In a personal injury case, the examiner has to review the claim information before him to determine if the case is one that may not be compensable, therefore warranting investigation.
If doubt exists as to compensability of the claim it should be promptly assigned to an investigator for the development of the record. There is no set rule about which case should be the subject of investigation but generally all serious cases, all questionable cases, all subrogation cases must be carefully examined and investigated. The investigation should be a fair one and the information garnered should not be distorted in an effort to avoid accepting a case. The facts must be collected quickly so that a prompt decision can be made as to whether a claim will be accepted or controverted.
The field investigation can be preceded by a telephone investigation in order to collect preliminary information. Proper use of the techniques in regard to telephone investigation and analysis of such information and analysis of the investigation can cut down the amount of field investigation. A form can be prepared outlining the questions to be answered in each telephone investigation which can be used by the examiner or investigator. Here are some of the questions that can be used on such a form:
1. Claimant: first name, middle, last name: address; Social Security number; age of claimant; weekly wage; five, six or seven day worker; occupation marital status state of jurisdiction.
2. Location of accident: street; city; state of jurisdiction.
3. Date of accident: month, day, year, hour.
4. Description of accident: Be as specific as possible.
5. Witnesses: name, address, position of each.
6. When the injury was first reported by employees: to whom?
7. Date first disabled: date returned to work; full or part time?
8. Medical aspects: treated by; other physicians; S-rays; treatment to date; estimated future treatments; hospital; ambulance; police notified?
9. Nature and extend of injury: Be as specific as possible.
10. Nature of employment; when hired; occupation when injured; was this regular occupation; was claimant regular employee of assured; on payroll of assured; wages continued; reimbursement desired; letter received?
11. Third party aspect: was third party involved; name and address of third party; general contractor (name and address); other contractors; liens filed.
12. Name of claimant’s attorney.
13. Name of informant: title or position held.
14. Name of investigator assigned.
15. Special remarks.