What is the investigator's primary role in pursuing compensability?

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

Answer: (A)

Fact-finding is the primary duty of the investigator. Their job is to gather and verify every piece of information about the incident and the claim—what happened, when and where, how it occurred, who was involved, who reported it, medical treatment, payroll and coverage details, witness statements, and relevant documents. This thorough factual record is the foundation for any later decision, because whether a claim is compensable depends on the facts mapped to policy terms and applicable laws. Investigators aren’t charged with ruling on fraud as their main task, nor with deciding whether benefits are due; those conclusions come after the facts are collected and reviewed by the appropriate claims professionals. So the core objective is to determine all the facts.