Insurance claimants' stories often change over time; memories fade naturally or, sadly, people don't always tell the truth. Regardless of why a claimant's narrative shifts, recorded documentation of their version of events near the time of their alleged injury can be the difference between winning and losing. As part of any initial investigation, the claims representative should always attempt to obtain a recorded statement from the claimant. It is obviously important as part of the initial determination of whether a claim is compensable or not. It is also potentially invaluable later if the claim becomes subject to litigation. The first step is to obtain and/or verify identifying information for the claimant, such as their physical description, address, names of other persons living in their residence, vehicles driven, hobbies and other items. Ideally, these details will be irrelevant. But if the insurer decides surveillance of the claimant is necessary to verify or dispute their claims, this information will be crucial. The investigator needs enough evidence to locate the claimant and distinguish them from other similar-looking individuals. For example, we recently had a case where the claimant moved residences after he gave his recorded statement. The information we collected allowed us to provide the investigator with a detailed physical description of the claimant and the truck he drove. Once the investigator located the claimant's new residence, he was able to easily identify the claimant. He then obtained footage of the claimant performing remodeling work on a house while simultaneously informing his treating physician he could barely walk, could not bend and could not lift anything due to extreme pain. The surveillance video showed just the opposite, and we were able to use that surveillance video when we met with the claimant's treating physician. Prior to that meeting (and the doctor's viewing of the surveillance video), the claimant had been recommended for shoulder surgery and lumbar spine injections. Following that meeting, the doctor released the claimant to return to regular duty work with no restrictions, and we were able to successfully close out the claim for a nominal amount. |

Additional pertinent details

It's important to obtain other information including details about the claimant's job duties, work history and other aspects of employment, followed by key facts about the alleged accident/injury. Consider another case that involved a school employee. The employee stated in her recorded statement that she twisted her ankle because a student ran out of the classroom and bumped into her. We were lucky enough to have security video of the incident, which showed she tripped over her own feet with no student in the vicinity. When we presented the video to the claimant's attorney, he responded that the adjuster must have misheard or misunderstood the claimant, and she did not say she had been bumped by a student. Rather, the attorney said, his client turned her ankle slipping on something on the hallway floor. We then provided him with the recorded statement of the claimant, in her own words, claiming she was bumped by a student. The claimant's attorney withdrew and dismissed the claim the following day. |

Medical concerns

A final portion of the recorded statement should address the claimant's medical treatment following the alleged injury and any relevant prior medical history. We frequently see important differences in the medical records regarding how the claimant explains the injury to doctors. While this can be good evidence at a hearing, the claimant can always explain that the doctor misunderstood what they said. If we have a recording of the claimant's own words describing the accident, we have very good evidence for impeachment and other purposes at the hearing if the medical records differ from the recorded statement. Although the items we ask about and record are intended to be exhaustive, there are certainly other questions that may be relevant depending on the circumstances. For example, if the employee is alleging an injury due to repetitive motion, it will be important to ask questions regarding any outside activities that could cause the same symptoms. The more detail that can be gathered up front, the better the claim can be defended at the outset and going forward. The slideshow above illustrates some of the essential information that should be gathered during a claimant interview. James D. Johnson is a partner at Swift, Currie, McGhee & Hiers, LLP, where he represents businesses, insurance carriers and individuals in litigation matters related to personal injury claims and workers' compensation claims ranging from minor to catastrophic injuries. He works in the firm's Atlanta office. Opinions expressed in this article are the author's own. See also: |

• 5 Lessons learned from insurance claim investigations
• 4 things to know about filing a workers' comp claim