Cost Containment Strategies for the Beginning of the Workers’ Compensation Claim: Background Investigation (Part 4 of 10)

This segment in the Cost Containment Strategies Blog Series will focus on the first initial investigation cost containment strategy- background investigation for examining the alleged accident and the claimant.

Background Investigation- Alleged Accident

The employer/claims adjuster should investigate the background of the alleged accident/incident leading to the workers’ compensation claim.  Examples of questions to ask include:

• Were there any witnesses?
• What did the claimant report versus what the witnesses saw, if there were any witnesses?
• Were there cameras in the vicinity of the alleged accident?
• Did the employer complete any incident/accident report?
• Did the claimant complete any incident/accident report?
• When did the alleged accident/incident occur?
• Was there anything odd timing wise concerning the alleged accident/incident, such as Monday morning/Friday afternoon/right before or after holiday/vacation?
• Was the claimant working in a strange location at the time of the alleged accident/incident?
• Was the claimant performing his/her normal job in the usual way, or was there something unusual about the job or circumstances?

Background Investigation- Claimant

In addition to investigating the accident, the employer/claims adjuster should investigate the claimant.  Background investigation can be performed through a Social Media search.

Be careful when consulting a claimant’s Social Media sites.  Part Eight (8) of this Cost Containment Blog Series is devoted to best practices for conducting Social Media investigation.

Employers/claims adjusters may view Social Media sites the claimant has made public.  If the claimant has privacy settings turned on, the employer/claims adjuster should not friend/request access to the site by the claimant.  Since privacy controls may change in a moment’s notice, if the claimant’s site is set to public access, it is important for the employer/claims adjuster to document exactly when he/she views the claimant’s Social Media site; what the privacy setting is at that time; what Social Media site is reviewed; and what information is learned.

Practice Tip: 

Print off the Social Media site information when it is viewed to memorialize the information learned and the privacy settings at the time the Social Media site is viewed.

Background Investigation- Work History

In addition, the claims adjuster may find it helpful to learn additional information about the claimant’s work history.  Key questions may include:

• What is the claimant’s current work status?
• Has the claimant been terminated, and if so, when and why?
• Had the claimant received any corrective actions or other disciplinary action leading up to the alleged incident?
• Was the claimant on probation or a performance improvement plan at the time of the alleged incident?
• Had the employer initiated a layoff process?
• Was the claimant discussing possible retirement at the time of the allege incident?

Gathering this information can be accomplished through talking with the employer.  In addition, the claims adjuster may also learn additional information about the claimant’s work history, as well as current work status, through taking a Recorded Statement, which will be addressed during the next part, or Part Five (5), of this Cost Containment Blog Series.

Questions?  Please contact Jennifer directly at (919) 863-8846 or jjones@cshlaw.com.