Factual Investigations for Workers Compensation in NSW: What Employers Need to Know
Factual investigations are essential to the workers compensation (WC) process in New South Wales (NSW). They help clarify the circumstances surrounding workplace injuries and ensure that claims are handled fairly. Understanding these investigations is crucial for all involved—especially businesses managing injured workers and insurance companies reviewing their claims. This post takes a closer look at the purpose of these investigations, relevant regulation and laws, and key things to consider if you are part of an investigation.
What are WC Factual Investigations?
Factual investigations involve gathering information and evidence related to a WC claim. These investigations aim to establish the facts of an injury, check the legitimacy of the claim, and ensure adherence to relevant regulations. By collecting detailed information, investigators can produce a report that helps determine whether a claim should be approved or denied. For example, when a claim is made for an injured back, investigators may gather incident reports, witness statements, and medical records to support employers and insurers verify the worker’s account.
Who Authorises Factual Investigations for WC Claims?
In NSW, the State Insurance Regulatory Authority (SIRA) oversees progress in the WC sector. SIRA outlines the processes and standards that govern factual investigations in this area. SIRA mandates that "Insurers must only undertake factual investigations when required information cannot be obtained by another less intrusive means [...]". Once SIRA requirements have been satisfied employers and insurers typically contract factual investigations to independent investigation companies who hold the appropriate licences under the Security Industry Act 1997.
When do WC Claims warrant Investigation?
WC claims may be referred for investigation under several circumstances to ensure the validity of the claim and to prevent fraud. Here are some examples of common scenarios that may trigger an investigation:
Uncertainty About the Injury
Serious Injuries
Third-Party Involvement
Inconsistencies in the Claim
How Employers Can Prepare for WC Factual Investigations
Preparing for factual investigations in the workplace is essential to ensure a smooth process and to uphold fairness and transparency. Here are important considerations for employers to effectively prepare their workplaces:
Notify the Injured Worker
Share details about the purpose of the investigation and the contact details of the investigator with the injured worker. Advise the injured worker that they are not obligated to participate in the factual investigation, however the factual investigation will be used to make decisions about their claim.
Notify Other Relevant Employees
Identify and inform all relevant employees about the initiation of the investigation. This may be the injured worker's manager, or potential witnesses. Communicate the purpose and scope of the investigation to relevant employees to ensure transparency.
Assign an Employer Point of Contact
Appoint a specific individual or team to correspond with the investigator, the insurer and employees. This person should be knowledgeable about the process and available to answer questions from all different stakeholders.
Uphold Best Practices for Handling Sensitive Information
Emphasise the importance of confidentiality during investigations. Remind employees how to handle sensitive information and remind them of their responsibility to maintain privacy for all parties involved. This helps to create a safe environment for witnesses and those under investigation.
Gather Relevant Resources
Identify and collect documents that may be relevant to an injured worker's claim to ensure a thorough investigation. By compiling documents including, but not limited to, employment contracts, timesheets, payslips, performance reviews, emails, policies and procedures, employers can streamline the investigation process and enhance their ability to respond effectively.
Offer Support
Prioritise the well-being of employees involved in the factual investigation process by offering flexible work arrangements for interviews, allowing interviews to occur at times convenient for employees and by supporting employees with evidence collection, where applicable.
Understanding Your Role in the Process
Factual investigations are vital in the WC system in NSW. By knowing what these investigations entail, where they come from, why they are used and how to prepare for them, employers can navigate this complex process more effectively.