When it comes to managing and investigating federal workers’ compensation claims, agencies with their own law enforcement branches and access to Department of Labor (DOL) investigators might question the need for additional contracted claims investigators. However, even with these resources, using contracted investigators offers unique benefits that can enhance case efficiency, reduce costs, and provide specialized expertise that complements the work of in-house and DOL teams. Here’s how contracted claims investigators bring value, even in well-resourced agencies.
- Expanded Capacity Without Additional Burden
Federal law enforcement personnel and DOL investigators have broad responsibilities, often handling complex cases across various areas. Contracted claims investigators, however, focus specifically on FECA workers’ compensation claims and related indications of fraud, bringing dedicated resources without pulling internal staff away from their primary duties. Benefits include:
- Relieving the workload of agency law enforcement and DOL teams, allowing them to prioritize more critical or complex cases.
- Providing immediate support for urgent investigations when there is an indication of a scheduled event or activity, which ensures that claims investigations are timely and efficient.
- Scaling up investigative capacity as needed without the need for long-term commitments, ideal for managing peaks in caseloads.
- Identifying responsible third parties to allow the federal government to pursue reimbursement of paid out benefits through subrogation.
- Specialized Claims and Workers’ Compensation Expertise
Contracted investigators bring focused experience in claims investigation that goes beyond standard investigative practices. This expertise ensures thorough, accurate handling of workers’ compensation claims, with a skill set tailored specifically to detecting and managing compensation-related fraud:
- Knowledge of workers’ compensation red flags such as unreported income, exaggerated injury symptoms, or falsified medical documentation.
- Efficiency in claims investigations investigators experienced with the Federal Employees’ Compensation Act (FECA) guidelines, allows for faster, more effective case resolution.
- Ability to focus on nuanced claims issues that may not rise to the threshold of importance by general law enforcement or DOL investigators.
- Cost Savings and Operational Efficiency
Using contracted investigators can be a cost-effective solution that saves time and reduces operational costs associated with long-term investigative staffing:
- Lower fixed costs: Contract investigators don’t require salaries, benefits, or extensive training, unlike permanent hires.
- Flexible deployment: Contracted investigators can be brought in only as needed, optimizing agency budgets and enabling federal resources to be allocated to more critical tasks.
- Faster case resolution: Contracted investigators dedicated solely to claims can accelerate investigations, reducing the time and cost associated with prolonged claims.
- Pre-screen files for fraud: Using contracted investigators for administrative investigations supports criminal investigators by identifying which files have possible fraudulent activities.
For instance, if a claim requires in-depth surveillance or rapid fact-checking, contracted investigators can complete these tasks when internal staff may be tied up with broader responsibilities.
- Independent and Objective Investigations
Agencies with law enforcement branches may sometimes face challenges in maintaining an objective viewpoint, especially if internal staff have longstanding relationships with claimants or colleagues involved in the claims process. Contracted investigators bring an unbiased, third-party perspective:
- Unbiased assessment: As outside entities, contract investigators can handle sensitive cases with impartiality, preserving the integrity of the investigation.
- Enhanced credibility in contested cases: When presenting findings to OWCP, an objective investigation by a third-party investigator may lend additional weight to the agency’s position.
- Reliable documentation and evidence: Contracted investigators are trained to produce clear, comprehensive reports that comply with federal standards, providing strong support for the agency’s case if claims are disputed.
- Complementing Law Enforcement and DOL Investigations
While DOL investigators and agency law enforcement have extensive experience, their investigative focus may cover a broader range of responsibilities. Contracted investigators, on the other hand, specialize in claims and workers’ compensation fraud, making them valuable partners for agencies providing the DOL with fully vetted claims:
- Support for complex or prolonged cases: Contract investigators can handle ongoing monitoring, surveillance, and follow-up that internal teams may not have the capacity to manage continuously.
- Capacity and breadth of resources: A national investigation firm can support multi-state cases where local presence or rapid response is necessary.
- Focused expertise in detecting specific fraud patterns: With in-depth knowledge of current claims fraud tactics, contracted investigators can help law enforcement identify red flags more efficiently, enhancing case outcomes.
- Enhanced Focus on Agency Mission and Core Duties
Federal law enforcement and DOL investigators are vital to an agency’s mission, focusing on broad issues like public safety, regulatory compliance, and complex fraud. By outsourcing the administrative function of claims-specific investigations, agencies ensure that their core teams remain focused on high-priority cases:
- Maintaining strategic focus: Internal teams can dedicate more attention to cases that require specialized law enforcement action, while contracted investigators handle claims-specific tasks that primarily are concerned with returning an injured employee back to work as soon as they are medically fit.
- Supporting efficient case resolution: Contract investigators help resolve claims-related issues of malingering and exaggeration without diverting critical resources from the agency’s primary law enforcement duties.
- Building a comprehensive claims strategy: Contracted investigators work within the agency’s broader claims management strategy, helping to improve outcomes and reduce costs while internal teams continue focusing on their essential roles.
Conclusion: Maximizing Efficiency and Expertise with Contracted Claims Investigators
Even in federal agencies with dedicated law enforcement branches and access to DOL investigators, contracted claims investigators provide distinct benefits. From enhanced capacity and cost savings to specialized knowledge and objective insights, contracted investigators complement the agency’s existing resources while adding flexibility, efficiency, and targeted expertise. As federal agencies navigate complex claims and evolving workloads, contracted investigators ensure the FECA workers’ compensation program remains fair, effective, and aligned with agency missions, supporting long-term program integrity and fiscal responsibility.
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Disclaimer: This blog post is for informational purposes only and should not be considered legal advice. Please consult your general counsel for specific legal guidance. Frasco investigators are licensed, and our operations comply with US industry, federal, state, and local laws.