your employer is uncooperative.
- There is no clear evidence showing that you got injured at work and there are no witnesses to back up your claim.
- The insurance company suspects that the claim is not valid, and they are trying to find ways to dodge it.
Ideally, the insurer will pay all genuine claims to avoid a confrontation in court. However, when they do decide to carry out an investigation, the chances are good that they are pretty confident that the case will be thrown out and they only need evidence to support their theory.
Should you get a lawyer?
Workers' compensation cases can drag on for a long time, especially if you don't have legal representation. That's why it would be a good idea to have a workers' compensation lawyer. In a case where an investigation is being conducted, a lawyer will come in handy to ensure that you give the facts of the incident as clearly as possible. The attorney will also help you to navigate the case and ensure that you don't give out any information which could jeopardize your statement and render the claim invalid.
What if you don't cooperate?
You are not under any obligation to talk to the insurer's investigator about the workplace injury. However, failing to cooperate can work against your case. Most investigators will conclude that your failure to answer questions means that you doubt the validity of your claim as well. This is the easiest way to get the matter thrown out. The best option is to get an advocate immediately after the investigator contacts you so that you can navigate the issue with legal help.
A lawyer will help you file a lawsuit if the insurer throws out your workers' compensation claim after the investigations.
Share