Frustration over the lack of compassion. The lack of creative problem-solving. And, perhaps most frustrating, the lack of willingness to think beyond a script or a set of predetermined answers.
My frustration stems from helping care for my mom following a stroke. My sister and I have navigated some frightening moments, celebrated Mom’s recovery, and learned to adapt to her ongoing needs. There is so much to be thankful for, but the journey has also opened my eyes to just how difficult everyday tasks can become when life changes in an instant.
Mom is 85. She’s fun-loving, strong-willed, and resilient. She’s also living with limitations that make some things we take for granted much more difficult. Technology isn’t her strong suit. She doesn’t even have an email address, and using a cell phone is challenging, particularly when she has only one fully functional hand.
So, imagine spending more than 3.5 hours on the phone with her supplemental insurance company trying to resolve an issue. Imagine making repeated calls because the company specifically instructed you to call back the following week. Then imagine being told you’re calling repeatedly because you’re fishing for a different answer.
That was my experience.
I requested the opportunity to speak with a leader who could help evaluate the situation, or better yet, the person who had written the letter offering the instructions I was attempting to follow. My request was denied, and eventually, the call was disconnected.
I did my best to remain calm, keep my tone warm, and approach the situation constructively. Yet we remained trapped in a cycle of scripted responses and rigid processes, with no apparent path to someone empowered to consider the circumstances and help find a solution.
I’ll leave the specifics of the dispute between us. The details aren’t the point. The experience is.
When did we become so focused on following the process that we forgot to serve the person?
We live in a world increasingly driven by technology, automated decision trees, standardized responses, and efficiency metrics. Those tools have their place. But they should support good customer service, not become barriers to it.
A script cannot replace judgment. A decision tree cannot account for every circumstance. And a frontline employee should not be left without a path to escalate a situation that requires thoughtful consideration.
Sometimes, the answer isn’t immediately obvious. Sometimes, the solution requires asking another question, involving someone with greater authority, or simply taking the time to understand what the person on the other end of the phone is actually experiencing.
That isn’t asking for special treatment. That’s asking for customer service with compassion, patience, and empathy.
Throughout my career, I’ve seen firsthand how much the way we treat people matters. An injured worker navigating a claim may be dealing with pain, uncertainty, financial stress, family responsibilities, and a future that suddenly looks very different. The last thing that person needs is to feel like another number in a system that has no room for their circumstances.
We talk about compliance, efficiency, processes, and outcomes. We invest in technology and develop procedures to ensure consistency. We should absolutely do those things.
But we cannot allow the process to become more important than the person it was designed to serve. Experiencing that lack of compassion and advocacy during my lengthy phone call was frustrating enough. But having spent years working to instill those very values in the team I led, experiencing their absence firsthand made it all the more frustrating.
My post-retirement goal has been to influence positive change in an industry of which I care deeply. That means continuing to challenge ourselves to do better, even when the conversation is uncomfortable.
Here’s my plea, whether you work in workers’ compensation or any industry that serves people:
Lead with empathy. You rarely know the full story of the person on the other end of the phone or counter.
Listen to understand, not just to respond. The answer may be hidden in the details your script doesn’t ask about.
Empower your people. Give employees the training, judgment, authority, and escalation pathways they need to resolve problems.
Think beyond the checklist. Consistency matters, but so does recognizing when a situation requires a different approach.
Treat every interaction as an opportunity to help. Even when you cannot give someone the answer they want, you can still treat them with dignity, explain their options, and help them understand the next step.
We may not always be able to say yes. We may not always be able to change an outcome. But we can choose how we treat people along the way.
My mom and I felt backed into a corner, with no clear path forward and no one willing to help us find one.
We can do better than that.
Listen with compassion, not judgment. Think beyond the script. And never forget that behind every call, every claim, and every customer service interaction is a human being who deserves to be heard.
That’s the kind of service our industry needs. And it’s the kind of service we should all expect from ourselves.
Every CFO eventually asks the same question about the training line item: what did we get for it? The answer that usually comes back is attendance numbers and a satisfaction score. Neither number survives a budget review, and neither should.
There is a better answer, and it has existed for decades. Jack Phillips built a five-level evaluation model that most learning and development departments already know by name: reaction, learning, application, business results, and financial ROI. The trouble is that almost nobody finishes the climb. Training Industry’s own review of the Phillips ROI Methodology notes that only 5 to 10% of corporate training programs are ever evaluated at that fifth level, the level that turns training into a dollar figure a CFO can compare against anything else competing for the same budget. In terms of workers’ compensation, where the training line item competes against the technology spend, headcount, and reserves, that gap is expensive. It means most claims organizations are running a training program and hoping it works, without ever finding out the utility or efficacy.
Timing makes the gap harder to ignore. WCRI’s CompScope Benchmarks, 2026 Edition, shows total claim costs rising at 6% a year across the median of its 18 study states from 2022 through 2025. That is not a one-year spike. It is a multi-year trend across medical payments, indemnity, and benefit delivery expense. A training program that cannot demonstrate its effect on that trend is not neutral. It is a cost sitting next to a rising cost, unaccounted for either way.
Start the model with a realistic number for what the training itself costs. ATD’s 2026 State of the Industry report put direct training expenditure at $846 per employee in 2025, down sharply from $1,254 the year before, even as formal learning hours rose from 13.7 to 16.7 per employee. A one-year swing that large in the dollar figure is more likely a reporting change than a true shift in spending, so treat the number as a starting anchor rather than gospel. The more reliable signal is the second half of that sentence. Organizations are trying to teach more on a tighter budget, which is exactly the discipline a 12-month ROI model is built to support.
The model itself follows Phillips’ levels in calendar order, because claims data develops slowly and the levels happen to unfold in roughly the same order the data becomes available.
Months 1 and 2establish the baseline. Before a single adjuster sits through a session, pull the claims scorecard by cohort: average claim duration, reopen rate, litigation rate, reserve accuracy, and medical cost trend. This step gets skipped more often than any other, and skipping it is what turns a training program into an anecdote instead of a measurement.
Months 3 and 4 are delivery and comprehension, Phillips’ levels one and two. Test what adjusters actually retained, not how they felt about the room or the instructor. A satisfaction score of 4.8 out of 5 does not appear on anyone’s income statement.
Months 5 and 6 move to level three, behavior on the file. Audit a sample of claims handled by trained adjusters. Is mechanism of injury documented before advanced imaging is ordered? Is peer review referred earlier when a diagnosis outruns the objective findings? This is where most programs stop measuring, and it is also where most of the eventual financial value is still invisible on a P&L.
Months 7 through 9 are level four, business results starting to surface. Rerun the same scorecard from months 1 and 2. Reopen rate and reserve accuracy tend to move first because they reflect decisions made close to the point of training. Litigation rate and claim duration lag behind, because those outcomes depend on how a claim was handled months earlier.
