Do Insurance Companies Investigate Injury Claims?
Do Insurance Companies Investigate Injury Claims?
Accidents can happen anywhere—on a busy road, at a construction site, or even in your home. They can cause serious harm, like large burns, deep cuts, or broken bones.
You might get hurt in a slip and fall, a car crash, or an explosion. No matter how it happens, you may need to file an insurance claim. A personal injury lawyer can guide you through the process and protect your rights. Insurance companies often investigate these claims, which can be surprising or even scary if you do not know what to expect.
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What Is an Insurance Claim for an Injury?
When someone else’s carelessness hurts you, you may need money for medical bills, lost work time, or other expenses. You usually ask for this money from an insurance company.
Let’s say you got burned in a fire at a warehouse. The warehouse might have insurance. You can file a claim with them. Or if you fell on a broken step at a store, the store’s insurance might pay for your treatment.
These are just basics. The big question is, will the insurance company simply hand over the money? Often, the answer is no. They usually investigate first.
Why Do Insurance Companies Investigate?
Insurance companies want to be sure your claim is true. As you said, they do not want to pay money if they think the accident did not happen. They also worry that some people might lie to get money they do not deserve. So they investigate to check the facts.
But there is more to it. Insurance companies are businesses. They want to save money. The less they pay in claims, the more money they keep. So, even if your case is real, the company might still try to reduce how much they pay you. If you have a personal injury lawyer, that lawyer can push back and fight for a fair amount.
Do Insurance Companies Investigate Every Claim the Same Way?
Not always. Sometimes, if your injury is less severe, they might look at hospital bills and pay quickly. But if your injury is serious—like a burn that needs skin grafts or a spine injury that can paralyze you—they might do a deeper check. They may ask for more medical records or even talk to people who saw the accident happen.
Catastrophic and serious injuries often mean a larger payout. For example, if you were in an explosion at a construction site, you can not work for months or years. You might need surgeries and rehab. That can cost a lot. Insurance companies know that. They look harder to see if they can find ways to reduce what they owe.
How Do Insurance Companies Investigate?
They have many tools and methods. Some companies hire investigators who look for details to show your story might not be completely true or that your injuries might not be as bad as you say. Below, we will list some common ways they check. Remember, if you feel confused or worried, a personal injury attorney can step in and protect your rights.
- Asking You Questions: Adjusters or investigators might call you. They will ask for details about the accident or your injuries. They might record your answers. If you say something that sounds different from what you said before, they might try to use that against you.
- Reviewing Documents: They might examine police reports, doctor’s notes, or pictures from the scene to determine whether the facts match up.
- Checking Social Media: Sometimes, they check Facebook, Instagram, or other sites to see if you are posting pictures of doing physical activities that do not match your injury claim.
- Talking to Witnesses: They may contact people who saw the accident or know about your injuries.
- Sending Their Doctor: Sometimes, the insurance company asks you to see a doctor they pick. This doctor might say your injuries are not that bad.
If you have a serious or catastrophic injury, they will dig deeper. This is why many people hire a personal injury lawyer immediately.
What Kinds of Injuries Lead to Major Investigations?
Some injuries are so severe that the costs can be huge. You might need a lifetime of medical care. You might never return to the same job. These are catastrophic and serious injuries.
A few examples are:
- Severe burns from fires, explosions, or chemicals
- Spinal cord damage from a bad fall, car crash, or construction accident
- Traumatic brain injuries (TBI) can occur if you sustain a blow to the head
- Electrocution on a work site or near faulty wiring
When you have a serious injury, the insurance company might question everything. They know the bill can be very high and seek reasons to deny or reduce your claim. This is when having a personal injury attorney can make all the difference.
Why Are Certain Accidents More Likely to Be Investigated?
Some types of accidents often bring large claims. If you are dealing with:
- Workers’ Compensation: You might file a workers’ comp claim if you suffered an injury. Employers and their insurance carriers may check carefully to see if your injury happened at work or off hours.
- Construction Accidents: Falling from a height or getting crushed by equipment can lead to large medical bills. Insurance companies often investigate these deeply.
- Product Liability: If you say a defective product exploded or burned you, the company might blame you for using it wrong.
- Slip & Fall (Premises Liability): Stores or property owners might deny that their place was unsafe.
- Car or Truck Accidents: Vehicle accidents can cause huge injuries, especially if you are a pedestrian or bicyclist. Insurance companies know these claims can get expensive.
If an accident caused a wrongful death, the insurance company might also work hard to reduce the payout. When someone dies, the claim can be very large. Again, this is where a personal injury attorney helps show that the accident truly caused the loss.
What if You Were Seriously Burned or Electrocuted?
Burns and electrocutions often require long hospital stays. You might need skin grafts or surgeries to repair damage. You cannot work for a long time, if ever. In some cases, nerves can suffer damage, leading to a loss of feeling in parts of your body.
Insurance companies see that these injuries can be permanent. They may have to pay for years of treatment. They dig deep to see if they can shift blame or say the burn or electrocution was not as severe as you claim. A personal injury lawyer who knows about serious burns and electrocutions will gather doctor records, talk to professionals, and prove exactly what happened and how it changed your life.
