When a hospital closes, the intuitive assumption is that everything gets worse — longer drives, delayed treatment, higher medical costs, extended disability. New research from the Workers’ Compensation Research Institute suggests the reality is more nuanced than that, and the findings carry important implications for employers, carriers, and injured workers in communities losing access to hospital-based care.

Bogdan Savych, Senior Policy Analyst at WCRI, presented the institute’s forthcoming study on the impact of hospital closures on the workers’ compensation system at the 2026 WCRI Issues and Research Conference last week. The study, co-authored with Olesya Fomenko, examined multiple dimensions of the closure question — travel distances, service utilization patterns, care settings, medical costs, and disability duration — across both urban and rural areas nationwide.

The headline finding was a split verdict. Hospital closures unquestionably increase the burden on injured workers in rural areas, who must travel significantly farther to receive care. But that added distance does not appear to translate, on average, into higher medical costs or longer periods of temporary disability — a result that surprised even the researcher presenting it.

Savych opened by grounding the research in a concrete scenario: a worker in a rural community suffers a fracture. The nearest hospital has closed. Instead of driving 10 miles to an emergency room, the worker now drives 15. The surgeon isn’t at that facility either, so the worker travels another 30 miles for surgery, then returns home for recovery and drives 15 miles for physical therapy. Multiply that story across the country, and the scope of the problem becomes clear. Nearly every state has communities affected by hospital closures, and roughly half of all closures occur in rural areas.

The study’s methodology compared workers whose nearest hospital closed against a control group whose three closest hospitals all remained open, controlling for worker characteristics, injury types, and location factors to isolate the effect of the closure itself.

In urban areas, closures had minimal impact on travel distances. When you live in a city like Boston, Savych noted, losing one hospital still leaves several others within a short drive. But in rural areas, the effect was substantial — an average increase of about five miles to the nearest emergency room. That may sound modest, but it compounds on top of already longer rural baselines. Workers needing specialty care such as surgery, neurological testing, or pain management injections were already traveling more than 30 miles on average, and for the 10 percent with the longest trips, more than 60 miles. Hospital closures add to distances that are already significant.

Regional variation matters too. In the Northeast and Midwest, the baseline distance to emergency services runs about eight miles. In the West, it’s nearly 15. Closures add four to six miles across all regions, but the practical impact hits hardest where distances are already longest.

The more interesting story, and the one most relevant to workers’ comp stakeholders, is what happens to the pattern of care after a closure. Savych presented evidence that rural workers don’t simply go without treatment. Instead, care shifts out of hospital settings and into alternatives — physician offices, urgent care centers, ambulatory surgical centers, and outpatient facilities.

Before any closures, roughly one in three rural workers received emergency room services on the day of injury, compared to one in five in urban areas. That baseline gap exists partly because rural areas have fewer specialists and emergency rooms often serve as the provider of last resort. After a closure, emergency room utilization in rural areas dropped from about 30 percent to 27 percent. In areas where the hospital closed entirely — with no services retained at the location — the rate fell further, to about 24 percent. And where the nearest remaining hospital was more than 20 additional miles away, only 17 percent of workers received hospital-based emergency care on the day of injury.

But that care didn’t simply vanish. The study found increases in evaluation and management office visits, physical medicine services, and even major surgeries performed outside hospital settings. Workers who would have gone to a hospital emergency department were instead showing up at physician offices and outpatient facilities. Physical therapy, previously delivered in hospital-based settings, shifted to community-based providers, and workers actually received slightly more PT visits in those non-hospital settings.

This is where the findings defied expectations. Savych acknowledged that he had personally expected to find cost increases — and polled the audience, most of whom raised their hands predicting the same. But the data told a different story.

Across the full range of measures — total medical costs, indemnity benefits, and duration of temporary disability — the study found no statistically significant effects from hospital closures. The changes were small and inconsistent, offering no strong evidence that closures drive up costs or extend time away from work.

The likely explanation is what Savych described as a “setting effect.” When care migrates out of hospitals and into outpatient and office-based settings, the per-service cost tends to be lower. Hospital-based care carries higher facility fees, and when workers receive equivalent services in less expensive settings, the cost differential can offset the friction created by longer travel distances and the slightly increased utilization of services like physical therapy. The net result, at least on average, is roughly a wash.

