Published in the March/April 2005 Issue of the CWCE (California Workers’ Compensation Educator) The ABC’s of AOE/COE Investigation By Sam Andreano and Jason Hethcoat Taking AOE/COE statements are commonplace for any private investigator providing services to California’s workers’ compensation community. Unfortunately, most investigators didn’t obtain their AOE/COE training behind an examiner’s desk and, therefore, only have only a slight sense of what is needed by the adjuster to assist in the defense of a claim. In addition, many use template questions regardless of the claim details. This type of investigation does not produce the results needed by the workers’ compensation claims examiner. Co – Defendants Many employers understand that they take the employee as they are and any injury alleged is going to be there responsibility, barring medical apportionment. However, if a co-defendant can be identified, the employer can share the financial responsibility with someone else. Identifying a co-defendant is very easy for a defense attorney to handle. They are going to probe into the possibility very carefully during a deposition. The problem lies in the fact that by the time they reach a deposition, the applicant has been coached by his/her attorney and will usually know exactly what to say to keep the complications of a co- defendant out of the mix. However, most AOE/COE statements are taken before there is any attorney involvement, nor do the employees have any idea of the ramifications of their statements. Although this is a perfect time to develop the co-defendant issue, if the investigator does not ask the right questions, the whole statement might just as well have been used as floor covering when painting your garage. How many investigations have you seen go this way: In this scenario, an employee complains of wrist pain after four months on the job. The 5020 sent to the investigator documents the date of hire. The personnel file also reflects that the employee did data entry at another company just before her current employment. Investigator (I): When did you start noticing pain with your wrist? Employee (E): Around September 2004. I: And did you seek treatment? E: Yes, I did. I: To whom did you go for treatment? E: I went to my family Doctor. Dr. Jones. He is located at 444 Main Street, Santa Ana. I: Did you report the injury to anyone at work? E: No, I waited a few weeks. |