AOE/COE Investigations for Employers – Workplace Injury Claim Investigations – Determine the Facts with Professional AOE/COE Claims Investigation Services by Stryker Investigations.

AOE-COE Investigations are utilized to establish whether the employee’s alleged injury was work-related and happened in the course and scope of employment or whether the injury was non-industrial or affected by third parties. In the early stages of a workers’ compensation claim, a thorough AOE/COE claim investigation is crucial in order to determine and document injury-related accident facts before evidence gets lost or memories deteriorate. Stryker Investigations’ battle-tested insurance defense services encompass all aspects of insurance investigations, workers’ compensation, activity checks, surveillance, subrogation, AOE/COE statements, and fraud investigations. We provide these services to insurance carriers, third-party administrators, law firms, municipalities, and private-sector employers.

When questions arise about whether a workers’ compensation claim legitimately occurred within the scope of employment, our investigators conduct thorough AOE-COE investigations to determine if the injury truly arose out of and in the course of employment. We meticulously examine the reported circumstances, interview relevant witnesses, review security footage, analyze workplace conditions, and document inconsistencies that may indicate the injury occurred outside of work duties or work hours. Our detailed investigations help employers and insurance carriers establish if there are discrepancies between the employee’s account and the evidence, whether the injury mechanism aligns with reported job duties, and if there were any non-work-related activities that may have contributed to or caused the claimed injury. These findings provide crucial documentation for employers to make informed decisions about claim validity and potential defense strategies.

Professional AOE/COE claims investigations determine whether workplace injuries are directly connected to employment, a critical factor in processing workers’ compensation claims. Our experienced investigators document every aspect of workplace incidents, including accident scene details, potential recreational injuries, occupational diseases, and other relevant circumstances that may affect claim validity. Through thorough investigation methods, we gather comprehensive evidence including recorded statements, photographic documentation, accident scene sketches, signed medical releases, and pertinent personnel records.

Our essential investigative services include:

• Thorough documentation of accident scenes and workplace conditions
• Our interviews can be conducted in person
• Our interviews can be conducted virtually with a Zoom meeting
• Collection of witness statements and employment records
• Review of social media, news releases, and public records

Every investigation is unique, and there is no one-size-fits-all approach regarding Activity Checks, Surveillance, Subrogation, AOE/COE Statements, and Fraud Investigations. We work directly with examiners, attorneys, and management to conduct services around specific client requests, service instructions, or significant claim activity. 

What are AOE/COE investigations? The terminology (Arising Out of Employment / Course of Employment) refers to a type of workers’ compensation investigation used to determine the facts surrounding an alleged injury to a worker on the job.

AOE and COE are abbreviations for a work-related injury “arise out of employment” and occurring during the “course of employment“. This is a legal standard in most states for whether an employee’s injuries are covered by workers’ compensation. (AOE–COE) and triggers the right to medical treatment if the cause is industrial. 2. Causation of Disability deals with a determination of accurate permanent disability and apportionment between industrial and non-industrial factors.

Professional AOE-COE Claims investigations determine whether workplace injuries are directly connected to employment, a critical factor in processing workers’ compensation claims. Our experienced investigators meticulously document every aspect of workplace incidents, from initial accident reports to detailed scene analysis, including potential recreational injuries, occupational diseases, and other circumstances that may affect claim validity. Through comprehensive investigation methods, we gather extensive evidence, including recorded statements, photographic documentation, accident scene sketches, signed medical releases, and pertinent personnel records.

Our investigators conduct detailed interviews with witnesses, review workplace safety protocols, and examine maintenance records to establish a complete picture of the incident circumstances. This thorough approach includes analyzing workplace conditions, equipment status, and any contributing environmental factors that may have played a role in the injury. We also review training records, safety meeting documentation, and prior incident reports to provide context for current investigations.

Our essential investigative services include:

• Thorough documentation of accident scenes, workplace conditions, and environmental factors
• Collection of witness statements, employment records, and safety compliance documentation
• Review of social media, news releases, public records, and relevant digital footprints

Written testimony serves as legally binding evidence, whether provided in a courtroom or during an investigation. When a witness signs a written statement, they affirm under penalty of perjury that their account is truthful and accurate. Professional investigators meticulously document these statements, as false testimony can result in serious legal consequences. Even outside formal court proceedings, signed written statements carry significant legal weight and can be used in future litigation, insurance claims, or enforcement actions. 

These documented statements become permanent records that can significantly impact legal proceedings and insurance investigations. Insurance carriers, attorneys, and courts rely on these sworn statements to establish facts, verify claims, and determine proper resolution of cases. 

Fraud occurs when someone knowingly lies to obtain a benefit or advantage to which they are not otherwise entitled or someone knowingly denies a benefit that is due and to which someone is entitled. Filing a fraudulent workers’ compensation claim constitutes a “false claim” under the False Claims Act, which imposes liability on individuals who knowingly submit deceptive claims for payment.

Civil Liability The False Claims Act permits both government entities and insurance carriers to pursue civil litigation against fraudulent claimants. Civil penalties often include:

• Repayment of all fraudulently obtained benefits
• Multiple damages (often two to three times the original amount)
• Civil monetary penalties for each fraudulent claim
• Payment of investigation and litigation costs

Filing a fraudulent workers’ compensation claim constitutes a “false claim” under the False Claims Act, which imposes liability on individuals who knowingly submit deceptive claims for payment. The law specifically addresses cases where individuals intentionally provide misleading or false information to obtain benefits they are not entitled to receive. Violations can result in severe penalties including criminal prosecution, substantial fines, restitution payments, and potential imprisonment.

The False Claims Act enables prosecutors to pursue both criminal and civil actions against individuals who commit workers’ compensation fraud. Criminal penalties may include felony charges, particularly in cases involving substantial monetary amounts or systematic deception. Civil penalties often require fraudulent claimants to repay all illegally obtained benefits, plus additional damages and investigation costs.