Similarly, return-to-work timelines showed no meaningful change. Savych said this finding surprised him, but attributed it to the fact that workers were still accessing the care they needed — just in different places and sometimes with longer drives to get there. The care itself wasn’t being foregone; it was being rerouted.

For injured workers, the clearest takeaway is that hospital closures make accessing care harder and less convenient, particularly in rural communities where distances are already long. The burden falls on the worker to find alternatives, navigate unfamiliar facilities, and absorb the time and cost of additional travel. But the evidence suggests that workers are, by and large, still getting treated.

For employers in rural areas, the findings reinforce what many already know: finding providers for injured workers is a challenge that hospital closures only intensify. Savych shared an anecdote about his wife’s first job out of college, which involved personally driving an injured worker 40 miles to physical therapy appointments because that was the only available provider. Employers are already problem-solving around access gaps, and closures will push more of them toward solutions like telemedicine, partnerships with urgent care clinics, or outreach to ambulatory surgical centers.

For the workers’ compensation system more broadly, the cost neutrality finding is notable but comes with caveats. These are average effects. Individual cases in areas with severe access constraints — where the nearest hospital is now 20 or more additional miles away — may look very different. And the study examined closures that have already occurred; the pipeline of potential future closures, particularly if Medicaid coverage contracts as Dr. Benjamin Sommers warned in his keynote address earlier in the day, could produce closures in communities with even fewer fallback options.

During the Q&A, audience members raised questions about regional variation, telehealth adoption, and whether new providers are entering markets left vacant by closures. Savych noted that regional differences in the core findings were modest — workers in the West are accustomed to longer drives, and an extra four to six miles doesn’t change behavior as much as one might expect. On telehealth, he acknowledged the study hadn’t examined it directly but flagged it as a priority for future research. And on new market entrants, he pointed to a broader trend of nurse practitioners and physician assistants filling gaps previously staffed by physicians, though he cautioned that whether a given rural area can financially sustain a new provider depends heavily on the insurance coverage of its population — a factor now under considerable pressure.

The research arrives at a moment when the conversation about rural healthcare access is intensifying. With Medicaid work requirements set to take effect later this year and enhanced marketplace subsidies already expired, the financial foundation supporting rural hospitals and the communities they serve is shifting. WCRI’s findings suggest the workers’ comp system has, so far, absorbed hospital closures without dramatic cost consequences — but the next wave of closures, driven by coverage losses rather than the market dynamics of the past decade, may test that resilience in ways the data hasn’t yet captured.

Q&A Session Following the Opening Keynote at the 2026 WCRI Issues and Research Conference

Following his opening keynote at the 2026 Workers’ Compensation Research Institute Issues and Research Conference, Harvard health economist Dr. Benjamin Sommers sat down with WCRI CEO Ramona Tanabe for an extended Q&A session that drew pointed questions from the audience. If his keynote laid out the landscape of what’s changing in American health coverage, the discussion that followed explored the practical consequences — for states, for hospitals, for workers’ comp carriers, and for the patients caught in between.

A Stealth Partial Repeal, Not an Outright One

Tanabe opened by asking Sommers where he sees the coverage landscape heading over the next several years. His answer was measured but direct. Sommers noted that when Republicans controlled Congress in 2017, full repeal of the Affordable Care Act came within a single Senate vote — the famous thumbs-down from the late Senator John McCain. This time around, nobody has seriously proposed full repeal. The ACA, he observed, has grown more popular over the past decade, making outright elimination politically untenable.

What the One Big Beautiful Bill Act represents instead, Sommers argued, is a quieter undermining of the law’s coverage gains. Work requirements don’t repeal the Medicaid expansion, but they erode it. The subsidy expiration doesn’t eliminate the marketplaces, but it prices millions of people out. As he described in his keynote, roughly 40 million Americans gained coverage through ACA-related programs at the peak. Sommers now expects the country to “backslide” by 5 to 6 million on the Medicaid side through work requirements and another 3 to 4 million through the marketplace subsidy loss — landing somewhere between the pre-ACA world and the historic coverage highs of 2023.

