Workers’ Compensation: How to Handle Claims Administrators and Injury Investigators

Work Injury Claim form on clipboard with wooden gavel

How to Handle Workers’ Compensation Investigations

If you have been injured in a workplace accident, you will need to file a workers’ compensation claim to cover the expenses of your lost wages and medical care. It isn’t always easy to successfully carry out the legal and administrative process of a workers’ compensation case. If you have been contacted by an Insurance Claims Administrator or an Injury Investigator, make sure your first call is The Alberhasky Law Firm. Our experienced workers’ compensation legal team is ready to fight for your rights and faithfully represent your interests. Read on for more information about how to handle Insurance Claims Administrators and Insurance Investigators.

What is an Insurance Claims Administrator?

Insurance companies must investigate workers’ compensation claims, so they can ensure that they are providing compensation only in cases that are legitimate. Insurance companies employ Claims Administrators to handle the investigation and confirmation of workers’ compensation claims. The claims administrator will request your employer’s injury documentation, medical records, witness statements and other pertinent information related to the workplace injury.

What is an Injury Investigator?

If an insurance claim administrator is unable to get the information and documentation they require to confirm your claim, they will bring in an Injury Investigator conduct a thorough, on-site investigation into the circumstances of the workers’ compensation claim. There are many reasons that a claim administrator may be unable to confirm a claim, so it is relatively common to involve an Injury Investigator. An Injury Investigator may be an employee of the insurance company, or they may be a local private investigator who is contracted to investigate your case.

The Injury Investigator or Attorney Asked to Interview Me – What Now?

When an insurance investigator or attorney has been hired to review your case, it is common for them to request an interview or deposition with the injured party who made the workers’ compensation claim. If you have been requested to interview with an insurance investigator regarding your workers’ compensation case, it is important to understand that your statements are considered legally admissible, and may be used to disqualify your claim.   If you find yourself in this circumstance, it is highly recommended that you retain the services of a workers’ compensation attorney. You are not obligated to submit to an interview with the Insurance Investigator, but an outright refusal to be interviewed can be used as grounds for disqualification and an attorney can compel you to provide deposition testimony. During the interview, you are not obligated to answer every single question, but in a deposition you are. Refusal to participate in key questioning may be used as grounds for disqualification.   Experienced workers’ compensation attorneys from The Alberhasky Law Firm will prepare you for the Injury Investigation interview. We will review with you the questions expected from the investigator or attorney, and we will prepare you to answer these questions, without exposing you to difficult and legally compromising questioning. With the assistance of an experienced attorney, you will have an advocate who will be able to object to undue lines of questioning on your behalf.   The information you provide during an Investigation Interview or deposition can be used against you later. It will be compared with prior statements and medical documentation you have provided, and if discrepancies are found they may be used to disqualify your claim. It is extremely important that your legal interests are properly protected during the process of an Insurance Investigator interview or deposition.

The Default Position of Insurance Investigations is to Deny the Claim

If an injury investigator is unable to acquire the necessary documents to clearly qualify your claim, the default action by the insurer is to deny your claim. This is why it is so important to secure a qualified workers’ compensation attorney to represent your interests. The attorneys at The Alberhasky Law Firm will ensure that every piece of documentation is prepared and presented to the injury investigator, or ultimately the judge, so your claim will be approved and your compensation will be received quickly and completely. If your claim has already been denied, we will assist you to appeal the denial and submit the documentation required to win your claim.

The Alberhasky Law Firm is Here to Represent Your Interests

No matter where you are in the process of your claim, the workers’ compensation attorneys at The Alberhasky Law Firm are ready to help. We will faithfully represent your interests, so you are properly compensated for your workplace injury and you can get back to your life. Contact us today for information about workers’ compensation legal assistance.

About the Author

When it comes to workers’ compensation cases, Randy Alberhasky has over 25 years of experience. During his legal career he has personally tried over 200 workers’ compensation hearings and jury trials in courts throughout the State of Missouri. Many people who have suffered from a workplace injury and illness are unaware of the legal action they can take to receive the financial compensation that they’re entitled to.  The Alberhasky Law Firm, P.C. is proud to help our clients receive the compensation they deserve.

About Randy

During his legal career he has personally tried over 200 workers’ compensation hearings and jury trials, has been counsel in over 50 cases before the Missouri Labor and Industrial Relations Commission, 35 cases in front of the Missouri Court of Appeals and 3 cases before the Missouri Supreme Court. Read More…

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