Pinnacle group
Work Comp Coordinators
Workers' Compensation Claims Investigations
Workers' Compensation Claims Investigations
Bilingual Spanish
Submit incident report, state forms, personnel file, wage statement to carrier or Third Party Administrator.
Contact injured employee on date of injury.
Maintain weekly contact with injured employee. Allow injured employee to contact us anytime via phone call or email.
Contact injured employee after each medical appointment to determine current work status, work restrictions, pending requests, or complete discharge.
Prepare modified duty offer letter. Monitor modified duties.
Address/resolve concerns of injured employee.
Maintain regular communication with claims adjuster and broker.
Issue weekly Excel claims status report to employer and their management team.
Workers' Compensation Claims Investigations
Workers' Compensation Claims Investigations
Workers' Compensation Claims Investigations
Every workers compensation claim must meet the AOE/COE (Arising Out of and in the Course of Employment) criteria for the claim to be accepted as a work related injury.
We have decades of experience conducting investigations into all types of claims: psyche, fatalities, cumulative trauma, specific orthopedic injuries, vehicle accidents and many more.
Our comprehensive reports identify possible affirmative defenses as well as providing a list of Red Flags.
Included is a social media check, subrogation investigation, and a check of any previously litigated workers compensation claims.
When appropriate we obtain CHP and coroner reports.
Our services are provided onsite, telephonically, or via video conference by our bilingual Spanish investigators.
Risk Management Services
Risk Management Services
Risk Management Services
Provide General Managers with training regarding how to reduce claims costs.
Email safety training recommendations to General Manager and Safety Department.
Provide General Managers with safety topics for staff.
Available to GM and staff via phone call or email.
Attend claims review
Monitor reserves. Review settlement authority requests.
Defense firm recommendation
Bring top tier brokerage firm to review
all insurance programs. Discuss with employer best insurance options: high deductible, self-insured, self-insured group, captive, group captive.
Surveillance
Risk Management Services
Risk Management Services
We conduct surveillance to provide our clients with evidence they can use to determine if the injured workers life's activities are consistent with the subjective pain complaints mentioned to their treating doctor.
Red Flags for surveillance:
Does the injured worker not answer calls during normal work hours?
Has the injured worker also stopped working their second job?
Subjective complaints in a medical report are not consistent with objective findings.
Injured worker refuses to return to modified duties.
Injured worker is off work for a longer period of time than normal for same injury.
These are just a few Red Flags that could trigger a request for surveillance.
Contact us to discuss your need for surveillance.