Can the Claims Administrator on my Workers’ Compensation Claim have an Investigator contact me?
Yes. Claims Administrators have a duty to investigate claims for the purposes of accepting or denying liability within the first 90 days that they are aware of a claim. See Labor Code Section 5402.
Why Does a Claims Administrator hire an investigator?
Insurance Companies have duty to investigate claims. There are times in which the Insurance Company does not get much assistance from the Employer concerning the facts of the case. An Employer can be out of business or due to the sensitivity of the claim, they do not want to cooperate.
As a result, the Claims Administrator may hire the Investigator to obtain information to ascertain the validity of the claim. Sometimes, a Claims Administrator, as a matter of policy, may routinely hire an Investigator to do a work-up a claim. Other times, when it is clear that an injury occurred for which there is accepted liability, the Claims Administrator will not hire an Investigator. Part of the Investigator’s role would be to take a statement of the injured worker.
Who is the Insurance Investigator who wants to interview me?
An Investigator can be a Private Investigator. They can also be internal Investigators from within the Claims Administrator. Some of these investigators are retired law enforcement personnel.
If I have an Attorney, Do I have to speak to an Investigator?
No. There is no obligation to speak to an Investigator. If you are represented and are contacted by an Investigator, you should contact your attorney immediately and get advice.
If I do not have an attorney, Do I have to speak to an Investigator?
No. There is no obligation to speak to an Investigator.
What can the Investigator ask me about?
Generally, the Investigator should ask questions about the Injury itself. They can ask background questions as well. While caselaw has noted that “ [t]he scope of the inquiry permitted depends upon the nature of the injuries which the patient-litigant himself has brought before the court.” Alllison vs. WCAB (1999). Allison applies to depositions. An investigator may not be well versed on Allison and be respectful to it during the taking of an investigation statement. Investigators are not bound by the deposition process. The witness statement is not a deposition. Further, if you went into the investigation alone you will not have an advisor to make the objection. If you speak to them and refuse to provide answers, the Claims Administrator may use that as a basis for denying the claim.
Why is it not advised to speak to an Investigator?
Since an Investigator is not bound by the rules of depositions and subject to privacy objections, an Investigator may be able to obtain information beyond that what an attorney could obtain. This information may compromise an Injured Worker’s case. In a deposition, an Injured Worker, if represented, will be prepared for it by a skilled Attorney concerning how to answer the questions. Further, they will be present to provide counsel during the course of the deposition.
What are the consequences to not speaking to an Insurance Investigator?
The general consequence of not speaking to an Investigator is that the Claims Administrator will deny the claim based upon the fact that you are not cooperating with their investigation into your claim. Many times, however, if a Claims Administrator has hired an Investigator, it is likely that they claim will be denied anyway. Personally, I do not want my clients to speak to an investigator.
If I gave a statement, Am I entitled to get a copy?
Yes. There is case law which provides that “[w]here good cause has been shown, each party to a Workers’ Compensation proceeding must make available to the other party for inspection all non-privileged statements of witnesses which are in his possession, or which might come into his possession before the time of trial, since the denial of discovery of non-privileged statement would unfairly prejudice the opposing party in preparing his case and would unduly expose him to the danger of surprise at trial. [See generally Hanna, California Law of Employee Injuries and Workmen’s Compensation, Vol. 1, §§ 15.03, 17.01.] Patricia Ann Hardesty et al., (John D. Hardesty, Jr., deceased), v. McCord & Holdren, Inc. and Industrial Indemnity Company (1976) 41 CCC 111.” In sum, You or Your Attorney can demand a copy of it.
Can my Witness Statement from an Investigator be used against me in my Workers’ Compensation Case?
Yes. A witness statement contains facts and representations. It may contain facts about prior injuries and accidents. It may contain facts about how the accident happened. It may contain information concerning your medical complaints. This statement can be compared against your future representations which may be at a deposition which is a sworn statement under oath as well as at a Trial. Your witness statement, in those circumstances, could impeach your credibility. Your witness statement could be sent to examining or treating doctors. Again, they will likely weigh the statement against your representations in the evaluation. Witness statements can be sent to vocational evaluators.
If you would like a free consultation regarding workers’ compensation law, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.