insurance investigations

The Benefits of a Comprehensive Investigation from the Onset of a Claim

Issues covered during the investigation, when properly utilized, can assist with the discussion to accept or deny a claim for benefits, setting the case based reserve, and in the negotiation of a compromise settlement.

A proper investigation should cover issues like:

  • Course and Scope (Statutory employer and borrowing employer issues)
  • Cause of the incident (Subrogation Issues)
  • Arising out of (witness identified)
  • Injuries (Compensability issues)
  • Prior medical history (Second Injury Fund Issues)
  • Prior education (Return to work issues)
  • Work history (Return to work issues)
  • Family structure (Secondary gain issues)
  • Average weekly wage (a prime target for penalty and attorney fee claims)

how can risksavers help?

During the meeting with the injured worker a competent representative can explain  workers compensation benefits and rules to injured workers and the employer. 

During an in person meeting the injured worker can be asked to sign a:

  1. Medical authorization
  2. Choice of physician
  3. 1025EE

A photo can be taken of the injured workers driver’s license.  Taking a photo of a driver’s license instead of the injured worker can be less invasive and threatening. An ID photograph, of an injured person, can assist a PI with the difficult task of identifying the subject during surveillance operations.

Why investigate your lost time workers compensation injuries?

Direct contact gives the ability to meet the injured person and family face to face, scope the location for possible future surveillance, including direction to the subject’s home. A friendly business-like meeting can open the door for future direct contact including settlement talks.  RiskSAVER has played a direct role in the settlement of 38% of cases referred for investigation prior to the involvement of counsel. 

Information collected by the person to person contact, when properly utilized, improves outcomes.

Cases that can benefit from person to person contact include

  • Catastrophic Injuries*
  • Owner-Operator Claims*
  • Drug Defense Cases*
  • Horseplay
  • Identification of Second Injury Fund Claims
  • Uninsured Sub-Contractor Claims
  • Dependency Issues in Death Cases
  • Back, Shoulder, Knee Cases*
  • Cardiac and Stroke Claims*
  • Aggressor Claims/Intentional Tort Suits
  • Subrogation Claims
  • Statutory, Borrowing/Joint Employer Situation*
  • Potential 1208 and 1208.1 Cases
  • Medical Set Aside Issues

* High Potential for Second Injury Fund Recovery

Put our risksavers to work for you