Home / Workers' Compensation / Tried and True Tips for Initial Claim Investigation

Tried and True Tips for Initial Claim Investigation

Matthew Riddle

A solid initial investigation pays significant dividends in all types of workers’ compensation claims.  It helps to ensure that valid claims are handled efficiently and that invalid claims are properly denied. One of the most important aspects of an investigation is to talk to the injured employee about the accident as early as possible in the claim.  In addition to those questions asking when, where, and how the accident occurred, the employer/carrier should inquire as to whether the injured worker had previously experienced the same or similar symptoms.  If the employee admits that he or she has experienced similar symptoms in the past, the employer should obtain a complete description as to the nature of the preexisting problems and the identities of the health care professionals from whom the worker received treatment. The employer may also wish to return to the site of the accident with the injured worker so the worker can “reenact” the accident or describe precisely how the injury occurred. 

Below are some guidelines that employers should use in obtaining useful information from employees.

  1. Don’t ask Leading questions.  Let the employee tell the story.
  2. Find out all information about the accident.
    1. Who was present or knew about the accident.
    2. What happened.
    3. When it happened.
    4. Where it happened.
  3. Don’t suggest an accident date, if the employee is uncertain as to when the accident occured.
  4. If time and resources permit, have the employee write out the details of the accident and injuries received, or write a statement for the employee and have the employee sign it.

It is important that employers document everything relevant to the claim.  Of course, the employer can never know for sure what information will be relevant.  So, the rule of thumb should be, unless you know that information will not be relevant to the claim, document it for later use.  Often times, the validity of workers’ compensation claims are determined by the relative credibility of the witnesses involved in the claim.   It should not come as a surprise that when different people are relating what was said or done months or years earlier, their perspective and testimony, differs.  Commissioners must decide whose testimony is the most believable. Usually, if one can testify that not only does he or she remember what occurred and what was said, but also that he or she made a note of it at the time so he or she would not forget the details, that generally causes commissioners to find that person’s testimony is more persuasive than the employee who is relying on his or her memory long after the fact.