Category: CompMed Insights

Every claim organization has run this math at some point. A senior adjuster leaves. The open requisition sits for weeks. A new hire finally starts, spends the first six months learning the file types, the jurisdictional rules, and the carrier's own claims philosophy. Somewhere in that gap, claim drifts. Reserves get set late. Litigation rates creep up. The organization pays for all of it twice, once in recruiting cost and…

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How Spinal Fusion Can Create New Complications Several weeks ago, I wrote about two of the most dreaded words in workers’ compensation. The words “spinal fusion” can represent a significant problem in addressing workers compensation cases. With the assumption that the need for a lumbar fusion has been adjudicated, and the perceived need is a function of the compensable event, one must realize that in an effort to address these…

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Why Claim Resolution Often Goes Off Track Obtaining a resolution for a compensable injury is the ultimate goal of every workers’ compensation professional. However, the path to closure is rarely a straight line. Between clinical hurdles, occupational rehabilitation issues, and administrative friction, the process is often bogged down by “tangential factors” that distract from the primary objective. A key component of this process is establishing a return-to-work (RTW) plan in a manner…

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A framework for making education spend defensible, not discretionary Training budgets get cut first. Not because they matter least, but because they are usually presented as if they matter least. When a budget staffer or committee is trimming for the year, discretionary line items go before core operating costs. If professional education shows up in your budget package as a discretionary line, it will be treated as one, regardless of…

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A Line-Item Breakdown Adjuster turnover tends to get filed under human resources. That is a mistake. When a trained claims adjuster leaves your organization, the financial damage does not stay in the HR budget. It spreads across your loss ratio, your reserves, your litigation rate, and your claim duration numbers. It shows up everywhere except the place where you were looking. CFOs and VPs of Claims routinely underestimate the true…

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I am not sure why this popped into my head, but I was thinking about a song from the mid-80s from Dire Straits, the song “Money For Nothing” in the first line (and I will take the creative license with the lyric) “Money for nothing and your ‘checks’ (my bad) for free.” It seems a frequent consideration that a percentage of work comp claims are perceived as being embellished, fraudulent,…

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The numbers on adjuster turnover are not surprising once you see them. What surprises CFOs is the calculation they have never run: the full cost of losing and replacing a trained workers compensation adjuster, compared to the cost of keeping one through structured professional development. The research is consistent. The Society for Human Resource Management estimates that replacing a mid-level employee costs between 50% and 200% of annual salary. For…

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Litigation in workers’ compensation is often discussed as if it were an external force. Advertising trends. jurisdictional differences. social dynamics. All of those factors play a role. None of them are where most claims actually change direction. Litigation is rarely random. It is a downstream effect of earlier decisions. If you want to understand what fewer attorney-involved claims mean to your loss ratio, you have to start with a simple…

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In our professional careers within the workers’ compensation ecosystem, how many times have we seen the most straightforward injury or claim file become one of the most problematic scenarios imaginable? The reported injury is relatively simple: a warehouse employee missteps and sustains an ankle inversion event, resulting in a modest ankle injury. The initial clinical evaluation included plain radiographs, which revealed no fractures or other osseous abnormalities. Given the findings…

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It has been my experience that most C suite executives assume initial and ongoing training for workers compensation claim file handlers is a “discretionary soft expense.” This determination is incorrect and deserves a second look. An individual who is not trained, making significant decisions often produces measurable and avoidable claim cost inflation. I would like to ask each of you to run one additional calculation before you reach a final…

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