For those of you who grew up in the Sixties, you may recall the old TV show, Dragnet.  This cop drama took place in Los Angeles and featured detective sergeants, Joe Friday and Bill Gannon.  Each week, they would always seem to run into a witness who was a bit kooky and who would run on and on about weird things not relevant to the investigation.   Trying to get the witness to focus, Joe Friday’s now famous line was always, “Just the facts Ma’am, just the facts.”

Skip ahead to 2019 and you may wonder what relevance Joe Friday’s sage advice has to your organization’s workers’ compensation program.

The relevance is this.  Immediately after you receive notice of a claim, or an incident that could lead to a claim, you need to start gathering the facts.  This is true, even when you don’t have any suspicions about the claim’s legitimacy; but, is especially true when there is some aspect to the claim that concerns you.  The best time to gather this information is immediately after you have notice of a claim or potential claim.  As days, weeks or months pass, memories cloud and change.  Witnesses and the claimant typically have the clearest recollection of events, immediately after an injury event.

While every claim needs at least some basic investigation as to its facts, when you are particularly suspicious about claim validity, it is especially important to contact your claims manager at CRM to ask for help.  Your CRM claims manager can help direct and guide your preliminary investigation of a suspicious claim.  This includes identifying those who should be interviewed and determining whether signed statements should be obtained.    The rumor mill should be mined for information co-workers might have on the workers’ activities or behaviors that may have some bearing on the case.

You need to be cautious and sensitive how you conduct an investigation.  The worker should probably be the first person to be interviewed, regarding the details of the alleged injury.  Completing the Supervisor’s Report of Accident is a good place to start with this initial interview.   Treat the worker with respect and don’t express any suspicions you may have to him or her, openly.  Simply ask the questions you need to ask and keep notes on the claimant’s answers.  Immediately after the interview, you should draft an interview summary for your claim file.   It is likely this claimant interview will trigger further questions involving the need to interview co-workers about what they might know about the incident.  You also need to document these co-worker interviews.  When interviewing co-workers, be careful not to be accusatory toward the claimant. You may be interviewing the worker’s best friend.  You should also be careful about releasing confidential medical information, except where necessary to conduct your investigation.

When conducting an investigatory interview always ask questions that address the following:

  • Who
  • When
  • Where
  • What

Finally, whatever you develop during your investigation needs to be promptly forwarded to your CRM claims manager.  CRM’s goal is to have L&I make the correct decision on claim and condition allowance right, the first time.   It is much more difficult to get L&I to change its mind, after it has decided, than to get L&I to make the correct decision from the outset.  Having detailed investigation material to support your view of the claim to L&I is critical to CRM’s ability to convince L&I to do the right thing at the beginning of the claim.

As you can see, Joe Friday was right, “Just the facts, Ma’am, just the facts.”