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AOE/COE INVESTIGATIONS

An AOE/COE (Arising Out of Employment/Course of Employment) investigation is a workers’ compensation investigation to determine the facts surrounding an alleged injury to a worker on the job. The purpose of the investigation is to establish whether the employee’s alleged injury was work-related and happened in the course and scope of employment, or whether the injury was non-industrial or affected by third parties. In the early stages of a workers’ compensation claim, a thorough AOE/COE investigation is crucial to determine and document injury-related accident facts before evidence gets lost or memories deteriorate. It is important to document the claimant’s alleged reported injury, along with statements by any witnesses, prior to possible coaching by third parties’ workers’ compensation attorneys.

Bastion Investigation Investigators believe in detailed preparation and reviewing all available discovery to educate themselves on the claim, the reported mechanics of injury, the status of the claim, and to identify red flags before launching an investigation.

Every Workers’ Compensation Claim is different, with distinguishing sets of facts and circumstances. We focus on securing information from the injured worker, supervisor(s), co-workers, and witnesses that will assist with making informed compensability decisions for every specific claim we investigate in hopes of avoiding costly litigation and unnecessary expenses for our clients. 

Why Investigate?

  • To qualify compensability – Accept or Deny (Provide benefits as mandated by law)
  • Asset protection (Carrier/TPA & Insured)
  • Determine or establish extent of injury & disability
  • Determine or establish/credit applicable apportionment
  • Determine or establish Subrogation-Breach of Contract
  • Identify/Assert statutory defenses (self-inflicted, intoxication, horseplaying, suicide, etc.)
  • Identify abuse & fraud
  • Help you create leverage (for case resolution)
  • It is the Law
  • Avoid Medical Abuse (medical mills)
  • Avoid Employer Abuse
  • Avoid Lawyer Abuse
  • Avoid Capping
  • Avoid Add-on Claims
  • Set the stage for Future Depositions/Litigation
  • Set stage for Surveillance
    • AOE/COE Mission:
  • Protect the carrier/Insured
  • Treat the client’s assets as if they are ours
  • Investigate EVERY claim thoroughly (by taking into consideration past, present, and future exposure).
  • Never buy a claim without the “due-diligence”
    • Methodology:
  • Reviewing client service instructions, notes, and concerns
  • Reviewing the Workers’ Compensation claims file/documents if appropriate or available
  • An initial conference with the adjuster to identify background information including work location and environment, standard duties and responsibilities, typical work routines, employment status, wage information, and red flag concerns
  • Conducting background research including data search through EAMS, ISO, etc. (if appropriate)
  • Obtaining recorded statements from the injured worker, supervisors, department personnel representatives, representatives, coworkers, witnesses, and/or other involved parties
  • Responding to any new information or issues that arise during the investigation with appropriate action, including follow-up questions and/or further investigation
  • Providing prompt, clear, and concise written reports and evidence documentation
  • Providing regular status reports to the examiner by phone or in writing
  • Providing all services in accordance with all applicable legal codes and statutes.
  • If subrogation issues are identified during the initial investigation or if fraud is suspected, a more thorough investigation will ensue.
    • This effort may include the following procedures:
  • Identifying all parties involved
  • Identifying all insurance companies for all parties
  • Obtaining written and signed statements from persons with material information regarding the claim
  • Obtaining signed releases for medical and outside records
  • Obtaining all medical, personnel records and/or civil court records (if appropriate).
  • The Workers’ Compensation insurance company may request that a surveillance investigation be conducted to ascertain the nature and/or extent of a workers’ compensation injury, or if there is reasonable suspicion of potential fraud.
    • Such investigations include:
  • Preliminary, demographic, and background research
  • Active checks and active surveillance with frequent verbal and written updates to the (claims) examiner
  • Providing timely written reports and copies of surveillance footage and attaching any/all research documents
    • Financial Benefits:
  • AOE/COE Telephonic Investigation Program saves Insured/TPA time and money. It is an effective tool to investigate claims in a timely and cost-effective manner.
  • An investigation serves as a deterrent to other claims.
  • Investigations help identify denials or will lessen the number of settlements or lessen the dollar amount on payouts, which keeps work comp insurance rates low.
  • Information obtained in an investigation can identify problem areas and safety challenges at the workplace. These findings can help your safety team to create a plan to rectify and avoid future incidents, which keeps insurance costs low.
  • One AOE/COE Investigation alone can save the company tens of thousands of dollars.
    • Technical Benefits:
  • Throughout our Investigations, our continued contact with the client’s staff, we will build a strong workers’ compensation culture.
  • The client receives company service with boutique business attention.
  • Our Investigators can assist with training sessions to problem locations and assist on-site or branch-level employees to show them why their position is so valuable and helpful to our investigation – why their observations are important, their record keeping or note taking is important, their ability to get lineups set up in a timely fashion, etc.  If we include these employees in our process, they will feel involved, like they have a stake in this too, and they’ll work harder on these claims. 
    • Qualifications:
  • BASTION INVESTIGATIONS is a California state-licensed firm.
  • Our Investigators have 30 years of combined experience with workers’ compensation investigations, conducted thousands of AOE/COE investigations, and we have former police officers, and former criminal defense investigators.
  • Our extensive experience includes knowledge of legal defenses and the ability to identify inconsistencies and discrepancies in claimant and witness statements.
  • All Investigators are Bilingual (Fluent in Spanish).
  • All Investigators are trained on legal defenses and stay updated on changing case law.

BACKGROUND INVESTIGATIONS

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Background Investigation vs. a Background Check. With a background check, you verify against information provided by the applicant. In a background investigation, you verify against known and/or provided information and take further steps by developing and evaluating new information for a global view of the subject with the goal of producing a pattern of life as opposed to “fluff” contained in the application/resume.

Our Investigators utilize industry-leading technology to analyze a claimant’s background and social media digital footprint. Safeguarding digital evidence is paramount and our investigators preserve digital data by extracting Metadata, which is data that provides information about other data”, but not the content of the data, such as the text of a message or the image itself. There are many distinct types of metadata, including Descriptive metadata – the descriptive information about a resource, which is used for discovery and identification; and Exchangeable image file format data (EXIF), which is a standard that specifies formats for images, sound, and ancillary tags used by digital cameras, scanners, and other systems handling image and sound files recorded by digital cameras to ensure the evidence is ready for court.

We offer the following Background Investigative Services:

Background Investigations – Background Checks – Pre-Employment Screenings – Tenant Screenings – Social Media Intelligence Reports – Asset Search Investigations – Database Record Searches – Criminal Records – Financial Stress Reports – Record Retrieval – Property Records – Vehicle Sighting Reports