Workers Comp Investigators: What Are They Allowed to Do?

Workers' comp investigators — whether hired by your insurance carrier or a third-party firm — are legally allowed to conduct surveillance, interview witnesses, review public records, and gather other evidence to verify the legitimacy of a claim. As an employer, understanding these boundaries helps you work effectively with your carrier to protect your business from fraudulent claims that drive up your premiums.

Why Investigations Matter to Employers

Workers' compensation fraud costs U.S. employers and insurers an estimated $34 billion annually, according to the National Insurance Crime Bureau (NICB). Every fraudulent claim paid out can raise your Experience Modification Rate (E-Mod) — a multiplier applied to your premium that reflects your company's claim history compared to similar businesses. A higher E-Mod means higher premiums. Investigations exist to protect that number.

When you report a claim, your insurance carrier typically assigns a claims adjuster. In suspicious cases, they may bring in a Special Investigation Unit (SIU) — a team of trained fraud investigators — or retain an outside investigative firm. These investigators operate within a defined legal framework.

What Investigators Are Legally Allowed to Do

1. Conduct Surveillance in Public Spaces

Investigators can legally observe and record individuals in any public location — parking lots, parks, sporting events, social gatherings, or public sidewalks. This is one of the most common investigation techniques. They may use video cameras, photographs, or direct observation. Courts have consistently upheld that there is no reasonable expectation of privacy in public places.

What they cannot do: Investigators may not trespass on private property, record inside a person's home, or use any equipment to see through walls or into private spaces.

2. Review Publicly Available Social Media

Investigators can review any public social media profiles — Facebook, Instagram, TikTok, LinkedIn, X (formerly Twitter), and similar platforms. If a claimant posts photos of themselves rock climbing while claiming a debilitating back injury, that content is fair game as evidence.

What they cannot do: Investigators cannot create a fake profile to befriend a claimant and access private posts. This could constitute fraud or entrapment and could invalidate the investigation entirely.

3. Search Public Records

Investigators have broad access to public records, including:

• Court records (civil, criminal, divorce filings)
• Property records and deed transfers
• Business license filings
• Voter registration and DMV records (where permitted by state law)
• Prior workers' comp claims (through state databases and NCCI's Unit Statistical Plan)
• Bankruptcy and lien filings

Cross-referencing a claimant's prior claim history is particularly useful in identifying serial fraud.

4. Interview Witnesses

Investigators can speak with co-workers, supervisors, neighbors, or anyone else who may have relevant knowledge about the claimant's activities or the circumstances of the alleged injury. As an employer, you should cooperate fully with these interviews — and instruct your management team to do the same.

Important: Witnesses cannot be coerced, threatened, or offered incentives to change their statements. Investigators must identify themselves honestly if directly asked.

5. Review Medical Records (With Authorization)

Once a workers' comp claim is filed, the claimant typically signs a medical release. Investigators and adjusters can then review medical records related to the injury. They may also arrange for an Independent Medical Examination (IME) — an evaluation by a neutral physician chosen by the insurer — to assess the validity or severity of the claimed injury.

6. Conduct Recorded Statements

Adjusters and investigators can request a recorded statement from the claimant. While claimants generally must cooperate as a condition of receiving benefits, the rules vary by state. This is a reason why having a solid claim reporting procedure in your workplace is so important — your version of events matters too.

What Investigators Are NOT Allowed to Do

Understanding the limits protects your company from liability and keeps the investigation legally defensible:

• No trespassing — they cannot enter private property without permission
• No wiretapping or illegal recording — phone recordings must comply with one-party or two-party consent laws depending on your state
• No harassment or intimidation — investigators must not threaten, follow in a menacing way, or contact family members to intimidate the claimant
• No deception to gain private information — creating fake identities or pretexting (falsely claiming to be someone else) to obtain private records is illegal under federal law (the Gramm-Leach-Bliley Act covers financial pretexting; state laws vary for other records)
• No discrimination-based targeting — investigations must be triggered by objective red flags, not by a claimant's protected characteristics

Red Flags That Typically Trigger an Investigation

Your carrier's SIU doesn't investigate every claim. Investigations are typically triggered by specific red flags, such as:

• Injury reported on a Monday morning (suggesting a weekend incident)
• No witnesses to the injury
• Claimant's description of the injury is inconsistent with medical findings
• Prior history of workers' comp claims at multiple employers
• Claimant is known to have financial difficulties
• Claimant is terminated or about to be laid off before the claim is filed
• Social media activity inconsistent with claimed disability

As an employer, documenting these red flags at the time of reporting strengthens the investigation. A detailed First Report of Injury (FROI) is your first line of defense.

Your Role as an Employer During an Investigation

You have both rights and responsibilities during a workers' comp investigation:

• Cooperate fully with your carrier's SIU or assigned investigator
• Preserve evidence — security footage, timecards, witness statements, equipment logs
• Do not retaliate against the claimant — retaliation is illegal under state and federal law and creates massive liability
• Document everything from the moment you're notified of the injury
• Maintain confidentiality — sharing investigation details broadly in the workplace can compromise the case

For industry-specific guidance on claim reporting procedures, visit our workers' comp insurance services page or speak with one of our licensed agents on the team.

How a Strong Workers' Comp Policy Supports Investigations

Working with a broker who has access to multiple A-rated carriers means you can find a policy with robust SIU resources, strong claim advocacy, and carriers experienced in your specific industry. Carriers differ significantly in how aggressively they pursue fraud — and in construction, agriculture, trucking, and other high-risk industries, that difference can show up directly in your E-Mod over time.

If you operate in a specific state, the rules around investigations can vary. For example, California (governed by the California Division of Workers' Compensation) has strict regulations on surveillance use in litigation. Check your state's rules with your broker. Explore our state-specific resources at Kentucky workers' comp and related state pages.

Farm employers with seasonal or H-2A workers should also be aware that agricultural investigations carry additional nuances — visit our agriculture coverage page for more detail.

Frequently Asked Questions

Can an investigator follow a workers' comp claimant?

Yes — investigators can follow and observe a claimant in public spaces. They cannot follow them onto private property or engage in conduct that constitutes harassment or stalking under state law.

Can an investigator contact the claimant's doctor?

Investigators can review medical records provided through a signed medical release. Direct contact with a treating physician generally requires proper authorization or goes through the claims adjuster and legal process — investigators typically do not contact doctors independently.

How long can a workers' comp investigation last?

There is no universal time limit. Investigations continue as long as the claim is active and suspicious activity warrants monitoring. Some investigations run for weeks; complex fraud cases can take months. Your carrier's SIU will manage the timeline based on claim activity.

What happens if fraud is confirmed?

If fraud is confirmed, your carrier can deny the claim and potentially pursue criminal referral to state fraud bureaus. Most states have a dedicated workers' comp fraud unit. The claimant may face repayment obligations, civil liability, and criminal prosecution. Your employer premiums should also be protected from the fraudulent claim's impact on your E-Mod.

As an employer, can I hire my own investigator?

Yes, employers can retain private investigators independently. However, coordinate with your carrier's SIU first — parallel investigations can sometimes conflict. Any evidence you gather must be obtained legally to be usable. Consult your legal counsel before initiating an independent investigation.

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Protect your business and control your workers' comp costs with the right coverage and a carrier that actively fights fraud. Our licensed agents at The Workers' Comp Experts have access to multiple A-rated markets and can review your current policy to make sure you're getting the claim support you need. Get a free policy review — call 859-407-4888 or request a quote today.