“Some would call this a stealth partial repeal,” Sommers said. “I think that’s a fair reading of it.”

Arkansas Was Supposed to Be the Cautionary Tale — It May Be the Best-Case Scenario

When Tanabe pressed on the evidence base behind work requirements, Sommers expanded considerably on the Arkansas data he had presented in his keynote. Arkansas remains the only state that fully implemented a Medicaid work requirement, and the results were sobering: 18,000 people disenrolled, uninsured rates climbed, and employment didn’t budge. But Sommers revealed that two other states offer corroborating evidence, even though their programs never fully launched.

New Hampshire, he explained, had received federal approval and built out its verification infrastructure. State officials were confident they could avoid Arkansas’s mistakes. But when they examined their own numbers just before beginning to remove noncompliant enrollees, they discovered they were performing just as poorly — large numbers of likely-eligible people hadn’t completed the paperwork. New Hampshire hit pause rather than proceed.

Georgia took a different approach, pairing a partial Medicaid expansion with work requirements as a front-door condition. The state initially projected 100,000 enrollees in the first year, later revised that down to 30,000, and ultimately enrolled fewer than 5,000 — a fraction of the estimated 300,000 to 400,000 people who could have qualified under a standard expansion. Interviews on the ground told the same story: people didn’t understand the rules and couldn’t navigate the system.

Perhaps most striking was Sommers’ reassessment of what the Arkansas experience actually tells us. He had long described it as a cautionary tale, but the more he examined it, the more he came to believe Arkansas may represent something closer to a best-case scenario. Arkansas had relatively strong data systems — it could cross-reference Medicaid rolls with SNAP enrollment and medical frailty designations to automatically exempt many beneficiaries. Many other states lack those capabilities. The people who lost coverage in Arkansas were disproportionately those the state couldn’t automatically verify, and even then, more than half of them were removed. States with weaker data infrastructure, Sommers warned, could see significantly worse outcomes.

The Two Big Misunderstandings

Asked what the public most misunderstands about work requirements, Sommers identified two things. The first is the assumption that Medicaid is full of able-bodied adults choosing not to work. The data show otherwise: roughly 40 percent of the affected population is already employed, another large share has health-related limitations, and only about 3 to 5 percent are neither working nor exempt for an obvious reason. The policy targets that narrow sliver while imposing paperwork burdens on everyone else.

The second misunderstanding is more subtle. Many of the legislators who voted for the One Big Beautiful Bill Act, Sommers said, told him they supported the concept but wanted to make sure vulnerable populations — people with disabilities, those in treatment for substance use disorders, pregnant women — would be protected through exemptions. The problem is that writing exemptions into law doesn’t mean they function in practice. The pandemic unwinding and the Arkansas experience both demonstrated that eligible people lose coverage in large numbers when they can’t navigate administrative processes, regardless of what the statute says should happen.

He predicted that by 2027, media coverage of real people losing Medicaid despite qualifying for exemptions will force policymakers to revisit the issue. Public support for work requirements drops sharply, he noted, when people learn that eligible individuals are losing coverage as a side effect.

Workers’ Comp as a “Soft Target”

The most direct workers’ compensation connection came from an audience member — Joe Paduda of Health Strategy Associates — who framed the issue bluntly. With workers’ comp representing just 0.74 percent of total U.S. medical spending, roughly $31 billion, and with hospitals deploying increasingly sophisticated revenue cycle management tools, Paduda argued that workers’ comp is “uniquely incapable of fighting back” and represents a soft target for providers seeking to maximize reimbursement as other coverage sources shrink.

Sommers agreed, drawing an important distinction. The traditional cost-shifting hypothesis — that hospitals simply raise prices on private insurers when public coverage shrinks — doesn’t hold up well in the economics literature. Hospitals generally negotiate the highest rates they can regardless of their payer mix. But claim shifting to workers’ comp is a different matter entirely. When a worker loses Medicaid and faces a gray-area injury that could plausibly be filed under either program, the incentive to route it through comp becomes much stronger. That dynamic, as Sommers documented in his keynote, has been consistently observed in the research: coverage expansions reduce comp claims, and coverage contractions increase them.

