Illinois Workers’ Comp Investigations: What Investigators Look For & How to Protect Your Claim
What does the insurance adjuster mean “it’s under investigation”?
You hurt yourself at work and you opened a claim with the insurance company. They should be paying your benefits, right? But the adjuster is telling you that they are investigating and don’t want to pay. What does that mean, and what can you do next?
In Illinois, the insurance company does need certain things before paying benefits at the start of a case
The employer or their insurance company has a right to some degree of initial investigation. An accident report is often submitted, and they may talk to witnesses or your supervisor. They need medical records from your doctor documenting the accident, your injury, what treatment is needed, and whether you can work. This is all understandble. They have to do this swiftly, however. You’re home, not getting paid, and not receiving the medical care you need. They should not be taking their time with this. Frequently, someone hires us to help with a workers compensation case because the adjuster is not getting back to them or is telling them that they are still “investigating”, but not paying benefits or approving medical care. An experienced, aggressive workers compensation attorney can file your case with the IWCC and, if needed, file an emergency motion for a hearing date.
Even after a case is initially accepted, the insurance company may still hire an investigator
In some cases the company will hire a workers’ comp private investigator to dig into the details of your claim and in some cases monitor your behavior after you file your claim. The purpose of this investigation is to prevent workers’ compensation fraud. The private investigator will then provide the company with their investigation report and the company will use that to inform their decision on whether or not to approve your claim or to continue providing you with workers’ compensation benefits.
Common Workers’ Comp Investigator Tactics in Illinois
Workers’ comp investigators will go to great lengths to disprove a workers’ claim. The majority of their evidence is gathered when following or monitoring the worker while they are in public running errands, going to appointments, etc. after their injury. This can include any of the following tactics:
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The use of video or photo surveillance – For example, if you are seen to be lifting a heavy object after filing a claim based on a severe back injury that prevents you from lifting anything over 10 lbs, a photo of you lifting a 30lb object could be grounds to disprove your claim
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Monitoring your social media accounts – An investigator will typically monitor any public social media accounts you have; this can include Facebook, Instagram, TikTok, and more. If you are found to be posting photos of you doing something that would exacerbate a work-related injury, this could have an impact on your claim.
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Talking to your family or friends – A workers’ comp investigator may talk to your close family or friends to try to gather information about your injuries. If someone close to you says something that contradicts an element of your claim, this could hurt your workers’ comp claim.
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Conducting background checks – An investigator may also take steps to determine if you have accepted employment while still receiving workers’ compensation from another job. In many cases this would violate the grounds for receiving workers’ compensation.
What Can’t Workers’ Comp Investigators Do?
While it’s true that private investigators will often go to great lengths to disprove a workers’ comp claim, there are still rules that they must follow when surveilling a worker. For example, workers’ comp cannot tap your phone, hack into your private email or phone accounts, or impersonate a police officer in an attempt to get information from you. They also may not enter your home without permission. Essentially, an investigator can use any method available to them as long as they don’t break the law or violate your right to privacy.
Workers Compensation fraud does exist in Illinois, but it’s uncommon
A small number of fraudulent workers’ compensation claims are filed each year throughout the U.S. This not only bogs down the workers’ compensation system, but also costs tax-payers thousands of dollars. As a result, most insurance companies have resorted to using private investigators to conduct investigations into the claims and behaviors of injured workers both during the claim filing process and even after they have already received a workers’ compensation settlement. While catching fraudulent claims is beneficial for the entire system, there are times when insurance companies abuse this process by using investigations as a means to disprove legitimate claims so that they don’t have to pay. The purpose of this blog is to answer your workers’ comp investigation questions and provide you with some insight on how you can protect your own claim when under investigation.
How do I protect my workers compensation case?