Months 10 through 12 are level five, the financial calculation itself. Compare the trained cohort’s scorecard to its own baseline, and if the organization is large enough to support it, to an untrained comparison cohort managing a similar mix of claims. Multiply the measured movement by claim volume and by a defensible average cost per claim.
A worked example keeps the model honest. Take a mid-size TPA with 50 adjusters handling 6,000 claims a year. Training investment at the ATD-anchored figure runs 50 times $846, or $42,300 for the year. The National Safety Council’s Injury Facts data, sourced from NCCI’s Workers Compensation Statistical Plan, puts the average cost across all claims at $47,316. Multiply that by 6,000 claims and the book represents roughly $284 million in claims exposure for the year. Against that base, the entire training line-item breaks even at a movement of about 0.015% in average claim cost across the book. That is not a bet on a large effect. It is a very small ask of the data; smaller than the quarter-to-quarter noise most claims organizations already see in their own numbers.
That does not mean every improvement in the scorecard belongs to the training program. Reserve philosophy changes, panel changes, litigation posture, and the same macro severity trend from WCRI all move at the same time. A rigorous 12-month model accounts for that by comparing trained and untrained cohorts side by side, or by staggering the rollout so some offices train in month three and others in month nine, giving the model an internal control group instead of a single before-and-after snapshot.
This does not require perfect attribution to be useful. It requires a documented baseline, a known training cost, a known claim volume, and a scorecard rerun at regular intervals rather than reviewed once. Built this way, the 12-month model answers the CFO’s question in the CFO’s own language: dollars measured against a number the CFO already follows.
For claims professionals who want to build fluency in the clinical side of that scorecard, particularly how mechanism of injury and objective findings should drive documentation and cost, WorkCompCollege.com offers certification coursework built for exactly that gap.
Sources
Phillips ROI Methodology, Training Industry glossary, trainingindustry.com/glossary/phillips-roi-methodology.
Workers Compensation Research Institute, CompScope Benchmarks, 2026 Edition, wcrinet.org.
Association for Talent Development, 2026 State of the Industry Report, td.org.
National Safety Council, Injury Facts, Workers’ Compensation Costs, sourced from NCCI Workers Compensation Statistical Plan database, injuryfacts.nsc.org.
Four words have quietly ended more careers than any layoff: “I already know enough.”
I started my professional career as a mainframe computer operator. Today, I’m the Provost of WorkCompCollege.com.
There is no logical career path connecting those two jobs, at least not one I could have predicted when I was sitting at the console of a mainframe computer four decades ago.
The common thread throughout was curiosity. I have spent my entire adult life wanting to know more than I knew yesterday. Not simply about the job I was doing, but about subjects, technologies, people, and perspectives that might have little obvious connection to my immediate responsibilities.
I believe the moment you stop learning is the moment you start becoming irrelevant. With the pace of change we’re experiencing today, being a lifelong learner is even more important.
My first professional reinvention was from mainframe computer operator to software developer. I taught myself multiple programming languages and platforms, which eventually led to business analysis, project management, and department management. Then I entered the workers’ compensation industry and began to engage in an entirely different world: insurance, healthcare, legal, regulations, claims management, human behavior. As I leveraged my software development skills to create new products, I added more skills like marketing and sales. That led to an opportunity to write and speak at conferences, ultimately creating the RxProfessor brand. I even evolved my subjects over time, from opioids to AI.
Then, in 2021, I got laid off. After decades of building a reputation, I had to answer a question I hadn’t asked myself in years: What now? The answer had been built, piece by piece, from everything I’d learned when nobody required me to. My employer’s decision led to my next reinvention: business owner and Provost of WorkCompCollege.com.
I sometimes joke that I’m on version 476 of Mark Pew.
I didn’t learn all those things because I knew I would need them someday. I learned because I was interested. When new opportunities appeared, or circumstances forced me to change direction, my accumulated knowledge and experiences made those transitions possible. Everything I learned yesterday was quietly building toward today.
I’ve lived through the transitions from no computers to mainframes, personal computers, the internet, mobile, cloud computing, and remote work. Each transformation changed how people worked and what they needed to know. AI feels different, though, because of the speed and breadth of its potential impact. Skills that were valuable yesterday may become automated tomorrow. Tasks that once required specialized expertise can increasingly be accomplished by someone who knows how to ask the right questions and evaluate the answers. The World Economic Forum’s 2025 Future of Jobs Report estimates that 39% of workers’ core skills will change by 2030. The status quo isn’t coming back.
I’ve discovered that knowledge from seemingly unrelated subjects frequently becomes useful in unexpected ways. My technology background influences how I think about education and business development. My experience in project management helps me organize complex initiatives. Marketing taught me to communicate ideas provocatively. Speaking and writing have forced me to clarify what I believe in a concise and understandable manner. Studying human behavior has fundamentally changed how I interact with the world, both professionally and personally.
Experience is a wonderful teacher, but it can also become a trap. Nobody says “I already know enough” out loud. We say it with our calendars, by what we never make time to learn.
Author David Epstein explains why in Range: Why Generalists Triumph in a Specialized World. He describes “kind” learning environments, like golf or chess, where the rules are clear and practice makes perfect. Then there are “wicked” environments, where the rules shift, feedback is delayed, and today’s situation rarely matches yesterday’s. In wicked environments, people who draw on a wide range of experience consistently adapt better than those who know only one thing. If you’ve ever handled a work comp claim, you already know which kind of environment we work in. Learn one thing every quarter that your job doesn’t require.
A claims adjuster needs to understand statutes, case law, compensability, medical terminology, financial reserving, claims procedures, and return-to-work best practices (among many others). But to be effective, they also need to understand:
Psychology: recognizing fear avoidance and catastrophizing before they stall recovery
Effective communication: the first call that sets the tone for the whole claim
Artificial intelligence: knowing what to automate, and what to double-check
Leadership: influencing outcomes you don’t control
The economics of healthcare: why the cheapest provider is rarely the least expensive claim
The same principle applies to clinicians, attorneys, salespeople, executives, and just about everyone else.
Sometimes the most valuable thing you learn has nothing to do with what you thought you needed to learn. That’s why I encourage people to seek information from multiple sources and perspectives, including those that challenge their assumptions. For example, I don’t limit my daily reading to work comp content, because macro trends eventually find their way into our industry.
Ask yourself these three questions:
What have I learned in the past 90 days that genuinely changed my thinking?
What subject outside my immediate expertise could make me more effective, personally or professionally?
What am I doing today to prepare for opportunities or disruptions that I cannot yet anticipate?
Those questions apply whether you’re just entering the workforce or approaching retirement. Give question two your attention for 30 minutes per week for the next 90 days. When the 90 days are up, answer question one again. After all, the value of education isn’t what you know when the course ends. It’s what you do differently afterward.
