A “red flag” from the view of an insurance company is a signal that a workers’ compensation claim may not be legitimate.
If the insurance company discovers one or more “red flags,” it may hire an investigator. He or she will probably do a “neighborhood check” and may also put you under surveillance.
When a “red flag” is found, the insurance company may promptly schedule an “independent medical examination” (IME) with a doctor of its choosing. The insurance company often selects doctors who no longer have an active medical practice, but who earn substantial income examining injured workers for insurance companies. As a result, these doctors often are biased in favor of the insurance company.
Types of Red Flags:
Examples of “red flags,” which may be significant, but usually are inconsequential, include those in which:
- You delayed reporting the injury.
- There were no witnesses to your injury.
- The injury was reported on a Monday (the inference being that the injury happened over the weekend).
- You were recently hired.
- You participate in sports outside of work.
- You have had prior injuries which resulted in time off work.
- Your close friends or relatives have filed workers’ compensation claims in the past which have resulted in payment of compensation.
- While off work as a result of a workers’ compensation claim, you frequently cannot be contacted by telephone at your home number.
- You are subject to an imminent or suspected termination or layoff.
- You are seeking medical treatment from a physician with a reputation of questionable diagnosis and treatment practices.
- You miss physician visits and/or physical therapy sessions.
- You change medical providers, particularly if your initial physician released you to return to work.
- You have had numerous prior employers.
- Your spouse is not working and is receiving workers’ compensation benefits, Social Security disability payments, welfare, or unemployment compensation.
- You are nearing retirement age.
- Your medical treatment changes from one body part to another after you have been treated for a while.
- Your injury related to a pre-existing medical condition or health problem.
If one or more of these apply to you, you should be aware that an investigator may be canvassing your neighbors, staking out your home, and following you. Also, do not be surprised if the insurance carrier schedules you for an “independent medical examination” to try to determine how severe your injuries are.
How We Help
In most cases, red flags are meaningless. People do get injured on Mondays, and sometimes they are injured shortly after becoming employed. However, if an insurance company can find any evidence that a work injury did not occur, or that the injuries are exaggerated, they will deny your claim.
Insurance companies profit by denying claims, we do our best to hold the accountable.
For an experienced workers’ compensation attorney, contact the Law Office of Stephen L. Weiss today.