Do I have to take the carrier's independent exam?

Benefit continuation is usually conditioned on cooperating with an examination the carrier requests. Refusing can stall payments, so attend and bring your treating provider's notes with the restrictions and dates. Ask what the examiner was told before you answer questions.

Can I do any work while on workers' comp?

Work that exceeds your stated restrictions can end benefits and create a fraud allegation. Light duty offered by the employer is different: it is a documented offer with a rate and hours that should be in the file. Get the restriction language in writing before you accept any shift.

What triggers a fraud investigation?

Inconsistency: undisclosed side work, statements that contradict medical notes, or unanswered requests. A single odd date is usually explainable. Answer in writing, attach the record, and ask for the specific allegation in writing so you can respond to it.

Does unemployment benefits affect my comp claim?

The two programs certify different things, and each can read the other's record. Weekly certifications that say you are available for full work can conflict with medical restrictions. Keep both sets of statements consistent, and keep every filing dated in one tracker.

Workers' Comp Audits: Records & Fraud Flags

Workers' comp carriers audit claims with an arsenal: independent medical exams, surveillance, earnings cross-checks, and payment audits. The claim file is the defense — keep it complete from day one.

The Audit Set

IME exams: carrier-appointed doctors can cut benefits; get your own records and a treating physician's report. The ADA accommodation lane is in the ADA guide, and the remote claim rules in the remote injury guide.
Surveillance & earnings: reported activity vs claimed restrictions; side work and gig weeks are cross-matched (see the gig weeks guide). The settlement lines are in the comp settlements guide.
Payment audits: weekly wage proofs, offsets, and the structured payout trail (see the severance structure guide).

Fraud flags carry criminal exposure; the weekly certifications audit is in the unemployment audit guide. The wage side follows the FLSA test in the FLSA workweek guide, and the claim base in the workers' comp guide.

Put the rule into action

Write the letter with the free Raise Denial Response Letter generator. The state pages carry the local payout and notice windows, and the application tracker keeps the follow-up date in writing.

What the carrier requests

A workers' compensation audit is a records request, and the requests arrive in a predictable order. Knowing the shape of the request is the difference between answering and improvising.

Medical records and an independent exam. A carrier can ask for an examination by its own physician. Your treating provider notes are the counterweight: keep copies, and make sure the restrictions stated by your provider are the restrictions the carrier reads.
Wage and earnings proof. Benefit calculations use earned wages, so paystubs, the W-2 history, and any post-injury work are cross-checked.
Activity checks. Reported restrictions are compared with what you actually do. A gig week, a freelance invoice, or a shift for another employer is discoverable and is treated as a statement about your capacity.
Weekly certifications. If you also draw unemployment, the certifications and the comp record are read together; see the weekly certification entry.

Keeping the claim file

Build one file, in date order, and keep a copy outside the employer systems.

The injury report and the date it was filed, with the channel it was filed through.
Every medical note that states restrictions, and the date it was written.
Benefit calculation letters, showing the weekly amount and the effective dates.
Return-to-work and light-duty offers, with the pay rate and the hours.
Every letter you sent, with its date: the return-to-work letter and the claim statement both belong in the file.

Never answer an audit question verbally when a written answer protects you. Reply in writing, attach the document, and keep the reply. If a remote-work injury is involved, the location facts matter: home-office stipend, remote approval email, and the address on payroll, which is why the state pages on the state index carry jurisdiction-specific payout and claim rules.

Flags that escalate a claim

Most escalations come from inconsistency in the record, not from a single bad fact.

Statements that contradict the medical notes. Describing full duty to a manager while your provider lists restrictions reads as misrepresentation.
Undisclosed work. Side income during a benefit period is the classic fraud flag, and it also affects unemployment eligibility; the SGA concept is a similar test on the disability side.
Missing deadlines. An unanswered exam request or certification is read as avoidance.
Settlement language. A structured settlement changes benefit weeks and offsets; get the calculation before signing, and keep the release terms separate from medical rights.

If a request looks like an investigation rather than routine verification, stop improvising: answer in writing, cite the documents, and get the specific allegation stated in writing. Keep the claim dates in one place so every deadline is visible.

Audit tool	What the carrier is testing	Your matching record
Independent medical exam	Whether restrictions still apply	Treating provider notes with dates and stated limits
Surveillance or activity check	Reported limits versus observed activity	Your own log of work days, hours, and rest days
Earnings cross-check	Wage base used for benefits	Paystubs, W-2 history, and any post-injury earnings
Payment and certification audit	Whether statements match other claims	Weekly certifications and the comp benefit letters

Before you rely on a date or an amount on this page, check it against the California job exit rules page and the New York job exit rules page, along with the workplace remote reviews guide hub. Rules move, and those pages carry the current text.

Frequently Asked Questions

Do I have to take the carrier's independent exam?: Benefit continuation is usually conditioned on cooperating with an examination the carrier requests. Refusing can stall payments, so attend and bring your treating provider's notes with the restrictions and dates. Ask what the examiner was told before you answer questions.
Can I do any work while on workers' comp?: Work that exceeds your stated restrictions can end benefits and create a fraud allegation. Light duty offered by the employer is different: it is a documented offer with a rate and hours that should be in the file. Get the restriction language in writing before you accept any shift.
What triggers a fraud investigation?: Inconsistency: undisclosed side work, statements that contradict medical notes, or unanswered requests. A single odd date is usually explainable. Answer in writing, attach the record, and ask for the specific allegation in writing so you can respond to it.
Does unemployment benefits affect my comp claim?: The two programs certify different things, and each can read the other's record. Weekly certifications that say you are available for full work can conflict with medical restrictions. Keep both sets of statements consistent, and keep every filing dated in one tracker.

Workers compensation audits, benefit offsets, and the jurisdiction question for remote claims are state rules, decided by the agency in the state where the work happened. The severance offset model differs by state, so confirm the offset and the reporting duty with the state agency named on the state rule pages, keep the location facts (remote approval email, home-office stipend, payroll address) as the jurisdiction record described in remote termination jurisdiction, and log every week in the application tracker.