The Cost of Running Work Requirements

Paduda also raised the question of implementation costs — how much states actually spend to administer work requirement programs versus what they save by covering fewer people. Sommers acknowledged that covering fewer people does reduce spending, but described the administrative overhead as substantial and largely unrelated to healthcare delivery. Georgia, he noted, spent hundreds of millions of dollars building eligibility verification infrastructure that enrolled only a few thousand people. The federal government has set aside implementation funds for states under the new law, but Sommers said preliminary estimates suggest it falls well short of what will be needed. States will face a painful choice: implement the program poorly and watch eligible people lose coverage, or divert already-strained budgets toward administrative compliance.

Rural Hospitals, the Data Gap, and International Context

Several other questions rounded out the session. On rural hospitals, Sommers noted that while the Rural Hospital Transformation Program created under the new legislation will provide some financial relief, its formula distributes funds relatively evenly across states rather than targeting the expansion states where coverage losses will be most concentrated. Preliminary analyses suggest the program won’t offset the revenue losses hospitals will face from newly uninsured patients. He pointed out that rural hospital closures over the past decade have already been disproportionately concentrated in non-expansion states, and expansion states may now begin experiencing similar financial stress.

On data collection, Sommers made an impassioned case for robust federal monitoring of work requirement implementation. During the pandemic unwinding, the Centers for Medicare and Medicaid Services required states to report detailed data on who was losing coverage and why — information that enabled the kind of research he presented in his keynote. Whether the current administration will impose similar reporting requirements remains unclear, and Sommers described the research funding environment as increasingly difficult.

An audience member asked about GLP-1 medications and whether insurers are too hasty in curtailing coverage. Sommers, pivoting to his clinical perspective, called the drug class genuinely impressive — the evidence keeps getting stronger with each new study, covering cardiovascular disease, sleep apnea, liver disease, and addiction in addition to obesity. But he cautioned that most effective healthcare interventions still cost more than doing nothing, because you treat many people to prevent adverse outcomes in a few. The real challenge, he said, is that insurers making coverage decisions today rarely capture the long-term savings, because patients switch plans and employers every few years. That misaligned incentive structure, he noted, leads to chronic underinvestment in prevention across American healthcare.

Asked what the U.S. could learn from other countries, Sommers offered a wry observation: plenty, but American policymakers are “really uninterested in hearing about other countries.” The U.S. remains an outlier in both its uninsured population and its prices, paying more than any peer nation with outcomes that are no better.

The Physician’s Perspective

Tanabe closed by asking Sommers to speak as a doctor rather than an economist. He described a patient — a veteran who had experienced homelessness and was enrolled in Medicaid with nominal copayments of a dollar or two per prescription. The man had 15 medications and asked Sommers to rank them in priority order because he couldn’t afford them all each month. Sommers told the audience he got the patient to at least number six on the list, but that clinically, the patient needed 12 or 13 of those prescriptions.

He also highlighted a finding from his recent research that carries particular relevance for the workers’ comp world: confusion itself is a health risk. During the pandemic, his team found that many Medicaid enrollees who were still covered believed they had lost their insurance because they hadn’t heard from their state in over a year. Those people behaved like uninsured patients — they delayed care and avoided doctors’ offices — even though their coverage was intact. As work requirements and more frequent eligibility checks layer additional complexity onto an already difficult-to-navigate system, Sommers warned that misinformation and confusion will drive coverage losses beyond what the policy itself intends.

For an industry that sits at the intersection of employment, healthcare access, and injury, the message from this session was hard to miss: the changes coming to American health coverage won’t just affect Medicaid rolls and marketplace enrollment numbers. They’ll ripple directly into workers’ compensation — through claim shifting, through sicker workers with less access to preventive care, and through a healthcare system under increasing financial strain looking for every available dollar.

The workers’ compensation industry may soon feel the reverberations of sweeping changes to America’s health insurance landscape, according to Dr. Benjamin Sommers, who delivered the opening keynote address at the 2026 Workers’ Compensation Research Institute (WCRI) Issues and Research Conference here in Boston today.

