External

(INVESTIGATION-IN-CONFIDENCE (WHEN COMPLETED))

Investigation Report

DETAILS OF THE PERSON INVESTIGATED

Surname:

Investigation Case No:

Given Names:

Claim/Provider No:

(N/A if Staff Member)

DETAILS OF THE PERSON MAKING THE ALLEGATION

Date Received:

Received By:

Received From:

Contact Telephone No:

Preliminary Report

Allegation:

(Full details of allegation)

Background:

(Summary of information available on claim and claimant, the type of service provided by a service provider or a description of the staff members duties.)

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(INVESTIGATION-IN-CONFIDENCE (WHEN COMPLETED))

Validation:

(Narrative of the investigative steps taken to test the allegation.  Examples may be:  A review of PRACSYS, a review of claim file and/or interview of witness(es).  If a service provider is involved, a review of contract data and information of the service provided.  If allegation is not true (e.g. the person being investigated is not a Comcare claimant or anonymous information is not consistent with claim information) explain in detail.

Category of Investigation

Claimant, Internal Staff or Service Provider

Allegation:-

How Received:-

Anonymous Telephone Call, Anonymous Letter, Letter, Telephone Call, Agency, Internal Staff, Program Developed

Type of Allegation:-

Medical, Undeclared Income , Internal Staff or Service Provider

Details of the person investigated (If Appropriate)

Date of Injury:-

Claim Status:-Opened or Closed

Injury Type:- Back, Fracture excluding back, Strain excluding back, Open wounds, Contusion/Crush, External Effects, Multiple injuries, Other injuries, OOS, Stress, Other diseases

Case Estimates (If Appropriate)

Actual Payments:-

Outstanding Liabilities:-

(INVESTIGATION-IN-CONFIDENCE (WHEN COMPLETED))

(INVESTIGATION-IN-CONFIDENCE (WHEN COMPLETED))

Investigator Comments/Actions:

(List an investigation plan.  What you plan to do.   If you decide not to proceed with an investigation, give details and reason why.)

Office Manager Comments:

(Short statement of agreement or disagreement.  This is most important when not proceeding with an investigation.)

(Signature & Date Required)

Investigator

(date)

Fraud Prevention Group Comments:

(Comments of National interests, suggestions for investigation plan and other appropriate comments.)

(Signature & Date Required)

(INVESTIGATION-IN-CONFIDENCE (WHEN COMPLETED))