Long-live the classic who done it game in which you race to figure out who, what, where, when and how. You turn into instant investigators and try to piece together clues in a timely fashion. Investigating a claim is much the same way. Once a claim occurs, its essential to gather as much information as possible at the onset of the claim. This helps determine compensability and can prevent a claim from going off track. Staffing companies are at a severe disadvantage since employees are working at a clients location. Unless there is a supervisor from the staffing company on-site, its difficult to get the documentation needed to properly manage, accept, deny and or subrogate the claim in a timely manner. Most carriers look to their insured to report the claim immediately and have investigation procedures already established. In a hardening insurance market, some companies wont even consider quoting an account without these procedures already in place.
Deciding Who and Where
The first step in creating an investigation process is to determine who is responsible for the claims process.You need to select someone that has the time to gather the information and potentially visit a customers location for any severe or multiple injury occurrences. If you conduct business in multiple offices and states, keep one key contact person at each location. In addition, establish a backup person in case the main contact is sick or on vacation. If the person needs training or is new to the position, seek information from your insurance agent on loss control services. Many forms and examples can be given free of charge.
Preparing the Evidence
Next, establish in writing your investigation procedures. This will detail not only what the company procedures are, but also the employee and client responsibilities if a loss occurs. When creating investigation procedures, use specific forms to gather information. The four main investigation forms most staffing companies use are:
- Supervisor Report Form
- Employee Report Form
- Witness Form
- Customer Report Form
These forms can sometimes be your front line of defense, especially if the injury mysteriously changes over time or what occurred in the loss as well. Do not create a form that is overly complicated. Too many questions can cause a person to delay filling it out. Within 12-24 hours (which is much longer than the board game but still a quick turnaround), you want to get the main facts and compare the forms to make sure they match what occurred and/or the injury being claimed. Also, consider having the report forms translated into other languages for your employee base in order to alleviate any barriers.
The investigation process documentation and the report forms should then be kept in a separate claim file and not put with other employment records. If the employee requests a copy, you do not have an obligation to give them one, as these are internal documents.