AOE/COE investigations defined

AOE/COE (Arising Out of Employment / Course of Employment) investigation is a workers’ compensation investigation to determine the facts surrounding an alleged injury to a worker on the job. The purpose of the investigation is 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 investigation is crucial in order to determine and document injury-related accident facts before evidence gets lost or memories deteriorate. It is important to document the claimant’s alleged reported injury, along with statements by any witnesses, prior to possible coaching by third parties’ workers’ compensation attorneys.

The term “investigation” is one of such breadth as to encompass all methods, procedures, and situations having to do with securing the information necessary to help process such insurance claims for payment or rejection, or to help the client in any given situation.

AOE/COE investigations may include:

  • reviewing assignment documents
  • reviewing the Workers’ Compensation claims file/documents if appropriate
  • an initial conference (in person and/or phone) with the adjuster to identify background information including work location and environment, standard duties and responsibilities, typical work routines, employment status and wage information
  • conducting background research including data search through Mike Doris at Merlin (merlindata.com), DMV search etc.
  • obtaining recorded statements from the injured worker, supervisors, department personnel representatives, co-workers, witnesses, and/or other involved parties
  • responding to any new information or issues that arise during the investigation with appropriate action, including follow-up questions and/or further investigation
  • providing prompt, clear and concise written reports and evidence documentation
  • providing regular status reports to the examiner by phone or in writing
  • providing all services in accordance with all applicable legal codes and statutes