If question two left you stuck, that’s exactly why we built the Advanced Training & Education Center (ATEC) at WorkCompCollege.com. ATEC reflects what I think continuing education should look like: broad, ongoing, and intentionally diverse. Rather than focusing exclusively on a single certification or discipline, ATEC provides an expanding library of learning opportunities across the workers’ compensation ecosystem. There are resources covering claims management, medical management, legal issues, risk management, return to work, humanities, and technology. Specialized offerings explore subjects such as mental injury claims, independent medical examinations, medical settlements, and practical AI applications. Jurisdiction-specific content now covers 38 states, each explained by a human expert in that state’s nuances. Pick the course farthest from your job description, as that could be your answer to question two.
So who owns your professional development? TIP: You do.
An employer can provide opportunities. A manager can encourage you. An organization can pay for training. But nobody can make you curious. Nobody can force you to ask better questions, explore unfamiliar subjects, or reconsider long-held assumptions. Face it … nobody has a greater stake in your future than you do.
Replace “I already know enough” with three better words: “Tell me more.” I’m working on version 477. What version are you on?
Comprehensive course developed by internationally recognized impairment expert Christopher R. Brigham, MD
LAKEWOOD RANCH, FL – October 13, 2026: WorkCompCollege.com today announced the official launch of its AMA Guides® to the Evaluation of Permanent Impairment, Sixth Edition 2025 Mastery Training Program, believed to be the first comprehensive, fully online, and self-paced training curriculum developed specifically for the American Medical Association’s most current version.
Available through AMAguides.com, the program was developed in partnership with Christopher R. Brigham, an internationally recognized authority on impairment and disability assessment who served as Senior Contributing Editor of the AMA Guides Sixth Edition and for nearly three decades as Editor of the Guides Newsletter. Dr. Brigham also developed the Fifth and Sixth 2008 Edition Mastery Training programs acquired by WorkCompCollege.com earlier this year.
Published digitally by the AMA rather than as a traditional printed textbook, the Sixth 2025 Guides incorporate evidence-based updates made since the original Sixth Edition was published in 2008. The AMA’s digital platform enables future revisions as medical evidence and clinical practice evolve. The Guides can be accessed at https://ama-guides.ama-assn.org/.
“A new edition is only as good as the people trained to use it well,” said Mark Pew, Provost of WorkCompCollege.com. “We built this curriculum so professionals get both speed and rigor through Dr. Brigham’s expertise in how the Guides work and Dr. Buttar’s clinical oversight into how they should be taught.”
The curriculum covers all 17 chapters and includes approximately 200 unique modules and over 20 hours of video content. The training program also includes comprehension quizzes, study guides, interactive learning resources, and vignettes to provide a rich learning experience.
“Knowing where to find a table or formula is not the same as understanding how to perform a high-quality impairment evaluation,” said Dr. Brigham. “This training program is designed to help professionals understand not only how to apply the Guides, but the principles and reasoning necessary to produce accurate, consistent, unbiased and defensible impairment assessments.”
The curriculum underwent extensive quality review led by Dr. Waqas Buttar, Medical Director of WorkCompCollege.com, with particular emphasis on clinical accuracy, usability and practical application.
“Impairment ratings can materially affect an individual’s future and the resolution of a claim,” said Dr. Buttar. “Our QA process approached this curriculum with the same expectation we would apply to the evaluation itself: the methodology must be clinically sound, clearly communicated and reproducible.”
While the AMA Guides are deeply embedded in U.S. workers’ compensation, their application extends internationally and across personal injury, motor vehicle, disability and other medicolegal systems. The new curriculum is available globally and on demand, allowing physicians, other qualified healthcare professionals, attorneys, claims professionals, and regulators to learn at their own pace.
Learn more about the Sixth 2025 Digital Mastery Training Program at AMAguides.com.
WorkCompCollege.com and its permanent impairment-related content – Impairment.com, AMAGuides.com, and CertifiedRater.com – are independent of the American Medical Association. The training program is neither endorsed nor sponsored by the AMA.
About Workers’ Compensation Educational Services, LLC
Workers’ Compensation Educational Services, LLC is the organization behind WorkCompCollege.com and a growing family of educational platforms dedicated to improving outcomes throughout the workers’ compensation system. Through online education, professional credentialing, conferences, publications, and industry resources, the organization serves employers, insurers, medical providers, attorneys, regulators, and claims professionals across the United States and internationally.
Key Insight:William’s story shows that a workplace injury can take away far more than physical ability. When an injured worker loses their routine, their role as a provider, and regular contact with their employer and adjuster, the loss of identity can weigh as heavily as the injury itself, and much of it can be prevented.
How Workplace Injuries Affect Identity, Purpose, and Mental Health
For most of his working life, William knew exactly who he was. He was the truck driver who took the extra shift. The one who picked up when another driver called out. The teammate other people leaned on.
Then, in February 2023, a drunk driver struck his truck. William came out of the crash with multiple injuries. Within weeks, he went from working 60 to 80 hours a week to sitting at home with no schedule, no clear timeline, and fewer people calling.
“I kept my head down a lot. I wasn’t used to sitting still. It was a very discouraging time.”
A workers’ compensation claim is built to track physical recovery. What it often misses is the slower loss that follows an injured worker home: the loss of routine, of purpose, and of belonging. For William, that loss hit harder than he ever expected. And much of it came not from the accident, but from the silence that followed it.
Meet William: A Truck Driver Whose Identity Was Built on Being Dependable
William’s job kept him on the road and on the move. He regularly volunteered for overtime and made himself available whenever the schedule needed filling. He liked the full days, and he liked the people: the customers he met on deliveries, the coworkers he considered friends, and an employer he felt he had a great relationship with.
He called himself a “team player,” and he meant it. “At work, I always made sure the guys knew I was there if they needed anything – an extra hand, a conversation,” he said.
His work also made him a provider. William earned enough to support his family, including helping care for an ill family member. He described himself as an outgoing guy, rooted in faith, with a positive attitude he didn’t think could be shaken.
The accident tested every part of that.
How the Lack of Light Duty Affected Recovery
William’s employer did not offer modified duty on site.
“There’s nothing light duty about being a truck driver, and nothing was available at the warehouse or office, so I felt forced to sit at home.”
So, he focused on the one part of recovery he felt he could control. He went to physical therapy regularly, believing that if he worked hard at healing his body, he would get back to work faster. But the weeks went on with very little progress. Frustration turned into uncertainty, and uncertainty turned into depression.
Being home all day gave him time he didn’t want. “The more time I spent at home doing nothing, the more I had time to think,” he said. “And I questioned a lot of things – my sense of belonging being a big one.”
The Financial and Emotional Weight of a Workplace Injury
For William, being out of work wasn’t only about missing the job. It was about losing his ability to take care of the people who depended on him.
