WORKERS COMP INVESTIGATOR
Workers Compensation fraud investigations are often referred to as Workers Comp investigations (slang). A Workers Comp investigator is either a Government appointed person, or a licensed private investigator. We are private investigators, private detectives. For a Workers Comp investigation, a private investigation, phone 1300 966 103, email us at [email protected], or 24/7 online Contact Us, free quotes.
Workers Comp investigations can be triggered by suspected fraud, at the start, where the claim is not accepted by the insurer. Once the claim is accepted the onus shifts to the employer to prove the fraud, this evidence then permits the insurer to take action.
A Workers Comp investigator may be appointed by the Government insurer, a private insurer, the self insured, to investigate, at the time that a claim is lodged. This is generally a factual investigation, an overt investigation, to gather and preserve evidence.
A private investigator may be appointed by the employer to gather evidence of fraud, for presentation to the insurer, or as part of the defence against a civil claim, after the formal Workers Compensation claim has been settled (the income support payments). A Workers Compensation claim has an immediate, and for more serious claims a long term cost (the civil claim).
When Workers Comp investigations, a Workers Comp investigator, is required, we have many years experience in Workers Compensation investigations, call us. We investigate for the Government insured, the privately insured (those who use a broker), and the self insured.
The objective of a Workers Comp investigation is to gather evidence of Workers Comp fraud, to protect the employer, the business, and reduce future insurance liability. This evidence can be presented to the insurance fraud section to confirm the employers Workers Compensation fraud allegations.
For the Government insured there may be a requirement to establish a reasonable suspicion of Workers Compensation fraud, so the insurance can actually take it further. This is generally about a week or so of surveillance, to gather evidence.
For the Government insured it can appear that, once a claim is accepted, the focus is the injured worker. It is about meeting the return to work objectives of the rehabilitation coordinator file manager.
For those milking the system this can be over an extended period, whilst they enjoy the pay without work status. The Insurance does not rejoin with the employer until the civil action at the end.
For the privately insured, through a broker, they may be a requirement to go further than this, with multiple periods of observation.
For the self insured the onus to gather evidence is greater, this may mean multiple periods of observation, over multiple years, for long term claimants. The evidence is required to establish the real level of restriction.
Private investigator surveillance, Workers Compensation surveillance, is about time on target. Observation over an extended period may be required to establish activity, the level of capacity, and if their is deception, fraud.
For fly in, fly out, (FIFO) workers who can work in one State, live in another, or have other arrangements long term surveillance can raise other issues. Locating the subject can be one.
If someone launches a claim in one State with a self insured miner they can move to another State, another mine, another employer. They may also use their parents property as a drop box, or a PO Box, for correspondence.
Sending out update forms, for personal information, on a six monthly basis can address this. Send it out to all employees, so you are not picking on anyone.
HR should be keeping up to date on things like next of kin, anyway. Divorce, and separation, child custody, drug use, are external forces which can affect workplace performance, and can be linked to Workcover claims.
Workplace actions such as a caution, disciplinary action, conflict, can also trigger Workers Compensation claims. A contract coming to an end may be another trigger, so the worker keeps the money coming in.
It is very important to establish a relationship, for the workplace to engage the subject. This may only be a phone call once a fortnight. It will give you some link, it may also give you some intelligence about availability.
Given the sense of entitlement of some you may also see whole families playing the Workers Compensation game, sometimes all at the same mine site! This makes surveillance even more challenging, as they are aware.
Evidence is crucial, where fraud is suspected. A private investigator is here to gather the evidence, preserve the evidence, to provide some protection to the employer where deception, fraud, is detected.
Indications of fraud are many. It can be the employee who does not recover from a simple injury. It can be a worker who gets worse, not better.
Sometimes you will see a morphing claim, or evidence of doctor shopping. Sometimes the doctor's certificate is a scammed, and doctored, document.
At times word may come back to you about them starting a business, or working from home. It may be information about social activities inconsistent with the claimed restrictions.
Social media evidence is not considered a suitable basis for a reasonable suspicion, it is only an indication. People lie on social media, or post old information.
Most Workers Compensation matters are conducted on the basis of civil standard, balance of probability. A reasonable suspicion is not definitive proof of fraud, it is evidence supporting the suspicion of deception, fraud.
To go to balance of probability means that a person who claims to be incapable of doing something is observed, and evidence recorded, on multiple occasions, doing something outside the stated scope of capacity. This should be multiple times, over a period of time.
Anyone can have a good day, but having a good week but still claiming the infirmity is less logical. Being observed for extended periods over many months, removes the logical claim of the restriction.
For court purposes all claims, testimonial, is about credibility, evidence, and surrounding circumstances. Credibility is established by evidence, and by what can be inferred by surrounding circumstances.
A private investigator, a private investigation, is performed by a licensed private investigator; the investigator may never meet the client, nor the subject. His only interest is the gathering of evidence.
This independence, and a surveillance journal (notes) with supporting video/still images, gives weight to the testimony, in court. This is why we conduct Workers Compensation surveillance.
Any workplace injury should be investigated, the circumstances documented. This has two roles. One is to ensure there is evidence should the matter become more serious. The second is an examination of the cause/s, the contributing factors.
For factual investigation the words of witnesses are recorded as affidavits, close to the time of the event. This closeness to the event is important, as gathering affidavits years later can lead to the corruption of memories.
The documents gathered are originals, generally. Still images give a clear picture of the area, as it was. When a court case occurs, years later, such evidence is crucial in giving a clear picture of events as they were at the time.
We are experienced private investigators. Private investigation, the gathering of evidence, is the central theme of our Workers Compensation investigations.
When you require a Workers Comp investigator, a Workers Comp investigation, call us. We are experienced.