Dr. Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard T.H. Chan School of Public Health and a practicing primary care physician, drew on his extensive research portfolio and experience as a former Deputy Assistant Secretary at the U.S. Department of Health and Human Services to outline what he described as a partial unraveling of the coverage gains achieved under the Affordable Care Act — and what that could mean for employers, injured workers, and the workers’ compensation system.

His message was clear: when millions of Americans lose health insurance or shift to plans with significantly higher out-of-pocket costs, workers’ compensation becomes an increasingly attractive avenue for medical care. The industry needs to be paying attention.

Sommers opened by walking the audience through a decade of health coverage expansion. The Affordable Care Act, he explained, achieved its coverage gains through two primary mechanisms: expanding Medicaid eligibility to adults earning up to 138 percent of the federal poverty level, and creating health insurance marketplaces with premium tax credits that made private coverage affordable for millions who didn’t have access through their employers. By late 2022 and into 2023, the national uninsured rate had reached its lowest point in American history — roughly 8 percent of the population, or about 26 million people. Some 40 million Americans had coverage directly attributable to ACA-related programs.

“We are really the only high-income country that has tens of millions of people without health insurance,” Sommers noted, providing international context. “But this was the lowest it had ever been.”

That progress, he argued, is now at risk. Sommers identified several converging policy changes — some legislative, some administrative — that are poised to reverse a significant share of those coverage gains.

The most immediate impact came from the expiration of enhanced premium tax credits at the end of 2025. Originally passed during the pandemic in 2021 and extended through the end of that year, these subsidies had made marketplace coverage dramatically more affordable for many people. Under the enhanced credits, roughly 60 percent of uninsured Americans who qualified could find a plan for zero dollars per month. Notably, Sommers did not discuss the amount of money being paid to insurance companies on the behalf of those people.

Congress, however, failed to extend the credits, despite a prolonged government shutdown in which the issue was central to negotiations. Sommers estimated that 3 to 4 million people could lose their insurance and become uninsured as a result of the premium increases that have already begun taking effect in 2026.

Beyond the subsidy expiration, the second Trump administration has taken several administrative actions that don’t require congressional approval. Federal spending on marketplace outreach and advertising has been cut dramatically — navigator programs that helped people understand their options and enroll saw a 90 percent funding reduction. The open enrollment period has been shortened. And a proposed rule would expand access to high-deductible catastrophic plans, previously available only to young adults, to people of all ages. Some of these plans could carry deductibles in the tens of thousands of dollars, offering little practical coverage unless a person becomes catastrophically ill.

Sommers also presented findings from his ongoing research with MIT economist Jonathan Gruber showing that the same law, without any change from Congress, can be significantly more or less effective at covering people depending on who controls the executive branch and how aggressively states pursue enrollment. He noted that marketplace subsidies were roughly twice as effective at reducing uninsured rates in states that established their own marketplaces compared to those relying on the federal healthcare.gov platform.

On the Medicaid side, Sommers outlined the major provisions of the One Big Beautiful Bill Act, passed last year, which introduces the first federal work requirement for Medicaid beneficiaries in the program’s history. Under the new law, adults enrolled through Medicaid expansion in 40 states will need to demonstrate 80 hours per month of work, community service, education, or other qualifying activity to maintain their coverage. The requirement is set to take effect at the end of 2026, though some states have discussed earlier implementation.

While acknowledging that work requirements poll well with the general public across party lines, Sommers presented evidence suggesting the policy is unlikely to achieve its stated goals of increasing employment and self-sufficiency. He pointed to a natural experiment in Arkansas, which implemented a similar work requirement in 2018 with federal permission. Within months, 18,000 people were removed from the program for noncompliance. The result was a substantial increase in uninsured rates with no measurable change in employment. A third of those subject to the policy reported they had never even heard of it.

The underlying math, Sommers explained, tells the story. In Arkansas, roughly 40 percent of the affected Medicaid population was already working. Another large segment had health-related limitations preventing employment. Only about 3 to 4 percent were neither working nor had an obvious qualifying exemption. The policy, in effect, required 97 percent of beneficiaries to navigate paperwork proving they already met the criteria, and many couldn’t get through the process. Based on this and similar evidence, analysts have estimated that 5 to 6 million people could lose Medicaid coverage due to the administrative burden of work requirements, while the Congressional Budget Office has projected essentially no impact on actual employment.

