S24. Factual investigations

Commencement date: 21 October 2019

Factual investigations can play an important role in the workers compensation scheme; however, they can erode worker trust and must therefore be used judiciously.

Principle

Factual investigations will only be used when necessary and will always be undertaken in a fair and ethical manner.

ExpectationsBenchmarks
S24.1

Insurers are only to undertake factual investigations when required information cannot be obtained by another less intrusive means. Insurers must also clearly document the purpose for undertaking any factual investigation.

Evidence on claim file

S24.3

If the worker is requested to participate in a factual investigation, the insurer is to advise the worker in writing and provide the following information:

  • the purpose of the factual investigation and the contact details of the investigator
  • the anticipated duration of the each interview, which is expected not to exceed two hours
  • that the worker can nominate the place of the interview and may have a support person (including union representative) present
  • that the worker may request an interpreter if required, who does not count as a support person
  • that the worker will receive a copy of their statement or transcript within 10 working days of the interview
  • that the worker can identify witnesses to be considered to assist the investigation, and
  • advice to the worker that they are not obligated to participate in the factual investigation, however the factual investigation may be used to help determine liability for their claim.

Complete advice provided to the worker at least five working days before the proposed factual interview.

If a shorter time is required because of exceptional and unavoidable circumstances, a reduced timeframe is to be agreed by all parties.

Factual investigations play an important role in the workers compensation scheme; however, they can erode worker trust and must therefore be used judiciously.

Factual investigations involve the use of a third-party service provider to conduct an investigation to determine the available facts of a claim.

Factual investigations may be used to gather information to inform decision-making with respect to liability and other entitlements. Circumstances under which a factual investigation may be warranted include but are not limited to:

  • determining if a worker meets the legislative definition of a worker
  • where the issues surrounding the injury are unclear or disputed, or
  • when there may be potential for recovery from a third-party.

A factual investigation may involve an interview with the worker, employer and/or witnesses, as well as a physical inspection or other external enquiries required to determine relevant details. Factual investigators are not to provide an opinion on medical aspects of the claim.

Factual services should only be used when necessary and should be conducted in an ethical manner. Any information obtained must be used and stored appropriately

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