Do You Need a Personal Injury Lawyer If the Insurance Company Investigates?
Yes, especially if you have a severe injury. A personal injury lawyer understands the law and knows how insurance companies think. They can protect you from saying the wrong thing or signing papers that hurt your case. Insurance adjusters might seem friendly, but they work for the insurance company. They want to pay as little as possible.
With a personal injury lawyer on your side, you get someone who works for you only. They can talk to the insurance company on your behalf. They can also collect evidence, hire accident professionals, and examine your medical records. This strengthens your case if the insurer tries to deny or reduce your payout.
How Does a Personal Injury Lawyer Help with Investigations?
A personal injury lawyer can handle many parts of an insurance investigation:
- Communicating: They can speak to the insurance company, so you do not have to worry about being tricked.
- Collecting Proof: They gather medical records, videos, and witness statements.
- Keeping You from Mistakes: They tell you what to share and what not to share on social media or phone calls.
- Fighting Back: If the insurance company says you are lying or exaggerating, your personal injury lawyer can show that your injuries are real and serious.
- Talking to Professionals: If the case involves a product explosion or a building code problem, they might call doctors or engineers.
By doing this, your personal injury lawyer takes a lot of stress away from you. You can focus on healing.
Can Insurance Companies Spy on You?
Sometimes, insurance companies might hire people to watch you. They can check if you are active outside your home or doing physical tasks that seem against your injury claims. They might look at your social media to see if you post photos that contradict what you told them.
This might feel strange or unfair, but it happens in some cases—especially catastrophes. They hope to catch you doing something that suggests your injury is not as bad as you claim. A personal injury lawyer can warn you about these tactics. They can remind you to avoid making statements or posts that the insurance company can twist around.
What Happens If The Insurance Adjuster Accuses You of Exaggerating?
If the insurance adjuster thinks you are exaggerating or lying, they might deny your claim or offer you very little money. This does not mean your injury is fake. People who have serious injuries, like a brain injury or major burn, often have hidden problems that do not show on the outside.
A personal injury lawyer can help by:
- Collecting detailed medical reports
- Having doctors explain why your injuries are serious
- Showing how you cannot do your job or daily tasks anymore
When you have professional proof, it is harder for the insurance company to say you are making things up.
Is Workers’ Compensation Any Different?
Yes, but you must conduct an investigation. Workers’ compensation pays if you sustain an injury on the job. The company’s insurance might send you to a special doctor they choose. That doctor might say your injury is less severe or not work-related. Your boss might also question if you got hurt at work.
In such cases, a personal injury lawyer who knows workers’ comp rules can guide you. They can help file the correct forms, keep track of deadlines, and fight if the insurance tries to say you are not covered. If you have a catastrophic work injury, you might need years of benefits to replace lost income and pay for medical care. The lawyer’s job is to ensure you do not get stuck with huge bills and no support.
What About Construction Accidents?
Construction accidents can be terrible. Falls from high places, getting hit by machinery, or electrocutions can lead to huge hospital bills. You might need multiple surgeries, therapy, or even special equipment like wheelchairs or braces.
Insurance companies in these accidents often try to place blame somewhere else. Maybe they say you should have worn better gear or were not careful. A personal injury lawyer can examine safety rules, building codes, or training records. They can see if your employer or a third party cut corners. If your injuries are large, the costs can be expensive, so the insurance company will investigate strongly. The lawyer can stand up to them.
Why Do Insurance Adjusters Investigate Slip & Fall Claims?
A simple slip might not seem like a huge deal, but sometimes it causes a major problem. You can break a hip, hurt your back, or even suffer a brain injury if you hit your head. You may file a premises liability claim when that happens, saying the property owner was careless.
Insurance companies worry about fraud. Some people might fake a slip or claim an old injury happened on the property. So they investigate. They check store cameras, talk to staff, and see if the floor is wet or uneven. A personal injury lawyer who handles serious slip & fall cases can show how the hazard caused your fall. This is key to getting fair money for large injuries.
What If the Insurance Company Acts in Bad Faith?
Insurance bad faith means the company is not being honest or fair. Maybe they lose your paperwork on purpose, refuse to pay without a reason, or keep stalling, so you give up. This is illegal. If you think this is happening, tell your personal injury lawyer right away.
If the lawyer proves bad faith, the court might make the insurance company pay even more. This penalty is to warn insurance companies not to cheat people. With a lawyer’s help, you can stand up for your rights and not let them treat you poorly.
Speak to a Personal Injury Lawyer Today
Dealing with insurance investigations can be stressful, especially if you have a catastrophic or life-changing injury. A personal injury lawyer can protect your rights, gather strong evidence, and fight for the full amount you deserve.
If you or a loved one suffered an injury in a construction accident, suffered a major burn, or got hurt on the job, don’t wait. Reach out to a personal injury lawyer now. They understand serious injuries and the long road to recovery. They also know how insurance companies investigate claims. With the right help, you can focus on healing while a lawyer handles the legal process.
Contact Bentley & More LLP today to learn your options, protect your future, and stand up to the insurance company’s tactics. You deserve fair treatment, and a skilled personal injury lawyer is ready to ensure you get it.