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

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

Answer: (B)

When compensability is in question, the investigator’s job is thorough fact-finding to build a complete factual record. This means gathering and verifying every relevant detail—how the injury occurred, when and where it happened, the worker’s duties at the time, medical reports and treatment, wage information, witness statements, and any documents that could support or challenge coverage. With all the facts collected, the claims decision-maker can evaluate whether the claim meets the criteria for compensability. The investigator does not make the compensability decision themselves, nor do they determine benefits due or probe for fraud—that comes later, using the facts the investigator has collected.