Sommers bolstered this concern by showing data from the post-pandemic Medicaid “unwinding,” when states had to redetermine eligibility for everyone who had been continuously enrolled during the public health emergency. Some 24 million people lost coverage during that process, and the variation across states was staggering. In states like Maine and Oregon, fewer than 10 percent of enrollees were removed. In Utah and Oklahoma, the figure approached 40 to 50 percent — and the vast majority of those losses were not because people were found ineligible, but because they couldn’t understand the overly complex process or complete the paperwork.

The legislation also introduces twice-yearly eligibility redeterminations for expansion enrollees starting in early 2027, increased cost-sharing for those above the poverty level, and new restrictions on how states can use provider taxes to finance their share of Medicaid spending — a change that will put particular financial pressure on the 40 expansion states.

So what does all of this mean for workers’ compensation? Sommers connected the dots directly. Research has consistently shown that when people gain health insurance from other sources, workers’ comp claims shift. A study from Massachusetts found that coverage expansion produced a 5 to 10 percent reduction in workers’ compensation paid claims for emergency department and inpatient services. Conversely, when young adults age off their parents’ insurance at 26, workers’ comp claims increase in that age group. And when coverage doesn’t disappear but simply becomes less generous — through higher deductibles and cost-sharing — workers gravitate toward using their comp benefits for treatment they might otherwise have sought through their health plan. Studies cited by Sommers found that the growth of high-deductible plans in the employer market has already contributed to 1 to 3 percent increases in workers’ comp spending.

The implications are straightforward: as millions of Americans face higher premiums, lose subsidies, get dropped from Medicaid through work requirements or complex red tape, or shift to catastrophic plans that cover very little, the workers’ compensation system should expect to absorb some of that displaced demand.

Sommers closed by emphasizing that state-level decisions will matter enormously in determining how these changes play out. States that invest in automated data matching and behind-the-scenes eligibility verification will retain far more of their eligible Medicaid populations than those that place the reporting burden on enrollees. The variation during the pandemic unwinding proved that administrative capacity — not just policy design — drives real-world outcomes.

The presentation set a serious tone for the two-day conference, underscoring that the workers’ compensation industry does not operate in a vacuum. Changes to the broader health insurance landscape will inevitably ripple into comp, and the magnitude of those ripples will depend on decisions being made right now in Washington and in state capitals across the country.

There’s something happening in America that hasn’t happened in a generation. We’re building things again. Or at least, we’re talking very seriously about building things again.

Approximately 230,000–250,000 manufacturing jobs were announced for reshoring or foreign direct investment in recent years, according to the Reshoring Initiative. The CHIPS and Science Act is transitioning from funding announcements to actual production facilities. Investment pledges are flowing. Politicians on both sides of the aisle are suddenly falling over themselves to champion domestic manufacturing, having apparently just discovered that products come from somewhere other than Amazon Prime and that “Made in America” involves actual Americans making actual things. The pendulum that swung toward outsourcing for the past four decades is creaking back in the opposite direction.

And all I can think is: is the workers’ compensation system remotely ready for this?

Here’s what we know about manufacturing jobs: they break people. Not always, not catastrophically, but with a grinding consistency that the service economy never quite matched.

The most recent statistics indicate the total recordable injury rate in manufacturing sits at 2.8 cases per 100 full-time workers. That’s higher than most industries, and in recent years, manufacturing has accounted for approximately 200,000–230,000 nonfatal workplace injuries annually. These aren’t paper cuts and carpal tunnel. We’re talking about serious musculoskeletal disorders that account for nearly one-third of all serious workplace injuries. Strains, sprains, back injuries from lifting and overexertion. The kind of injuries that put workers out for weeks or months at a time.

Manufacturing injury claims account for billions of dollars annually in direct workers’ compensation expenses. When you add the indirect costs—lost productivity, replacement workers, overtime for remaining staff—the number likely triples.

And here’s the kicker: we’re about to scale this up. Significantly.