“We had savings, but I needed to be able to continue to earn for my family, and I had no idea how long I would be kept from being able to do so. It caused a lot of stress.”
Not knowing how long he’d be out made the financial pressure harder to carry, and he felt he had no one to carry it with. “I felt like I had no one to talk to about it, either,” he said. The man who had always made himself available to others found that no one was making themselves available to him. “No one was there for me when I needed them. It was shocking to me, and extremely isolating.”
How Silence from Employers and Adjusters Affects Injured Workers During a Workers’ Compensation Claim
Over time, William’s coworkers stopped checking in. His employer rarely called. When William reached out himself, he said he usually got an excuse or was sent to voicemail.
“Getting hurt and taken out of work was eye-opening in ways I didn’t expect it would be … It just didn’t make sense to me.”
He started asking himself a question many injured workers never say out loud: Why am I the one who has to reach out to them? Shouldn’t it be the other way around?
The silence even changed how he felt about picking up the phone. He wondered whether his employer and adjuster were annoyed by his calls or ignoring him on purpose.
“My intention wasn’t to be a burden. I really just wanted to know where I stood and maybe feel reassured that my job would be there when I got better.”
That kind of worry has a measurable cost. In a study based on interviews with 3,200 injured workers across eight states, the Workers Compensation Research Institute (WCRI) found that workers who were strongly concerned about being fired after their injury were twice as likely to be out of work at follow-up (20% compared to 10%) and averaged about four more weeks of disability. Read a summary of the WCRI findings.
For William, the silence reached beyond work. It made him question relationships he had never doubted.
“I don’t like to admit it, but it was lonely. Here I thought I had all these people that cared about me – family, friends, coworkers, my boss – but their silence really said it all. And it made me wonder – was any of it genuine? I felt abandoned by the very people I cared about, and who I thought cared about me.”
When Medical Care Feels Rushed and Questions Go Unanswered
William’s medical care added to the uncertainty. He said his appointments felt hurried, and his concerns went unheard.
“I didn’t feel like I was getting the care I needed. I felt like my doctor was always in a rush, didn’t really listen to how I was feeling, like he was distracted. And he’d just schedule another appointment, or another PT session for me, or another steroid shot. And I just didn’t understand that course of treatment when I told him I wasn’t feeling any better.”
Sometimes, he said, he arrived at the office only to be told his appointment had been rescheduled.
The question he most wanted answered was the one he never got a clear reply to. “I wanted to get back to work. And I asked every time I met with my doctor, but I never really got any straightforward answers or explanations,” he said. “And I’ve spoken to other people in the same situation as me, and that seems to be common.”
How an Off-site Transitional Duty Assignment Through Transition2Work® Restored Routine and Purpose
Three months after his injury, a light-duty offer arrived in William’s mailbox. No one, not his employer and not his adjuster, had called ahead or mentioned it might be an option. The offer was for an off-site transitional duty assignment with a local nonprofit through ReEmployAbility’s Transition2Work program, which provides modified-duty work in the community when an employer can’t accommodate restrictions in-house.
After months without contact, an unannounced letter could easily have raised questions. William said his first feeling wasn’t hesitation. It was relief.
“I was so discouraged for months that this felt like an answer to a prayer. I didn’t question it at all. It gave me a reason to get up in the mornings again. It gave me that meaningful routine that I felt I had lost. I got to interact with folks rather than sitting at home and having my head down. I got to realize that regardless of an injury, I was still capable of doing something.”
The assignment reconnected him with people, including customers and staff who became friends, and gave his days a shape again. He no longer felt like he was drifting.
It didn’t fix everything. His frustrations with his medical treatment continued, and so did the gaps in communication with his employer and insurance company. The assignment gave William purpose, structure, and a place to belong. It did not give him the answers or the check-ins he had been waiting for. His Transition2Work file closed in February 2026, three years after the crash.
What Workers’ Compensation Professionals Can Learn About Identity Loss After an Injury
William’s physical injuries were real, and his recovery from them was slow. But when he describes what hurt most, he talks about losing his routine, his role as a provider, and his belief that the people around him cared. Those losses didn’t come from the crash. They came from what happened, and didn’t happen, after it.
Silence is not neutral. When an employer, adjuster, or provider goes quiet, the injured worker fills the gap, often with the worst possible explanation. William worried he was a burden. He wondered whether he still had a job. He questioned whether his relationships had ever been real. No one likely intended to send those messages, but the lack of contact sent them anyway.
“No light duty available” shouldn’t mean “wait at home.” For workers like truck drivers, whose jobs can’t easily be modified, the absence of on-site light duty can leave them with nothing to do but wait. William waited three months, long enough for discouragement to become depression. When on-site modified duty isn’t possible, off-site transitional duty can offer structure and connection far sooner.
Why an offer matters. William welcomed his light-duty offer, but it came by mail with no warning. For a worker who already feels forgotten, a quick call explaining what the offer is and why it’s being made can turn a letter into a conversation.
Workers need answers about their timeline, even imperfect ones. William asked his doctor at every visit when he could go back to work. “We don’t know yet, and here’s what we’re watching for” is still an answer. Repeating the same treatment without explanation left him feeling unheard.
Physical healing and emotional well-being move together. For William, fear, isolation, and loss of identity were not side effects of the claim. They were a central part of his recovery, and clear, consistent communication could have eased much of it.
Key Takeaways for Claim Professionals, Employers, and Medical Providers
Don’t wait for the injured worker to call. Set a regular check-in schedule and start with a simple question: “How are you doing?”
Address job security early and plainly. If the worker’s job is being held, tell them. Worry about job loss is linked to longer time out of work.
Act quickly when no light duty is available on site. Explore off-site transitional duty early, before weeks at home turn into months.
Call before the offer letter arrives. Explain the assignment, why it’s being offered, and what the worker can expect.
Explain the treatment plan and give a timeline, even a range. When a worker says they aren’t improving, acknowledge it and explain the next step.
Watch for signs of isolation and depression, especially in workers whose sense of self is tied to being busy, dependable, or the family provider.
Help keep workplace connections alive. Supervisors can encourage teammates to stay in touch, so an injured worker doesn’t feel forgotten by the people they worked beside.
William didn’t ask for much. “I really just wanted to know where I stood,” he said. For the professionals who handle his claim and the next one like it, that is a need that costs little to meet, and a great deal to ignore.
Most claims organizations treat attorney involvement as a symptom. The worker hired a lawyer, the reasoning goes, because the injury was serious enough to justify one. That explanation feels reasonable. It is also, according to two of the more rigorous datasets in workers compensation research, only part of the story. A meaningful share of litigation is not driven by injury severity alone. It is driven by how the claim was handled in the first days and weeks after it was reported.
