Claims Handling and Investigation
Claims handling begins the moment an injury is reported. The adjuster must investigate promptly, document contemporaneously, and make timely compensability decisions. Core concepts: the first report of injury, the employer's report, wage statements, medical records, and witness statements. Alaska requires the employer to file a report of injury with the Division, and the adjuster should confirm that filing occurred.
Investigation should establish: (1) the employment relationship and payroll status; (2) the mechanism of injury and whether it arose out of and in the course of employment; (3) notice timing; (4) pre-existing conditions and apportionment issues; and (5) red flags for fraud. The adjuster should obtain the medical records and causation opinion, interview the worker and witnesses, and check for prior claims and inconsistent accounts.
Traps in exam questions: assuming the adjuster may deny first and investigate later - Alaska expects a timely, reasoned decision; treating a delay in reporting as automatic denial (it may be excused for good cause); and confusing the employer's reporting duty with the worker's notice duty. Another trap is accepting a causation opinion from a treating provider without confirming it addresses work-relatedness.
Worked example: A worker reports a back injury three weeks after a lifting incident. The adjuster should not deny solely for late notice; instead, investigate whether the employer had actual knowledge, whether good cause exists, and whether the medical evidence supports work causation. Document each step with dates.
Rule of thumb: the claim file should let a reviewer reconstruct who knew what and when - if a fact is not in the file with a date, treat it as unproven.