If you are injured at work, the workers’ compensation insurer may appoint a private investigator to take a statement from you. When you are contacted by the investigator they often tell you they are independent. Investigator’s appointed by insurance companies are not independent.
Know Your Rights
You are not legally obliged to give a statement and you should not feel pressured into giving one. The purpose of the statement is to not just get an understanding of your claim but to acquire information about your past history. Many questions that are asked by the investigator may not be relevant to your workers’ compensation claim.
The investigator will often ask you to provide a history of previous claims, medical treatment and previous injuries going back over many years. The information you provide is then compared to information obtained by the insurance company from your doctor, hospitals, co-workers, Medicare and private health insurers.
If you fail to mention previous treatment or medical conditions because you have forgotten about them then your statement does not come over as being 100% accurate and may be used against you to delay and deny your workers’ compensation claim.
Also, the investigator may ask a question that has more than one meaning or interpretation. The investigator may also ask confusing questions and questions that prompt the answer wanted. The answers you give when asked in this way may make it appear that you are saying something that is inconsistent with the facts of your case.
A recent client had his worker’s compensation claim declined on the basis of the statement he had provided to the investigator. Our client suffered a back injury at work. He was asked whether he had ever had a previous back injury. Our client denied any previous back injuries.
The insurance company requested his clinical notes from his treating doctor. In the clinical notes there was a reference to an attendance on the doctor for back pain three years earlier. He was then sent to a specialist chosen by the workers’ compensation insurer who stated that our client was an unreliable historian and that his current back symptoms were not work related. The specialist went on to say given his history of back pain he would have been suffering from his current symptoms irrespective of the work duties.
We immediately requested a copy of our client’s clinical file and wrote to his treating doctor. The treating doctor confirmed that in the whole time our client had been a patient he had never treated him for a back injury. The treating doctor explained that the previous back pain was related to an episode of constipation. The clinical notes did not clearly state the connection between the constipation and back pain so was used by the insurance company to decline the claim.
We then filed an application at Workcover seeking orders that the insurance company accept liability for our client’s claim and commence weekly payments of compensation. We also sought an order for an interim payment for 12 weeks compensation.
At the conciliation conference we were able to demonstrate to the satisfaction of the Workcover conciliation officer that our client had never suffered a previous back injury.
At the conciliation conference the insurance company accepted liability for our client’s claim and agreed to commence weekly payments.
At Perth City Legal we prepare all our client’s statements to ensure that a clear and accurate history is provided to the workers’ compensation insurer.
If you have made a claim for workers’ compensation and are asked to give a statement contact Perth City Legal on 9486 8088 to speak to one of our lawyers.