This is a Sample Statement of Work for a past assignment for a FECA investigation.
Purpose – the claimant submitted a workers’ compensation claim for a left shoulder injury, so surveillance is requested to monitor his physical limitations if any, his ability to perform daily functions and routines and to determine if he has any other employment.
Scope – conduct video surveillance in separate blocks, at varying times of the day that will provide the greatest likelihood of activity from a middle age, middle income Hispanic male. Data research and neighborhood inquiries are expected to focus the times of surveillance.
Deliverables – Obtain objective video documentation and produce a detailed narrative report of observations and findings.
Cost and Schedule Estimates – the authorized budget is $ – with the understood billing rate of $ an hour, $ a mile. One day of surveillance is to occur on the future date of a scheduled medical appointment. Notification of that appointment will be provided when set. The report is due within 10 days of the completion of the last day of surveillance.
Constraints – the investigation is to be conducted in compliance with all local, state and federal laws and take into account public perceptions and best investigative practices.
Success criteria – Video is desired of the claimant active outside of his home engaged in daily errands to show his range of physical movement and activities. Particular focus will be placed on documenting any activities that are outside of his restrictions and any inconsistent pain behavior before, during or after a medical exam. Such documentation will be provided immediately to assist medical professionals in issuing their subjective medical findings.
Chain of command or management guidelines – the adjuster will be updated as to the findings by email after each period of surveillance or significant event.
Assumptions – the investigation will gather information that will substantiate the legitimacy of the claim, or will speed the claimant’s return to work, or will document fraudulent activities.
The investigator at a later date will be available to testify at any hearing or administrative board regarding video, report and all observations and findings.