What the reporting-lag data shows
In 2015, NCCI actuary Thomas Sheppard published a study of workers compensation claims across 44 states, examining what happened as the gap widened between the date of injury and the date the claim was reported to the insurer. The pattern held across sprains, strains, fractures, contusions, and lacerations. Claims reported the same day carried attorney representation 13% of the time. Claims reported more than four weeks later carried it 32% of the time, nearly a two-and-a-half-fold increase. The same late-reported claims also showed a lower closure rate at eighteen months, a lower paid-to-incurred ratio, and a much heavier reliance on lump-sum settlements, which made up 59% of total cost for the latest-reported claims versus 31% for same-day claims.
Sheppard and his co-authors were careful to note that this is a correlation, not a proven cause. I hold clinical evidence to the same standard, and I will not overstate this one. But a pattern of this consistent, across injury types and waiting-period structures, is not something a claims organization can afford to treat as background noise.
What the claim-complexity data adds
In 2024, the Workers Compensation Research Institute analyzed roughly 950,000 claims with more than seven days of lost time to isolate the effect of attorney representation on indemnity payments. Overall, 34% of these workers had an attorney. Representation raised total indemnity payments by an estimated $7,700 to $12,400 per claim. But the involvement rate was far from uniform.
Claims resolved with temporary disability payments only, the simplest and most cleanly compensable category, carried attorney involvement of just 14%. Claims that combined permanent partial disability with a lump-sum settlement, the most complex and contested category, carried it at 79%. By diagnosis, spine sprains and strains sat at 36% attorney involvement. Neurological pain diagnoses, which are harder to explain, harder to resolve on a clean timeline, and more prone to disputed causation, sat at 61%.
Read together, the two studies point to the same mechanism from different angles. Attorney involvement tracks ambiguity and delay, not just the severity of the underlying injury. A worker who receives a prompt, clear explanation of what is compensable, what happens next, and why, has less reason to seek outside representation than a worker whose claim sits unacknowledged, whose diagnosis is inconsistent with the mechanism of injury on file, or whose communication comes only after a dispute has already formed.
The equation
This is where training stops being a soft-skills conversation and becomes a loss ratio conversation. An adjuster who can recognize mechanism of injury, correctly match diagnosis to clinical presentation, and communicate a compensability decision within the first few days is not eliminating litigation. Some claims will always need an attorney, and some should have one. But that adjuster is narrowing the population of claims that drift into the high-representation categories by default, simply because no one closed the information gap early.
Run the numbers conservatively. A mid-size TPA handling 5,000 lost-time claims a year, at WCRI’s baseline 34% attorney involvement rate, has roughly 1,700 represented claims annually.
Reducing that rate by even three percentage points, through faster reporting discipline and more accurate first-notice communication, removes about 150 claims from the represented population.
Applying only the low end of WCRI’s indemnity differential, $7,700 per claim, which is approximately $1.16 million in avoided incremental indemnity spend in a single year. That number does not require a change in fee schedule, a renegotiated network contract, or a shift in reserve philosophy. It requires adjusters and supervisors who understand what drives a claim toward representation and who are trained to act in it in week one, not week six.
What does this means by role
For a CFO, this is a loss ratio lever that does not touch the fee schedule or the provider network. It lives entirely inside claim handling discipline in the first thirty days. For a VP of claims, this is as much a defensibility question as a cost question. A file that closes an information gap early, before an attorney does it instead, holds up better under audit and reads more consistently across adjusters. For a risk manager tracking total cost of risk, legal and administrative expense is one of the more controllable pieces of that total, and it responds directly to how well the front line is trained to recognize claims heading toward complexity before they get there.
None of this argues that legal representation is bad for the worker or the system. Represented claims often exist for good reason, and a fair claim handled fairly does not need to be an adversarial one. The point is narrower and more useful than that. A measurable share of litigation is a downstream effect of claim handling quality in the first days after injury, and claim handling quality in the first days after injury is a trained skill, not a fixed trait. That makes it one of the few levers in this business that a training investment can move directly.
If you want to see how we teach adjusters and supervisors to recognize these early signals and act on them before a claim drifts toward representation, WorkCompCollege.com has course tracks built specifically around first-notice clinical triage and mechanism-based decision making.
The workers’ compensation industry is focused on responding to injuries. What if the most important work comp claim is the one we prevent from ever happening?
That question was in my head while moderating the National Comp session “Before the Breaking Point: An Integrated Framework for Workplace Violence Prevention and Response” on September 29. Of all the great content included in the agenda, our session was the only one devoted specifically to workplace violence.
At first glance, that subject might seem a little out of place at a work comp conference. It is reasonable to assume that workplace violence is a safety, security, HR, or law enforcement issue. And it certainly is all of those.
Except when someone gets hurt and becomes a workers’ compensation issue. Maybe workers’ compensation needs to start thinking a little further upstream.
That premise launched an excellent discussion with Ari Stowell (Corporate Director of Workforce Health & Safety at HCA Healthcare), and Dan Hanlon (Director of Training & National Account Development at The Noble Group). Dr. Ann Hawkins (Chief Innovation & Marketing Officer at Health Karma Inc.), who helped plan the session, had a schedule conflict and couldn’t join us.
Dan spent 30 years in law enforcement before bringing that experience into workplace violence prevention. Based on his experience, serious incidents usually have a history. As Dr. Hawkins put it on one of our slides, “Workplace violence doesn’t begin with violence. It begins with warning signs.” Dan described those signs as increasing hostility, intimidation, threatening language, and talk of retaliation or harm, along with changes in behavior or attendance and substance abuse.
Dan’s concern wasn’t whether somebody noticed those warning signs. It was what happened next, which he distilled into four questions:
What did we know?
When did we know it?
What did we do?
What did we document?
Those are certainly important questions after something terrible happens. But they are much more valuable before they do. Dan mentioned the increasingly high cost of negligence and the evolving regulations around prevention and response that involve all four of those questions.
Unfortunately, the numbers are moving in the wrong direction. We discussed how COVID was an inflection point for mental health and wellness. According to NCCI, nonfatal workplace assaults rose at an annualized rate of 5.3% from 2011 through 2022. The Bureau of Labor Statistics counted 470 workplace homicides in 2024, up from 458 in 2023.
Dan said violence creates consequences beyond the person who is physically attacked. Coworkers witness it. Teams experience it. People may become afraid to return to the same environment. Psychological injuries can emerge alongside physical ones. Turnover, absenteeism, and morale can all be affected.
To underscore his point, Dan described the November 2022 incident in Chesapeake, Virginia, where a supervisor opened fire in the employee break room and killed six coworkers. The subsequent lawsuits allege the employer knew about the shooter’s prior threatening behavior, that employees had reported him, and that nothing was done. Dan described a survivor who was seated next to a coworker who was shot in the head. He did not sugarcoat what that means for a claim. That’s not a typical recovery timeline. It’s a claim that may last a lifetime.
