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The Enginev1

Occupational medicine

CASE-25-B — Workers’ Compensation Claim Delay

Authored demonstration. Not a live employer result.

01 · Situation

The claim was filed and confirmed. No adjuster is in evidence.

Illustrative first report of injury filed and state-confirmed; no adjuster assignment evidenced within the demonstration’s assignment window.

02 · Evidence

What the record holds.

  1. E1First report of injury

    Verified · Day 0

  2. E2State filing confirmation

    Verified · Day 1

  3. E3Adjuster assignment

    Not located · Due Day 3

  4. E4Claimant follow-up call log, no adjuster contact

    Verified · Day 10

03 · Obligations / Owners

The chain of responsibility.

  1. 01

    HR claims coordinator (file)

  2. 02

    TPA intake (assign adjuster by Day 3, per this demonstration’s illustrative case protocol)

  3. 03

    Adjuster (initial contact)

04 · Accountability Break

Where the chain broke.

The assignment window lapsed with no assignment artifact anywhere in the record.

05 · Next Action

The corrective obligation.

Escalate to TPA account manager; require an assignment-confirmation artifact as a contract deliverable.

06 · Economic Boundary

Where the evidence stops.

Not established — no employer-borne cost record supplied.

07 · Engine Answer

What the Engine can and cannot establish.

TPA intake was required by the illustrative case protocol to assign an adjuster by Day 3. The record contains the filed claim and state confirmation, and no assignment artifact appears, and the Day 10 call log shows no adjuster contact reported by the claimant. The Engine can demonstrate that assignment and initial contact are not evidenced by Day 10. It cannot establish that no adjuster was in fact assigned, employer cost, or why contact was not made.

The claim exists. The record does not show who is handling it.