WORKERS COMPENSATION INVESTIGATOR
A Workers Compensation investigator is a licensed, experienced, private investigator. We investigate a suspect claim, suspected fraud, and other claim concerns, as licensed investigators. To investigate phone 1300 966 103, email us at [email protected], or 24/7 online Contact Us, free quotes.
A Workers Compensation claim investigation, using a Workers Compensation investigator, a licensed Workers Compensation private investigator, by an employer, often arises after the claim is accepted. The insurer has become a rehabilitation coordinator, with the injured worker as the client.
At this point suspicion of Workers Compensation fraud, including a morphing claim, a worker getting worse not better, an injured worker working elsewhere, a worker starting their own business, or refusing to engage in return to work activities, becomes the employers problem; they must 'prove' that the fraud is occurring, before the insurer acts.
There are many indicators of deception, of fraud. These can include masking a recovery, doctor shopping, actual fraud with regards doctors certificates (scanners, modern technology make this much easier).
Sometimes the employer is blindsided by a claim after the fact. This make be a person who had been disciplined, dismissed, a contract terminated, or a short term hire.
It may be that the worker never reported an incident. It may be that no one saw the incident. It may be that the claim is illogical.
It is legal to investigate suspicion, using an appropriately licensed Workers Compensation private investigator; we are appropriately licensed private investigators.
The employer hires us to investigate, to gather evidence, to establish the real world level of restriction. This is often Workers Compensation surveillance, WorkCover surveillance investigations, discreet investigating.
There is often only one shot, after a claim is accepted, of getting the insurer to investigate further; the onus is on the employer to provide the evidence, to prompt further investigations.
We are experienced in such investigations. When you require a Workers Compensation investigator, a Workers Compensation private investigator, call us.
The objective of using a Workers Compensation investigator is to gather evidence of Workers Compensation 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 suspicion.
The standard generally required, when seeking to have the insurance provider engage, is a reasonable suspicion (civil standard) of Workers Compensation fraud. This requires evidence.
The suspect claim may be accepted by insurance, over the employers protests. This may cause you to contact us. We investigate these matters.
The actual level to be achieved, overall, to deny a Workers Compensation claim, especially at the point of the civil claim being contested in court, is balance of probability (again a civil law standard). This is reaching the fictional 51% evidence of deception, fraud, on balance, to be in the favour of the employer.
The calculation is actually more complex, as it does not rest on a single point, unless fraud is established. It is the level of liability, compensation, that is being adjudicated, at that point.
At times the insurance accepts liability, on behalf of the employer (sometimes despite their objections), and the only thing being considered is the compensation level. Negotiation takes place right up until the morning of the actual court case, as court is a gamble, for both sides.
For those with Government insurance, often called Workcover insurance, there may only be need for a week of surveillance, and possibly a small number of days of confirming surveillance, This may provide sufficient evidence to permit the approach to the fraud investigation section.
For those that go through a broker, there may be a need for slightly more. As you are not directly dealing with the insurance, but with the broker, who generally has a deal with the insurer, they do not want to spend as much money.
For the self insured there is generally a requirement to conduct more surveillance, to observe at various times, over a longer period, to gather evidence. They do not have the luxury of passing it over to others.
For the Government insured the insurance appears to work for the injured worker, during the rehabilitation phase. They do not, generally, rejoin the employer, until it is time for court, and the civil settlement.
Not all Workers Compensation insurance claims go to court. The majority of people injured at work are honest. They will rehabilitate, and return to work.
We do not investigate these. We are called in for the suspect claims, the suspected fraud, the suspected deception cases.
All workplace accidents, workplace incidents, should be investigated, documented. This is done for two reasons. The first is that a claim may arise later. The second is to see what contributed, and how it can be addressed.
There are often three components to be considered, when addressing a workplace injury claim. These are the physical injury, any mental injury, and the subsequent damages claim.
The physical injury is initially assessed, and medical support supplied. Some will seek to claim an associated mental injury, or will start the claim as a mental injury.
Mental injury may be something like a PTSD claim, which may arise from a single traumatic event, or multiple events over time. The actual claim, and injury, is generally assessed by a panel of medical professionals.
More common mental injury Workers Compensation claims are related to an aversion to the workplace, or an activity. The greatest challenge is the person who is displaying unusual activity (the cross dressing truck driver with a plastic friend, and the proudly lesbian couple, aggressive towards others, who objected to being split up in the workplace, are two that spring to mind), before their claim.
These are where workplace policy, workplace compliance with policy, become issues. Harassment, and bullying, must not be ignored, but must be actively discouraged. In complex matters their may also be drug abuse issues to consider.
The damages claim is the sting in the tail. That is where things such as lost future earnings, ongoing medical costs, are considered.
This is also where some employers learn about things like vicarious liability. The importance of actually investigating, documenting, at the time of the original incident becomes extremely obvious at this time.
Workers Compensation fraud, Workers Compensation claim fraud, is both short term, and long term, cost to the employer, the business. For a small business it can be enough to crush them.
Where suspicion exists, investigate. You will be reducing future liability, if fraud, deception, is established. You need to investigate.
Do not rely on things like Police investigations, unless it was a Traffic Accident Investigation Squad (TAIS) type investigation. Police investigations are variable in quality.
You cannot rely on social media posts, as evidence. People lie, people use old photographs.
You can have us conduct a factual investigation, close to the time of the event. This is done to record affidavits, to collect relevant correspondence (such as logs, journals, risk management forms, training histories). to record incident sites.
Later, when a suspicion forms that a claim is suspect, that there is deception, fraud, we are generally requested to conduct a surveillance investigation. This is a discreet, covert, investigation.
We conduct Workers Compensation surveillance investigations. We conduct workplace injury factual investigations.
In court evidence is weighted, based on credibility. A statement, with supporting evidence, and surrounding circumstances, carries more evidence than a statement without supporting evidence, and at odds with surrounding circumstances.
A private investigation, the private investigator surveillance journal, and supporting video, or still images, carry weight because the investigator and client may never meet. The investigator and subject never meet. The surveillance journal observations are supported by footage.
For a factual investigator the affidavits are signed, and dated, by the witness. The investigator is trained in non-leading questions, to draw out information. The affidavit is the subject's own memories, in their own words, taken close to the time of the incident.
Any document evidence is either a certified copy, or the original. The images recorded are time date stamped, and printed out.
Every effort is made to ensure that the evidence will stand alone, or together. This gives weight.
When investigating a physical injury, and a claimed restriction, the operative needs to know what restrictions are claimed. This is to enable the investigator to focus on those actions that are inconsistent with the claimed restrictions.
For mental injuries the requirement remains the same. If the person claims an inability to be around a workplace, if the person claims they cannot socialise, or enjoy things. If they claim not to be able to drive. These are what we look at.
Once a claim is accepted some liability, generally, attaches to the employer. The only time this is not true, is in a blatant fraud of large proportions.
Most time we are looking at the degree of liability, or the claim that turns fraudulent. Where we obtain good evidence, the insurance may subsequently launch fraud proceedings.
The term Workcover generally refers to a Government insurance scheme. The term Workers Compensation actually refers to the insurance payment made to an injured worker. Both are also used as wider generic references.
We are experienced, licensed, private investigators; we investigate. When you require a workers compensation fraud suspicion investigation, contact us.