specifically in the preliminary triage and
investigative stages, to support claims associates as they embark on the new challenges the inevitable fallout from these
decisions represent in Florida.
One such strategy, specifically the
“arising out of employment” or “course of
employment” (AOE/COE) approach in
the field, could be a solution. The AOE/
COE investigation is the most effective
way to empower claims associates to answer the fundamental question of com-pensability accurately and promptly. In
medical terms, the process is comparable
to a differential diagnosis.
The timing appears perfect to introduce Florida associates to the countless
benefits and profound impact that would
result from the application of AOE/COE
coverage-specific non-surveillance investigations in the field.
The AOE/COE approach originated in
California in the early 1980s, following a
particularly grievous case and judgment
finding quite similar in nature and scope
to Aguilera, which was entered against
the State Compensation Insurance Fund.
To ensure this scenario was not repeated, the Workers’ Compensation Appeals
Board (WCAB) of California mandated a
specific set of investigative steps be taken in each and every matter involving an
application for benefits, to better address
the fundamental industrial/non-industri-al or AOE/COE coverage question during
the first 30 days following receipt of the
initial notice of injury report.
Virtually all corollary elements associated with workers’ compensation cases, such as subrogation, apportionment
and pre-litigation discovery, flow from a
well-executed AOE/COE investigation.
Ultimately, our findings in this initial and
most critical process also come into play
in the development of SIU files, where
appropriate, as well as being instrumental
in the coordination of surveillance activities, which ultimately impact the ability
to defend questionable claims.
Equally important is the pivotal role
these preliminary investigations play in
routine claims involving serious injuries.
This service-oriented aspect enhances
relationship building through the face-to-face communication process, which
results from consistently applying this
model between the injured worker, employer and insurer.
This bridge-building between field and
claims associates represents the very definition of outstanding customer service
in the claims industry. An empathetic
approach not only reflects emotional
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Hancock prides itself on the ability to rapidly deploy
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DEDICATED CATASTROPHE TEAM
Hancock maintains a dedicated CAT Team 50+
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