Investigators conduct the bulk of claims investigations. They personally contact the policyholder, and often conduct on-site investigations of the accident scene when appropriate.
The investigation process typically will include employer interviews, taking of statements from witnesses, injured worker, and other parties. Investigators seek to establish any information or fact which may be relevant to the claim including the history, and background of the injured worker. Outside factors which may have an influence on the claim, or other credibility issues might also be explored.
An objective report, based on fact, and supported by documented evidence, provides you with pertinent information necessary to consider when making a determination on the claim. Supportive documentation gathered for you may include payroll, and attendance records, employment application, and other personnel records, as well as any company policies, and procedures. Credibility issues may be supported by other external witness statements, such as past employers, friends, relatives, or by other documents that might include items such as police or court records.
Investigations are appropriate where there is visual need for in-person, on-site investigations in order to gather the information necessary for claim decisions, or when in person interviews are indicated. Most attorney represented worker interviews are conducted in person.
You May Need An Investigation In these Circumstances
Questions of compensability or responsibility
Conflicting information in reports
Questionable medical issues
Comments