Ask the Wizard

When to do a factual investigation?
Just ask the Wizard!!

Our Investigation Wizard is here to help you decide when to investigate a claim. Will an investigation be money well spent? Will it assist you to manage the claim for a better outcome?

It's quick but comprehensive and will assist to focus your investigation requirements but remember the Wizard is only a generic tool. While it's focused on workers compensation claims, it applies to many other claim types. Always get professional advice if in doubt and call us to discuss your requirements.

Just follow the Wizard's prompts. It's quick and easy!

The Wizard seeks answers to all questions below to see if you need an investigation and so that if you consult us, we already have some understanding of the claim. The Wizard also provides you with some of the high level considerations applied to an investigation.

1. Is the claimant a 'worker' of the insured?
2. Did the incident occur off the insured's premises?
3. Was the incident witnessed?
4. Is potential for common law damages from negligence or unsafe systems alleged or suggested by known facts?
5. Is there potential for recovery?
6. Is the incident or cause of injury considered complex?
7. Are there reservations about the claim?

Disclaimer
The Lee Kelly Wizard is an advisory tool only and is not warranted to provide definitive advice or recommendations. Always consult your technical adviser, lawyer or insurance representative for independent advice.

1. For workers comp, is the claimant a 'worker' of the insured?

1. Yes. Claimant employed by insured at time of incident
2. Maybe. Claimant not employed but worked at insured and did not have a sub-contractor agreement in place with own workers compensation cover
3. No. Claimant not employed by insured and had a sub-contractor agreement in place with own workers compensation cover

2. Did the incident occur off the insured's premises?

1. No. Claimant was at insured's premises at time of incident. Insured's management support the claim.
2. Yes. Claimant was on a journey to/from work.
3. Yes. Claimant was on a break from insured's workplace.
4. Yes. Claimant was at a customer's premises doing work on behalf of the insured.
5. Not known.

3. Was the incident witnessed?

1. Yes. Directly witnessed and confirmed. Insured's management support the claim.
2. Yes. Directly witnessed but facts may be disputed.
3. No. No known witnesses.
4. Not known.

4. Is potential for common law damages from negligence or unsafe systems alleged, or suggested by known facts?

1. Issues with lack of training or adequate supervision.
2. Breach of workplace health and safety regulations.
3. Failure to comply with industry standards or safe practice.
4. Possible breach of internal standards, systems and workplace directions.
5. Previous similar incidents suggests injury was foreseeable.
6. Careless or reckless conduct by the claimant or others involved.
7. Bullying, harassment or offensive conduct alleged.
8. No suggestion that the claim is due to negligence or unsafe systems.

5. Is there potential for recovery?

1. Yes. Journey claims involving council or other parties, motor vehicles and public transport.
2. Yes. Claims where the accident/injury occurred off the insured's premises on a third party site.
3. Yes. Claims where the accident/injury occurred on the insured's premises but a contractor or employee of another company may have caused or contributed to the incident.
4. Yes. Claims where machinery, equipment or systems involved have been serviced or installed by third parties or operated by third parties.
5. Yes. Claims from construction sites or projects hosting multiple parties, any of whom may have had site safety responsibility, caused or contributed to incident.
6. Yes. Claims arising from use or operation of a registered motor vehicle.
7. Yes. Claims arising from an unregistered vehicle which should have been registered, operating on a public road or place.
8. Yes. Claims for injuries substantially attributable to prior employment or earlier insurer on risk.
9. Yes. Recovery of overpayments and inappropriate payments to claimants. Examples include:
   • Claimant over age of 65
   • Claimant has moved overseas
   • Exaggerated dependency claims
   • Undeclared employment
   • Fraudulent claims
10. Yes. Claims involving secondary injuries attributed to or exacerbated by incorrect treatment by providers.
11. No recovery potential identified.

6. Is the incident or cause of injury considered complex?

1. Claims arising from workplace management issues and questions of employer conduct leading to stress. Examples include:
   • Employment reviews
   • Retrenchments and unfair dismissals
   • Bullying and harassment
2. Claim involves domestic factors such as a family death or violence.
3. Catastrophic injury claim including death.
4. Accident situations causing injury to several people.
5. Claims with return to work failures and recurring claims.
6. Claims with no particular incident or accident. Injury developed over time due to the nature and conditions of employment.
7. No. It's not a complex claim.

7. Are there reservations about the claim?

1. Yes. Claimant's account inconsistent with information from co-workers, supervisors and others.
2. Employer disputes claim
3. Yes. Injury inconsistent with work duties and may have been caused by non-workplace activities.
4. Yes. Inconsistent time-frames, delayed reporting, unexpected duration of incapacity.
5. Yes. Claimed incapacity inconsistent with available duties, rehab assessments and return to work program.
6. No. Employer or insured support the claim.

You may require a factual investigation

The Wizard suggests an investigation should be undertaken. Please call us to discuss your requirements or contact us with your instructions.

Alternatively, just complete the details on our Contact Us page, and we'll contact you within the next business day.