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Claims investigation is one tool in our arsenal to help reduce the cost of workers' compensation. However, we need the employer's help. Information provided by our policyholders is critical in processing the claim.
Field Investigation - Initiated when telephone contact is unsuccessful or insufficient to secure signed statements and other documents, including payroll records, medical records, police reports, etc.
Field Activity Check - Visit is made to three properly identified and verifiable adult sources. An activity check is used to gauge a claimant’s degree of disability and activities by speaking with the claimant and neighborhood sources.
Permanent Disability and Beneficiary Field Reviews - An in-person visit to verify if the claimant or beneficiary is alive, residing at the address of record, receiving payments, is working, or determine marital and dependent status. Neighborhood sources may be contacted in these investigations.
Surveillance - Used for claims referred to NYSIF’s Division of Confidential Investigations to verify a claimant’s activities are consistent with the reported disability in cases of suspected fraud.
Telephone Investigation - Conducted when our first notification of an injury is the result of an activity of an injured worker, without contact by the employer or when information provided by the employer requires clarification or greater detail. This is often done when the short form on e-FROIsm is selected to notify NYSIF of an injury.
CPA Audit - A review of the employers’ records conducted by a Certified Public Accountant. Used to verify average weekly wage and reduced earnings.
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