In the context of compensability investigations, which statement best describes the investigator's role?

• A. Determine all of the facts
• B. Determine proof of claim being fraudulent
• C. Determine compensability from all facts gathered
• D. Determine if benefits are due to the injured worker

Answer: (C)

In compensability investigations, the main task is to decide whether a claim qualifies for benefits under the workers’ compensation plan based on every relevant fact gathered. The investigator collects information—the nature of the injury, when and where it happened, work status, medical findings, and policy details—and then weighs all of it to determine if the claim is compensable under the plan (that is, whether it meets the legal and plan criteria for benefits). This isn’t about proving fraud or simply listing facts; it’s about integrating all the information to reach a determination of compensability. Once compensability is established, the process proceeds to benefit decisions; if not, benefits aren’t due.