Run that case through the four questions, and the answers are hard to read.
Healthcare makes this particularly visible.
Ari told us that HCA Healthcare has seen a dramatic increase in workplace violence since the pandemic. HCA employs approximately 320,000 people across a system of roughly 190 hospitals and thousands of other care locations. Most people do not manage workplace safety at anything remotely approaching that scale. But what HCA learned while trying to solve the problem at that scale can apply to every employer.
Ari pointed out that, by her count, only 22 states currently have laws addressing workplace violence in healthcare. A review by Epstein Becker Green counted at least 20 as of March, so the list is growing fast. Dan pointed out that the mandates aren’t just for healthcare. California’s law reaches most employers, and New York has extended similar requirements to retail. In Dan’s opinion, California currently has the most stringent mandates and can be a good starting point for others. Whether or not your state requires a prevention program, the negligence lawsuits Dan described don’t wait for a mandate.
Ari identified five challenges: standardization, visibility, accountability, culture, and ownership. When she asked which mattered most, the room guessed it: culture.
Healthcare has historically tolerated a certain amount of violence as part of the job. When a patient is sick, confused, medicated, frightened, or elderly, it can be part of the culture that a behavioral health crisis is “understandable.” While those circumstances may explain behavior, they do not make an employee’s injury acceptable.
That distinction matters far beyond healthcare. Every organization has things they simply learn to tolerate:
“That’s just how he is”
“She was angry”
“Nothing actually happened”
“We don’t want to overreact”
Until something bad happens and “nobody saw it coming.”
Interestingly, Ari said that when HCA made reporting easier and more consistent, its reported numbers initially went up. That wasn’t failure. It was visibility. You cannot manage what people are afraid, unwilling, or unable to tell you about.
HCA eventually organized its approach around three pillars: people, process and technology:
People means leadership involvement, accountability, and culture
Process means standardized reporting, training, follow-up, and clear expectations
Technology means giving people practical ways to report problems, communicate quickly, and get help when something happens
At HCA, that includes executive oversight and workplace violence committees at individual facilities. It includes centralized incident reporting that allows employees to self-report and automatically alerts the appropriate team. It’s even piloting wearable duress buttons that employees can activate when they feel unsafe or threatened. HCA chose a top-down approach in which leadership is financially incentivized to plan, document, and enact both proactive safety steps and quick response. Each year, facilities earn credits or are charged debits based on how their program is graded. Regardless of an organization’s size or industry, a whole-of-enterprise system will uncover and address blind spots while reducing resistance to engaging with red flags early. In the famous words of Barney Fife, “nip it in the bud.”
Based on the insights from Dan and Ari, I noted five intentional things that every employer can do:
Decide who owns workplace violence and make sure the answer is “all of us.” Security cannot solve this alone. Neither can HR, risk management, workers’ compensation, or safety. Someone needs responsibility for coordinating the program, but information must move across all organizational silos. At HCA, workplace violence prevention deliberately brings together leadership, legal, HR, employee health, behavioral health, security, patient safety, and other disciplines. While smaller organizations may have fewer people and departments, silos still exist. On this subject, those communication and coordination barriers must be removed.
Give employees one obvious way to report concerns. If an employee sees troubling behavior, do they know where and when to report it? As importantly, do they have confidence that something will happen when they do? Reporting needs to be easy, understood, and trusted. Don’t measure success simply by fewer reports because, as Ari pointed out, sometimes more reporting means your reformed culture is working. As Dan recommended, offer a confidential or anonymous option for people who fear retaliation.
Train people to recognize what happens before violence. Don’t limit training to what employees should do once an attack begins. Teach supervisors and employees to recognize increasing hostility, intimidation, fixation on grievances, behavioral changes, and threatening language. Then teach them what to do with the red flags that are identified. You don’t want to be the one who “never saw it coming.”
Create a repeatable process for acting on information. A report without follow-up is just documentation, and the people who report it ultimately know if it’s a useful or useless exercise. Establish who reviews concerns, how risk is escalated, what corrective action is available, and how the response is documented. Periodically test whether the process works. This is very similar to an organization’s disaster recovery plan that looks good on paper but doesn’t work when a disaster happens.
Learn from every incident, including the ones that almost happened. Don’t close the file when the immediate danger ends. Ask what was known beforehand. What worked? What did not work? What communication succeeded or failed? What should change? The goal isn’t simply to recover from an event. It is to make the organization stronger because of what it learned.
To quote one of the most provocative slides: “Workers’ compensation isn’t only about paying claims after harm occurs. It’s about reducing frequency, severity, duration, and exposure.”
We talk constantly about injury prevention, ergonomics, slips and falls, fleet safety, safe lifting, and return to work programs. After preparing for and delivering this session, I’d argue that workplace violence belongs in that same conversation. Perhaps the artificial line between prevention and workers’ compensation deserves to disappear.
So, ask yourself: If someone at your company started showing these warning signs tomorrow, would anyone notice? Would anyone report it? Would anything happen if they did?
If your honest answer to any of those is “I don’t know,” that’s your first finding. Someone will eventually ask Dan’s four questions. The only choice is whether it happens before the incident or after.
What one young Gen Z leader made me think about the future of workers’ compensation.
One of the things I took away from ELEVATE came from a place I didn’t expect. It wasn’t something said by one of the industry’s most experienced leaders. It came from the youngest person on the panel during the session “Confronting the Talent Cliff in Workers’ Compensation and Insurance.”
Her name is Kaylee Bamfield. Kaylee is a college student from Colorado, an accomplished student-athlete and emerging leader who has already been recognized for both academic excellence and leadership. She has a passion for service, personal growth and developing the next generation of leaders. She was on that stage not simply as a representative of Gen Z, but as a young person who is already thinking seriously about the kind of leader she wants to become and the kind of world she wants to help create.
That made me listen differently.
Because Kaylee wasn’t asking us how to make young people fit into the insurance industry we have built. She was asking questions that made me wonder whether we are giving her generation enough opportunity to help shape the industry they are going to inherit.
We talk a lot about the “talent cliff” in workers’ compensation and insurance. We talk about an aging workforce, the number of experienced professionals who will retire, and the enormous amount of knowledge that could leave with them.
Those are very real concerns.
But as I listened to Kaylee talk about entering this industry, I found myself wondering if we’re looking at the problem from the wrong direction.
We keep asking how to get the next generation into our industry? Maybe we should also consider what we willing to let the next generation change about it because that distinction matters.
Kaylee talked about initially seeing insurance as boring. She had grown up around the industry and still didn’t really understand what her father did or the possibilities that existed within insurance.
During the session she asked questions about career paths, mentorship, development and whether an employer was genuinely investing in her or simply trying to fill an open position.
Those questions struck me because they weren’t really questions about a job, but they were questions about belonging.
