Workers Compensation claims are increasing nationwide and, at the time of writing this, cost Australian companies approximately $10.9 billion dollars in lost productivity each year, according to Safe Work Australia.
Many claims require the insurance company to perform some form of investigation. We have already written about the benefits of engaging an external investigator, so in this article, we clear up exactly why an investigation might be required in the first place, and which circumstances require factual or surveillance investigations.
An investigation into a claim might be required:
– Where you have received unclear evidence or conflicting information about a claim.
– To assist in determination of liability.
– To examine common law and/or recovery potential.
– To investigate other aspects of the claim.
– If the possibility of fraud has been identified and the type of fraud has been determined.
If your aim is to confirm or clarify any facts or circumstances of the claim, you likely want a factual investigation.
In a factual investigation, our investigators interview each party involved individual regarding the details of the claim and gather relevant evidence and statements in order to assist the insurer or employer in making a sound liability decision. This includes clarifying things such as:
– The employment relationship.
– Circumstances surrounding the injury or disease (including psychological claims).
– Whether the injury or disease has been caused by work duties.
– Previous work claims and histories.
– Any potential common law liability or recovery potential.
A factual investigation may also be required where there has been a death or severe injury – such as paraplegia – or where there is potential evidence of fraud.
Surveillance investigations may be required when information is received suggesting activity is inconsistent with the reported disability or incapacity, if there are doubts concerning the nature and extent of the alleged disabilities or incapacities, or if you suspect that the injured person is working elsewhere contrary to their allegations.
Regardless of the reasons for investigation, we highly recommend a well-planned and thorough investigation be conducted to ensure the best possible outcome for all parties.