The
worker’s compensation claim is the fastest growing
type of claim filed against an employer's various
insurance carriers. However, the nature of
those claims is changing. We are no longer
in the midst of our country’s industrial revolution;
a period that produced serious easy to identify
injuries. We are now well into our nation's
information age which produces more soft tissue
injuries, called “strains and sprains”, and stress
related conditions that are harder to detect and
identify. These obscure claims require more,
not less, outside investigation. Employers,
particularly self-insured employers, can waste time
and money by relegating the claim process to phone
calls and faxed questioners or investigations conducted
by non-skilled personnel. Employees can spot
gaps in the system that are favorable to fraudulent
claims or claims that drag on unnecessarily.
On site investigations conducted by professional
independent outside sources will create an atmosphere
that will discourage fraud and control expenses!
Preliminary
investigations
(Usually conducted within 3 days of reported
injury)
- Site
visit (within 50 miles)
- Statement
of victim
- Medical
record release form
- Photos
of injury site and physical injuries
- Job
description documentation
- Supervisor
interview
- Up
to 3 witness interviews
- Professional
report
- Package
cost - $350.00
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| Options
(may be applicable to employers or insurers
~ Hourly rate applicable) |
- Coverage
Investigation
This
option is designed to reveal facts relating
to jurisdiction, overlapping coverage,
multiple employments, separation of
duties and responsibilities in joint
venture situations.
- Factual
Investigation
Details of who, what, when, where, why,
and how relating to the injury (some
information included in preliminary
investigation)
- Insured's
Investigation
This option produces details of the
employment relationship between the
insured and the claimant, about the
insured and insured’s claim history,
alternate coverage, and training issues.
- Claimant's
Investigation Details
about the claimant’s background, dependencies,
and medical progress.
- Medical
Investigation
Details
relating to the providers of medical
care; qualifications of medical professionals,
doctor’s records relating to the claim,
hospital records, progress of recovery,
autopsy reports, and rehabilitation
progress.
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