Is there a place for me here? Can I grow here? Will you invest in me? Will you listen to me? And will there be room for me to become something different than the people who came before me?
That last question may be the one we don’t ask often enough.
My generation has spent decades building careers in this industry. We have systems, processes, traditions and ways of doing things that were shaped by the circumstances of our time. Many of those things exist for very good reasons. And we have an enormous responsibility to pass along what we have learned.
Passing along knowledge doesn’t have to mean passing along everything exactly as we found it. There is a difference between giving someone a foundation and giving them a blueprint they are expected to follow.
I think the next generation deserves the foundation, but they should have a hand in drawing the blueprint. That means we must be willing to let them influence the space they are entering.
They may communicate differently than we do. They may think differently about flexibility, technology, hierarchy and career progression. They may question processes that we’ve accepted for years. Those questions and the uncomfortableness that comes with them also make the system stronger.
Our willingness to explore their perspective doesn’t mean we abandon everything we’ve learned. Quite the opposite. Experience still matters. Institutional knowledge matters. The lessons earned through decades of dealing with difficult claims, injured workers, employers, regulations, relationships and changing markets matter enormously.
But that experience, again, should be a foundation, not a fence.
Perhaps our role as the more experienced generation is to open the door, share what we know, explain why things became the way they are, and then step back enough to let the next generation decide what still belongs in the room.
I was especially struck by the conversation about mentorship.
Mentorship shouldn’t simply be about teaching younger professionals how to do things the way we did them. It can be a two-way exchange.
We teach judgment, context, history and the lessons that aren’t found in a manual. The new generation teaches us what the future looks like from where they are standing.
That is a pretty powerful exchange when we’re willing to listen, and perhaps that is one of the opportunities hidden inside the talent cliff.
Yes, we need to recruit. Yes, we need to retain experienced professionals and transfer institutional knowledge. Yes, we need to make insurance a more visible and attractive career choice, but we also need to make room for new ideas, different approaches, questions, and technology. We need to allow existence for a successful career to be redefined, and perhaps most importantly, room for the next generation to leave its fingerprints on an industry that they will eventually lead.
As I watch a new generation step into this industry, I don’t think our responsibility is simply to make them fit into the world we built. Our responsibility is to give them the knowledge, relationships and confidence to build something we couldn’t yet see.
As leaders, we like to believe experience gives us an edge. We learn to trust our instincts, read situations, and identify problems before they become crises. After enough years in business, we assume we’re less susceptible to being misled.
One of the hardest lessons in leadership is accepting that appearances and reality are not always the same thing.
The Stoic philosopher Epictetus observed that some things are exactly as they appear, some are not, and wisdom lies in knowing the difference.
But experience can create its own blind spots.
The longer we know someone, the more likely we are to give them the benefit of the doubt. The longer a process exists, the more likely we are to accept it as effective. The more familiar a relationship becomes, the less likely we are to question it. Over time, what appears to be true slowly becomes what we believe to be true.
Experience teaches us that setbacks are inevitable, mistakes are part of the journey, and not every investment of time, money, or energy will produce the return we hoped for.
What we’re often less prepared for is the moment when the greatest mistake isn’t what happened. It’s what we failed to see happening. And when that realization comes, it can be both humbling and painful.
Then something happens that reminds us otherwise.
Recently, I found myself in a situation where a partner failed to deliver what was promised. The sales process was polished. The demonstrations were compelling. The contract appeared clear. Smart people reviewed it. Smart people approved it.
And yet, as the engagement unfolded, it became painfully obvious that what I thought I had signed up for was not what I was actually receiving. The more questions I asked, the more confusion I uncovered. So, I sought additional perspective. I talked to experienced executives, trusted advisors, and people who had no emotional investment in the outcome.
What happened next surprised me. Almost universally, they saw things I hadn’t seen. They pointed out inconsistencies I had overlooked. They questioned assumptions I had accepted. They challenged conclusions I had considered settled. That’s when the realization hit me:
I’ve been duped.
Not just by the partner. By my own assumptions. And perhaps most importantly, by my proximity to the situation.
The outside perspective didn’t reveal a new reality. It simply removed the filters through which we had been viewing the existing one.
When you’re close to something for a long period of time, it becomes difficult to see it objectively. You explain away concerns. You rationalize inconsistencies. You extend grace where accountability might be more appropriate. What should be viewed as a pattern gets dismissed as an isolated event.
Over time, assumptions begin to feel like facts simply because they’ve gone unchallenged. That realization caused me to reflect on more than just a vendor relationship. I’ve seen this same dynamic play out inside my own organization.
Strong performers earn trust. They should. The challenge for leaders is to ensure that trust remains connected to current reality. Over time, experience, history, and goodwill can create a lens through which we interpret new information more generously than we otherwise would. We explain away concerns. We grant the benefit of the doubt. We focus on what someone has accomplished rather than what is happening now.
Here’s the part that’s harder to admit: my team wasn’t missing it either.
In fact, many of them had been experiencing the same things I was experiencing. They’d raised concerns. We’d had conversations. The signals were there. The problem wasn’t a lack of awareness.
It was that all of us, myself included, found reasonable explanations for what we were seeing. We gave the benefit of the doubt. We assumed things would improve. We focused on the history rather than the current reality.
None of this happens with bad intent. In fact, it often stems from loyalty. Sometimes we’re so close to the situation that we stop seeing what’s actually there and continue seeing what we’ve always believed to be there.
The same is true of teams, partnerships, and even entire organizations. We become attached to the story we’ve been telling ourselves. We continue operating under assumptions that may have once been true but no longer reflect reality. We trust tenure instead of performance. Confidence instead of competence. Activity instead of outcomes. History instead of present-day results.
Because the change is gradual, it’s difficult to notice. Until someone with fresh eyes enters the picture and asks the questions everyone else has stopped asking. That was the lesson for me.
It wasn’t just one observation from one person. It was a collective group of respected executives looking at the same situation and seeing what I did not see. Their perspective didn’t create a new reality. It simply exposed the one that had been there all along. And if I’m being honest, I sensed it all along.
And like most meaningful leadership lessons, this one wasn’t free. There is a cost to unwinding a partnership that isn’t delivering on its promises. There is a cost to correcting decisions made on incomplete information. There is a cost when expectations and reality drift too far apart before anyone is willing to confront the gap.
The lesson is humbling. It’s also expensive. Not simply because of the dollars attached to a contract, a decision, or a course correction. Those costs are measurable. The greater costs are often the ones that don’t appear on a balance sheet: the time lost, the opportunities missed, the energy spent managing problems that should have been addressed much earlier, and the assumptions we continue carrying long after they’ve stopped serving us.
There is also the realization that someone from the outside was able to see what I had been unable to see from the inside. That’s the part that stings.
