One of the sessions I looked forward to at the California Coalition on Workers’ Compensation (CCWC) Annual Conference was presented by Dr. Tyrone Spears (City of Los Angeles) and Stephen Peacock (Safety National): “Are You Ready for a Workers’ Comp Catastrophe?“
The title immediately grabs your attention, which is one reason why the room was full.
Most of us don’t like thinking about catastrophic claims. They are, by definition, rare events. We hope they never happen to our organizations. We certainly don’t enjoy imagining the circumstances surrounding them: a firefighter trapped in a burning structure, a police officer suffering a fatal cardiac event, a catastrophic motor vehicle accident, a traumatic amputation, or a devastating spinal cord injury.
But as I sat listening to Tyrone and Stephen share story after story from their long careers, I realized something. The catastrophe isn’t always just the injury. Sometimes the catastrophe is compounded by what happens afterward.
Or perhaps more accurately, everything that doesn’t happen because no one prepared for it.
Stephen shared a striking figure. Only a small fraction of workers’ compensation claims – well under one percent – ultimately exceed one million dollars. That sounds reassuring until you hear his comparison: you’re still far more likely to experience one of these catastrophic claims than you are to win the lottery.
We buy insurance because unlikely events still happen. The same logic should apply to planning.
Throughout the presentation, Tyrone and Stephen told stories that were compelling, sometimes heartbreaking, and occasionally almost unbelievable. But what struck me wasn’t the severity of the injuries. It was how often the outcome depended on preparation rather than luck.
One story involved an injured worker remaining in the hospital longer than medically necessary because durable medical equipment wasn’t ready for discharge. Another described years of unnecessary hotel expenses because housing decisions weren’t addressed early enough. Yet another illustrated how a well-intentioned public statement to the media inadvertently eliminated potential legal defenses before the facts were even known.
None of those situations were caused by poor medical care. They were caused by poor preparation.
We spend enormous amounts of time discussing catastrophic medicine. Burn centers. Trauma centers. Rehabilitation hospitals. Centers of excellence. Nurse case management. For sure, all those resources are critically important.
But what Tyrone and Stephen demonstrated is that catastrophic claims are just as much about coordination as they are about clinical care.
- Who gets the first phone call?
- Who is responsible for communicating with the family?
- Who contacts the nurse case manager?
- Who coordinates with the treating hospital?
- Who activates specialized vendors?
- Who manages media inquiries?
- Who preserves evidence if third-party liability may exist?
- Who brings everyone together to make sure the right hand knows what the left hand is doing?
If those questions are first being asked after a catastrophic injury occurs, you’re already behind. Making important decisions with potentially large implications “on the fly” is almost a guarantee that what started out bad can turn worse.
One of the most memorable observations Tyrone shared was that families never forget the very first interaction they have after a catastrophic injury. They remember whether someone showed up (literally). They remember whether someone communicated with empathy (not claims speak). They remember whether someone reassured them that medical care and benefits would be taken care of (and they were). That first impression often shapes the entire relationship moving forward.
We often talk about first impressions in customer service. Catastrophic claims remind us they matter just as much in workers’ compensation.
Another point that resonated with me was the emphasis on creating a dedicated catastrophic claims team before one is ever needed. Tyrone described immediately activating nurse case managers, internal leadership, and key stakeholders when a catastrophic event occurs. Stephen expanded that concept by recommending organizations identify specialized adjusters, defense counsel, vendors, durable medical equipment providers, home modification specialists, and even media communication protocols long before tragedy strikes.
Preparation reduces chaos.
The presentation also challenged a subtle assumption that many organizations unknowingly make that a catastrophic claim simply requires doing “more” of what we normally do. In reality, they require doing many things differently.
Tyrone shared how, after a major fire injured twelve firefighters, they intentionally assigned a single adjuster to coordinate every claim arising from that event. Not because one adjuster could do all the work alone, but because consistency of communication mattered. Families weren’t receiving different answers. Medical decisions were coordinated. Expectations remained aligned. Importantly, he worked with his claims team to reassign some of that adjuster’s other open files so coordinating the fire claims could be their sole focus, not one more thing on an already full desk.
Consistency builds confidence. Fragmentation creates confusion.
One practical takeaway I particularly appreciated was the timeline checklist the presenters provided. Rather than treating catastrophic claims as one overwhelming event, they broke the response into manageable phases: what should already be in place before an injury occurs, what must happen during the first 24 hours, the first week, the following weeks, and the months beyond.
- Before the injury, identify your catastrophic response leader.
- Within the first 24 hours, activate medical, nursing, and family communication resources.
- During the first week, coordinate with hospitals, rehabilitation providers, excess carriers, and key stakeholders.
- In the weeks ahead, begin planning for discharge, home modifications, transportation needs, long-term rehabilitation, and future care.
That is a simple, logical, and effective plan that every organization can incorporate into its own catastrophic response playbook.
As I reflected on the session afterward, I realized this wasn’t really a presentation about catastrophic claims (even though that was the provocative title).
Instead, it was a presentation about organizational readiness.
Every organization (hopefully) has emergency evacuation plans, business continuity plans, cybersecurity incident response plans, and natural disaster plans.
Yet many workers’ compensation programs have never developed a formal catastrophic claims response plan. Instead, they rely on experienced people to figure it out.
Experienced professionals absolutely matter, but even experienced professionals perform better when they don’t have to invent the process during a crisis. That is the difference between reacting and responding. You don’t have to guess which one sets you up for failure versus success.
If your organization experienced a catastrophic injury tomorrow morning, would everyone involved know exactly what role they play? Or would they spend the first several hours trying to figure it out?
Those first hours matter. Not only because they influence medical or financial outcomes, but because they influence human outcomes.
A catastrophic injury will likely become one of the defining moments in an injured worker’s life. It may also become one of the defining moments for your workers’ compensation program. Especially if it’s handled poorly, with the ever-increasing costs showing up as a quarterly reminder.
You don’t discover the strength of your preparation when everything goes according to plan. You discover it on the worst day an employee and their family will ever experience.
That’s why the biggest takeaway from this session wasn’t a medical recommendation or a claims management tactic.
It was a mindset.
Hope is important. Preparation is indispensable.
When lives are changed in an instant, the most compassionate thing an organization can offer isn’t simply expertise. It is a well-prepared plan that is ready long before it’s ever needed.
