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.

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2.8.2.4 Schedule of fees

Note: Fees effective 1 July 2021

Investigation fees
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:

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.

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Maximum overnight absence fees
Type of expense Capital city rates Country rates
Breakfast $18.58 $13.32
Lunch $31.80 $23.85
Dinner $52.97 $45.17
Bed $169.44 $112.62

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.

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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:

  • Legal Panel Firm Request for Surveillance or
  • Legal Panel Firm Request for Factual Investigation form

and forwards a copy to the:

  • registered PI firm
  • Agent.
Agent

When Agents receive either of the forms they:

  • obtain a job allocation number (investigation ID)
  • enter the job allocation number on the form
  • keep a copy of the form on the claim file
  • return the form, including the job allocation number, to the Legal Panel Firm
  • mark the letter of instruction with 'Not used – LPF instruction' and keep the letter on the claim file.
Complete investigation Legal panel firm

When an investigation is complete the Legal Panel Firm forwards to the Agent:

  • a copy of the PI investigation report (including invoice for payment)
  • the completed Investigation Request form.
Agent
  • reviews the documentation
  • check that the PI invoice complies with the Fee Schedule
  • updates records.
Cancel investigation Legal panel firm If an investigation is cancelled the Legal Panel Firm provides the Agent with written advice of the cancellation.
Agent
  • updates its records
  • forwards notification of the cancellation to the Legal Panel Firm

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