Not because the perspective was wrong, but because it revealed how easily proximity can cloud judgment. How often we explain away what should be examined more closely. How readily we substitute trust, history, or optimism for evidence.
The uncomfortable truth is that avoiding difficult questions doesn’t eliminate the cost.
It usually increases it.
The reality is that problems rarely appear overnight. They develop quietly beneath the surface while leaders, teams, and organizations continue operating under a narrative they’ve questioned before but ultimately explained away. Until reality refuses to cooperate. Until results reveal what assumptions have been hiding.
Until someone from the outside sees in five minutes what we’ve failed to see for five years.
I’ve come to believe that one of the most important responsibilities of leadership is not having all the answers. It’s maintaining enough humility to recognize when we’re too close to a situation to see it clearly.
Trust is important. But trust without verification is not leadership. Curiosity is not skepticism. Accountability is not distrust. And asking difficult questions is not disloyalty. In fact, those disciplines are often what prevent us from being blindsided.
So yes, I’ve been duped.
But not solely by someone else’s promises. I’ve been duped by assumptions I didn’t challenge, conclusions I didn’t test, and narratives I allowed to continue for too long.
And then there’s the sadness that comes with it.
It’s disappointing to discover that something you believed in wasn’t what you thought it was. It’s painful to realize that trust, history, and goodwill may have clouded your judgment. And it’s difficult to reconcile the gap between the story you’ve been telling yourself and the reality that eventually emerges.
Those moments can feel personal because they are personal. Whether it’s a partnership, a decision, or a long-standing relationship, you’ve invested more than money. You’ve invested confidence, belief, and often a piece of yourself. That’s what makes these lessons hurt. But it’s also what makes them valuable.
Because once the disappointment fades, you’re left with something far more useful: clarity.
Thankfully, that’s also where value lives.
This experience reinforced for me that leadership isn’t about being right all the time. It’s about being willing to confront evidence when you’re wrong. It’s about inviting perspectives that challenge your thinking. And it’s about having the humility to recognize when trust, loyalty, or history have clouded your judgment.
Because the most costly deceptions are rarely the ones others create. They’re the ones we unknowingly help sustain.
Medical costs per claim are rising again. The Workers Compensation Research Institute reported in October 2025 that after several years of relative stability, medical payments per claim increased 5% in California, 6% a year in Wisconsin, 7% a year in Delaware, and 14% in a single year in Pennsylvania. Utilization, medical prices, and fee schedule updates are all pushing in the same direction. When the C-suite sees that trend line, the question is not whether to respond. The question is where the response comes from.
Training is usually not the first-place people look. This line item sits next to travel and software as a discretionary line, and discretionary lines tend to get cut first. That is a mistake, because the decision that determines whether a claim’s medical spend stays reasonable or drifts upward is made by an adjuster and their support system, not by a fee schedule. Fee schedules control price. They do not control whether the treatment plan submitted for approval matches what the evidence says should happen next. That judgment call is trained into that user, or it is not.
The mechanism: guideline-concordant care changes the outcome, not just the cost
A 2021 study published in PLOS ONE examined nearly 60,000 acute low back pain claims in the California workers’ compensation system between 2009 and 2018. The researchers compared lost workdays for workers who received only guideline-recommended interventions against workers who received only non-recommended interventions. After adjusting for other factors, workers who received guideline-concordant care had 11.5 fewer lost workdays than those who did not, a difference the study found statistically significant at well beyond conventional thresholds (Gaspar et al., PLOS ONE, 2021). Workers who were prescribed an opioid, a treatment protocol that guidelines generally do not recommend as a first-line intervention for acute low back pain, were out of work a median of four days longer than workers who were not.
A separate study in the Journal of Occupational and Environmental Medicine quantified the same relationship in dollars. It found a statistically significant trend between adherence to ACOEM guidelines for initial management of low back pain and lower claim costs, with medical and total costs trending down by roughly 353 dollars and 586 dollars respectively for each unit of improvement in the guideline compliance score. No outlier high-cost claims appeared in the groups with the best guideline compliance.
Put those two findings together and the plan to pursue is clear. The relationship to be followed is not that guideline adherence is not limited as a nice quality marker. It is that a treatment plan drifting away from the evidence-based medicine protocols tends to run longer and cost more, and this is easily identified in a way that is visible early, before the claim becomes an outlier. That fully trained and educated individual has to be able to see that drift when the request for authorization crosses their desk. That is a teachable skill. It is not a personality trait, and it is not something a fee schedule update can substitute for.
Where the judgment call actually happens
A skilled claim file handler who cannot distinguish a guideline-concordant treatment plan from one that has quietly expanded past what the mechanism of injury supports will approve what is in front of them, because the alternative is guessing without a framework. That is not a criticism of the adjuster. It is a description of what happens when clinical judgment is expected without clinical training to support it. The fix is not to make adjusters into clinicians. It is to give them enough grounding in how evidence-based treatment guidelines work, and enough comfort recognizing when a request for authorization needs a second look, that the decision in front of them gets made with the right frame of reference.
This is where the initial and ongoing education spend stops being a benefit and starts being a control. A trained claim file handler catches guideline drift in week two. An untrained handler catches it, if at all, when the claim is already six months old and the file has become expensive to unwind. The 11.5-day gap in the California study and the per-unit cost trend in the JOEM study are not abstractions. They describe the difference between those two claims.
Measure the outcome, not the seat time
Most training programs report attendance and satisfaction scores. Neither number notes the ROI of this aspect. If the much-needed education spend is going to survive the next budget cycle, it needs a scorecard built from the numbers that the finance section already tracks:
Average claim duration and lost workdays by injury type
Reopen rate
Share of treatment requests approved that match evidence-based guideline recommendations
Reserve accuracy at 90 and 180 days
Medical cost trend per claim, tracked against the WCRI benchmark for your state
Set a baseline before a training initiative, then track the same five numbers afterward, tied to the training calendar so movement can be traced to specific content. This is the same discipline a technology purchase is held to. A tool spend deck usually measures activity, logins, tickets closed, time saved. A competent spend deck should measure outcomes because that is where its value actually shows up. Against a medical cost trend running 5 to 14% a year, even a modest improvement in decision quality pays the program back several times over.
The practical takeaway
If education is up for review in next year’s budget, do not defend it as a benefit. Hold it to the same standard as any other cost-control investment. Ask what specific claims outcome each training dollar is meant to move, set a baseline, and measure the result against it. A program that cannot answer that question deserves the scrutiny it gets. A program that can answer it belongs in the same conversation as any other lever you pull to manage total cost of risk.
We spend a fair amount of time at WorkCompCollege.com on exactly this question, how to connect professional education to the claims outcomes that finance is already tracking. If you are building the case for a training budget and want a framework for measuring impact rather than attendance, that is the kind of thing the resources there are built to help with.
