What is the role of the investigator assigned to pursue issues of compensability?

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

Answer: (D)

The key task is to determine compensability from all the facts gathered. Compensability means the injury or illness is covered under workers’ compensation — it must arise out of employment and occur in the course of employment. The investigator collects a complete set of evidence (incident reports, medical records, statements from the employee and witnesses, employer records) and weighs how each piece supports whether the claim qualifies under that standard. The goal is to decide, based on the full factual picture, whether benefits should be paid for a compensable claim.

This is distinct from deciding benefits directly (that's the downstream step once compensability is established) and from fraud investigations (which focus on deception rather than whether the injury is work-related).