Worker's Comp Insurance

My mom is a Private Investigator and has done many a work comp case -- including being sent on a cruise all expenses paid to follow a woman who claimed vertigo and arm pain and had been off a long time....including hidden cameras, etc. I would say it is likely they hired a private eye to check him out.

As far as the declining surgery and work comp payment issues, your husband should get legal counsel to represent him in this first party work comp benefits case. I would not accept any settlements or make any decisions before getting an attorney.

Worker's Comp is a royal pain. We are finally settling after over 5 yrs of run around. They cannot refuse to compensate just because he refuses yet another surgery. But after you settle, if he decides to go ahead with it, they don't have to pay anything. My husband was also given the option of another surgery, open may not work and he declined. In our case, we were not followed around or checked out because we had documentation from several doctors that he was infact hurt. He had 2 back surgeries due to the injury and has to deal with nerve damage for the rest of his life. They will check you out though if they think there is a possibility the extent of the damage is being exaggerated. My brother had an accident and they checked him out though did not lie about who they were. They were checking to make sure he was home since he would not walk or drive. Where would he go? Anyway, thanks to fraud cases, they are cautious but sometimes as with anything you get a very overzealous person. Just keep documents of EVERYTHING. If you do not have a lawyer, get one. In Illinois, the lawyer can only charge 20% of settlement and does not get anything until it is settled. You should be able to look up Michigan Worker's Comp laws to get more info if you do not have anything yet. Do not fall for a regular accident attorney's pitch. There are legal requirements for Worker's Comp.
Just to add, once your husband is completely done with doctor intervention, meaning they cannot help with any kind of therapy or other techniques (medication does not count) he would be declared MMI-maximum medical intervention. That is when you would start looking for settlement of you case. For us, they had to pay until his case was approved for settlement.

I was a wc adjuster in CA & AZ, the law is different in every state but typically if your husband refuses surgery they will have him declared with a permanent disability and he will get the settlement as outlined by wc law. I second the recommendation to get an attorney. I typically hate the sue-happy mentality in this country, but wc law is very complex and there can be a lot of subjectivity based on the dr's opinions. You are most likely entitled to a second opinion, an attorney can help you find a doctor to help. You don't mention what type of injury your husband has, but if it's a back injury I highly recommend finding a physical medicine specialist (physiatrist) since he doesn't want further surgery. Physiatrists are trained in non-surgical pain-managment techniques for chronic injuries & pain; I had so many claimant who had multiple failed surgeries switch to physiatrists and get relief. They weren't 100%, but they were able to return to their daily living activities and saw significant improvement in their cases.

And yes, we used investigators when we suspected malingering or flat out fraud. With two failed surgeries and a third being recommended I would not be surprised if there was an investigator involved - the insurance company is looking at some serious medical bills and possible lifelong permanent disability payments if he has another failed surgery; they aren't trying to get out of paying what they owe, they are trying to prevent being bilked into paying what they don't owe. If your husband is being honest about his abilities then you have nothing to fear from a private investigator; his footage will only support your case. If your husband is inflating his injuries to get more time off or $$ then he will probably get caught.

In December 2009 by hubby torn his achilies tendon (total freak accident at work), they took him to the clinic and followed all procedures after that from the dr at the clinic. The same day the specialist (who did work on a part time basis for WC) ordered an MRI - and the day before xmas we were told he needed surgery which was scheduled that day for the 29th. Within 1 day of the injury we were already contacted by the WC insurance for his company. She was wonderful, I documented everything, I mean everything. He was off from 12/23 thru 6/2 - he had surgery and physical therapy. We were paid on time, weekly, the only thing that sucked was they did not offer direct deposit but we got use to it. We never received one bill from any doctor, I provided weekly/bi-weekly updates on my hubby to our agent via email which she appreciated. They always knew when appointments were, my hubby also worked when they had desk work for him and I got paid to drive him to and from work. We never had people watching us (I would have known since our street is very quiet).
I would call WC for state of michigan, they can give you more information and what they can and can't do and your rights.
You also might want to get a second opinion for your hubby.
Good luck WC can be a pain, I think we were the lucky ones but his company submitted the paperwork right away which really is the key to get the process going.

Updated

In December 2009 by hubby torn his achilies tendon (total freak accident at work), they took him to the clinic and followed all procedures after that from the dr at the clinic. The same day the specialist (who did work on a part time basis for WC) ordered an MRI - and the day before xmas we were told he needed surgery which was scheduled that day for the 29th. Within 1 day of the injury we were already contacted by the WC insurance for his company. She was wonderful, I documented everything, I mean everything. He was off from 12/23 thru 6/2 - he had surgery and physical therapy. We were paid on time, weekly, the only thing that sucked was they did not offer direct deposit but we got use to it. We never received one bill from any doctor, I provided weekly/bi-weekly updates on my hubby to our agent via email which she appreciated. They always knew when appointments were, my hubby also worked when they had desk work for him and I got paid to drive him to and from work. We never had people watching us (I would have known since our street is very quiet).
I would call WC for state of michigan, they can give you more information and what they can and can't do and your rights.
You also might want to get a second opinion for your hubby.
Good luck WC can be a pain, I think we were the lucky ones but his company submitted the paperwork right away which really is the key to get the process going.

It's a rough road. Be very patient and stay calm - seriously. They will try and decline you every step of the way. You will have to consider hiring a lawyer to represent you to get what is fair. Yes, they will likely hire people to follow and spy on you. We had NUMEROUS cars staked out at various places. Down the street, in the school parking lot behind our house and around the corners waiting for my husband to do anything they could say was not consistent with his "claim of injury" They are definitely trying to find something on you to prove your husband is lying. It's a nasty little business. My husband was even chased in a car twice - he didn't know what was happening at that point - just that "someone" was following him and he sped up to get away and they chased him which caused him even more stress. He didn't realize it was workman's compensation hired detectives - or you could call them idiots. I mean, who chases someone high speed for a comp injury? unbelievable. Good luck to you!! stay strong.

I would definitely talk to a lawyer. By refusing the 3rd surgery, WC can claim that he's "better" and doesn't need any additional pay and therefore can return to work. I know lawyers can take a good chuck of your settlement, but it maybe worth it, especially if your husband declines surgery.

Yes, people will follow you. My uncle is a insurance fraud investigator, and unfortunately, worker's comp is one most commonly abused. My uncle has caught a lot of people lying, but he's also followed a good number of people that were telling the truth. With insurance fraud as high as it is these days, I wouldn't be surprised if companies followed everyone. Any reason not to pay.

I am a WC insurance adjuster. They cannot deny benefits if he refuses surgery (however depending on the company they might try). If you are in Michigan, settlement is pretty easy. Some other states it is more difficult. A judge has to approve the settlement, so you could do it without and atty and keep more of the settlement and your rights are still protected with a judge overseeing the settlment. I have seen some not approve, because the insurance company did not offer enough. Yes they will hire surveillance companies to follow you. If you have any further questions, just send me a message and I'll try to answer them. Hope this helps.