The most important thing I would tell any client is this: tell the truth, and don’t do anything your doctor would not want you doing. They cannot “catch you” on camera doing something wrong if you’re doing the right thing! The overwhelming majority of the injured workers we talk to and represent are being completely honest, and have very real injuries. A few bad eggs ruin it for everyone. But if you’re not sure whether you should help your friend carry that couch, or do that side job for some extra cash, ask yourself whether your doctor would think it’s a good idea. Is this within the work restrictions you were given by the doctor? Is it close? Don’t take any risks. I’ve had cases with real injuries and good people who make one mistake and have their benefits cut off or surgery denied.
Has your legitimate claim been denied because the insurance company thinks it’s fraudulent? Our work injury lawyers at McHargue & Jones can help. Call (312) 739-0000 for skilled legal representation.
FAQ: Workers’ Compensation Investigations in Illinois
1. Can workers’ comp tap your phone or record you?
No. A workers’ compensation insurance company or investigator cannot legally tap your phone or record private conversations.
They may observe or film your public activities — such as walking, driving, shopping, or exercising — but they cannot invade your privacy.
If you believe surveillance has gone too far, you should contact an attorney immediately to protect your rights.
2. How long does a workers’ comp investigation take in Illinois?
It varies depending on the complexity of your case.
Most investigations last a few weeks to several months, especially if the insurer is verifying medical records or work duties.
If your benefits are delayed beyond 30 days without explanation, your lawyer can file a petition for penalties or attorney fees under Illinois law.
3. What do workers’ comp investigators look for?
They typically focus on:
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Whether your injury happened at work
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Whether your daily activities match your claimed restrictions
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Your social media posts (photos or comments about physical activity)
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Whether you’ve been working elsewhere while collecting benefits
Their goal is to ensure your claim is valid — not to harass you.
Always follow your doctor’s restrictions and keep accurate treatment records.
4. Can an investigation affect my settlement or benefits?
An investigation does not automatically hurt your claim, but it can slow down the process if inconsistencies are found.
If your medical documentation and statements are consistent, the investigation may actually confirm your credibility and strengthen your case.
It’s important to stay in contact with your attorney so they can respond to any requests or accusations quickly.
5. What should I do if I think I’m being watched or followed?
Stay calm, follow your doctor’s orders, and avoid exaggerating your injuries or limitations.
Do not confront anyone or alter your normal routine dramatically.
If you suspect surveillance, document what you notice (vehicle plates, dates, times) and inform your lawyer — they can handle communication with the insurance company.
6. Who hires workers’ comp investigators in Illinois?
Usually, the insurance carrier or a third-party administrator (like Sedgwick, Gallagher Bassett, or CorVel).
They often use private investigation firms to conduct limited-scope surveillance, medical record checks, and employment verification.
Your employer typically does not control the investigation directly, but they may be asked for workplace details.
7. How can a lawyer help if my claim is under investigation?
Your attorney can:
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Communicate with the insurer on your behalf
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Ensure the investigation stays within legal limits
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Protect your medical privacy rights
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File for penalties or sanctions if surveillance is abusive
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Keep your claim moving toward a fair settlement
Will You Have to Worry About Surveillance After You Get Your Settlement?
In some cases, yes. Even after your claim has been settled and you’ve been awarded workers’ compensation benefits, some companies will continue to surveille workers to ensure that they are not employed elsewhere or doing tasks that contradict the type of injury they have claimed to have. If they find that you are not living your daily life in accordance with the injuries you have claimed, there’s a chance that they could pursue a case against you for fraud.
Get Help Filing Your Claim Today!
If your claim is legitimate and you have genuinely been injured on the job, you shouldn’t have too much to worry about when being subjected to surveillance. However, there are times where insurance companies act selfishly and attempt to “disprove” a claim just so that they don’t have to pay the injured worker. In cases like this, it’s imperative that you hire an experienced workers’ compensation attorney to represent you and ensure that your benefits are protected.
Don’t wait! Call the work injury lawyers at McHargue & Jones, LLC today: (312) 739-0000. Our team offers free initial consultations to prospective clients.