2.8.2 Process for investigations
2.8.2.1 Check claims | 2.8.2.2 Allocate investigations | 2.8.2.3 Action investigation report | 2.8.2.4 Schedule of fees | 2.8.2.5 Legal panel firms initiate investigations
2.8.2.1 Check claims
Agents monitor claims by:
- checking for potential scheme abuse at regular intervals
- becoming aware of potential scheme abuse during normal claims management.
Agents must check all claims for potential scheme abuse.
2.8.2.2 Allocate investigations
Agents allocate investigations to Private Investigators (PIs).
See: Use of private investigators | Circumstance (factual) investigations | Surveillance (activity) investigations
2.8.2.3 Action investigation report
The Private Investigator reports their results in writing to the Agent.
PI written report
The PI Private Investigator submits a written report and invoice, accompanied by supporting documentation. Interim reports may be submitted, if necessary.
The report must:
- be provided promptly
- be professionally prepared and clearly drafted
- address all requirements in the initial instructions or requirements subsequently communicated.
Record outcome of investigation
The Agent records the outcome of the investigation.
Review investigation report
The Agent reviews the investigation report to ensure the report meets the desired standards including:
- it has been received within the required timelines
- correct information has been supplied in the report
- the authorised hours have been observed.
If necessary, the Agent instructs further investigations to gain a greater understanding of the relevant issues.
Pay invoice
The Agent checks the claimed amounts are in accordance with the fee structure - see Schedule of fees. If so, the Agent pays the invoice.
2.8.2.4 Schedule of fees
Note: Fees effective 1 July 2021
Investigation fees
- Circumstance (Factual) Investigations
- Online Review Service
- Travel Costs
- Surveillance (Activity) Investigations
Applicable to both circumstance (factual) investigations and surveillance (activity reviews)
Travel costs
Apportionment of travel costs over multiple jobs applies only in respect of that part of the travel that is outside the 35 kilometre radius and:
| Distance between jobs | Travel costs for investigation firms |
|---|---|
| less than 150km | shared on an equal basis over each job |
| greater than 150km | apply on a proportional basis |
Investigation activities
Investigation activities are confined to:
- conducting interviews and statements activities (includes making appointments, investigation related telephone calls, correspondence with claimant A person who applies for WorkCover benefits./employer)
- surveillance activity and photocopying investigation material
Only these activities are billable as investigation activities and must be itemised.
An activity that is not listed as an investigation activity will be defined as investigation support.
Investigation support fee activities
Activities which may include:
-
administration
-
reviewing
-
scoping
-
analysis
-
reading
-
assessing
-
perusing
-
instruction activities
-
allocation
-
checks
-
research
-
registration
-
searches
-
preparation
-
collation
-
compiling documentation
-
quality assurance
-
legal
Invoices
Invoices must:
- show the calculations relating to travel costs as they apply overall
- set out the apportionment figure for the particular job being charged
- provide cross references to all other jobs done simultaneously.
Maximum overnight absence fees
| 2021-22 | 2022-23 | |||
|---|---|---|---|---|
| Type of expense | Capital city rates | Country rates | Capital city rates | Country rates |
| Breakfast | $18.58 | $13.32 | $19.05 | $13.66 |
| Lunch | $31.80 | $23.85 | $32.60 | $24.45 |
| Dinner | $52.97 | $45.17 | $54.31 | $46.31 |
| Bed | $169.44 | $112.62 | $173.73 | $115.47 |
These rates only apply when the investigator is required to stay away overnight. Only actual incurred expenses, up to the maximum limit, will be reimbursed.
The date and accommodation establishment must be specified in the report.
Maximum reimbursement of photographic costs
| Type of expense | Amount |
|---|---|
| Digital video | $26.15 each |
| Stills | $3.30 each |
Incidental costs
These may only be reimbursed for:
- Police Reports
- Death Certificates
- Coroner's Reports
- Autopsy Reports
- Depositions
- ETag (if applicable)
- Specific search costs when requested in writing by the Agent or Legal Panel Firm.
Telephone calls will not be reimbursed.
Payment procedures
Detailed original invoices must be supplied for all WorkSafe business in accordance with the relevant costs/rates/fees, item numbers and other requirements specified by the PI firm (or WorkSafe).
Original invoices
Original invoices for activity reviews must outline:
- details of hours / times / dates spent on activities checks
- details of other charges / costs.
Original running sheets
Original running sheets supplied by each investigator must:
- be in the format specified by the PI firm
- provide names, dates and places
- show distance travelled between places if the travel is outside the 35km radius from the allocated GPO
- accompany the final report to your office (or WorkSafe).
Charge out centres
Private investigation firms must only submit travel expenses based on the specified COC Charge Out Centre.
There is no change to the Legal Panel firm WorkSafe approved legal representatives payments.
2.8.2.5 Legal panel firms initiate investigations
Follow these steps when a Legal Panel Firm needs to organise an investigation.
| Step | Who | Action |
|---|---|---|
| Obtain a job allocation number | Legal panel firm |
The Legal Panel Firm completes either a:
and forwards a copy to the:
|
| Agent |
When Agents receive either of the forms they:
|
|
| Complete investigation | Legal panel firm |
When an investigation is complete the Legal Panel Firm forwards to the Agent:
|
| Agent |
|
|
| Cancel investigation | Legal panel firm | If an investigation is cancelled the Legal Panel Firm provides the Agent with written advice of the cancellation. |
| Agent |
|