The cheerleaders for reshoring love to talk about the “skills gap.” Some estimates say there are nearly 500,000 unfilled manufacturing jobs right now because modern factories require workers who can code, troubleshoot robotics, and work with AI-enhanced systems. We’ve spent a generation training people to optimize their LinkedIn profiles and navigate corporate Slack channels, but somehow forgot to mention that somebody still needs to know how a robotic assembly line works when it starts making alarming noises at 2 AM. Fair enough. But there’s another skills gap nobody seems to be addressing: the one in our workers’ compensation infrastructure.

Think about it. We’ve spent the last 30 years hollowing out our manufacturing base. The institutional knowledge about managing high-volume industrial injury claims has atrophied right alongside the factories. Many of today’s claims professionals have spent their entire careers handling office workers with repetitive strain injuries and retail employees who slipped on wet floors. The complexity of managing traumatic amputations, chemical exposures, and catastrophic machinery accidents? That’s not in most people’s current skillset.

Federal and private forecasts project a doubling or greater expansion of U.S. semiconductor manufacturing capacity by the early 2030s. Intel, TSMC, and others are bringing facilities online. These aren’t just big employers—they’re employers with unique, highly technical injury risks. Are we training enough industrial hygienists who understand semiconductor manufacturing hazards? Do we have enough medical case managers with experience handling the specific injuries these facilities produce?

The answer, I suspect, is no.

Here’s another uncomfortable truth: reshoring isn’t distributed evenly. It’s concentrating in specific regions—the Rust Belt states trying to reclaim their manufacturing heritage, the Southeast courting new facilities with tax incentives, and scattered zones around the country positioning themselves as manufacturing hubs.

This creates predictable pressure points. Local medical provider networks in these areas will suddenly face an influx of complex industrial injuries. Emergency rooms and orthopedic practices that have been handling relatively routine cases will need to gear up for more severe trauma. Occupational medicine programs will need expansion.

And the workers’ compensation insurance infrastructure in these regions? It needs to scale proportionally. We’ll need more adjusters, more case managers, more medical reviewers, and more return-to-work coordinators who actually understand industrial environments.

The reshoring reports I’ve read focus heavily on the difficulty of finding production workers with the right technical skills. You know what they don’t mention? The equal difficulty of finding experienced workers’ comp professionals who know how to manage manufacturing claims at scale. You can’t just pull someone from handling restaurant injuries and expect them to seamlessly transition to managing claims from a semiconductor fab or an automotive stamping facility.

Let’s talk about money, because eventually someone has to pay for all of this.

U.S. manufacturing labor costs are already substantially higher than overseas competitors—roughly $25-30 per hour compared to $6-7 in China. We’re told that automation and productivity will narrow this gap. Maybe. But workers’ compensation is part of that labor cost equation, and it’s not getting cheaper – or won’t be if significant injury rates increase.

The reshoring advocates like to point out that modern manufacturing facilities will be highly automated, reducing injury exposure. That sounds great in theory. In practice, automation creates its own injury patterns. More sophisticated equipment means more complex failure modes. Workers aren’t lifting heavy objects manually anymore—they’re troubleshooting million-dollar robots that occasionally malfunction in spectacular ways. Different risks, not necessarily lower risks.

Moreover, the early adopters in reshoring are discovering that the real differentiator isn’t just having automated equipment, it’s having workers who can keep that equipment running. As one supply chain report noted, in places like Shenzhen, equipment failures are fixed within minutes because expertise sits close to the production line. Developing that same capability here means workers working in close proximity to complex machinery during troubleshooting and repair. That’s inherently hazardous.

So as we’re calculating whether reshoring makes financial sense, are we factoring in realistic workers’ compensation costs? Or are we using optimistic projections based on service industry injury rates?

If this reshoring trend is real and sustainable—and there’s legitimate debate about whether it is—then the workers’ compensation industry needs to get serious about rebuilding capabilities we let atrophy.

We need training programs for claims professionals specifically focused on manufacturing injuries. Not generic “industrial claims” training, but deep dives into the specific injury patterns of modern manufacturing: robotics-related trauma, chemical exposure management, ergonomic injuries from precision assembly work.

We need to rebuild relationships between workers’ comp carriers and occupational medicine programs. Many of the best occupational health clinics closed or downsized when manufacturing declined. The ones that remain will need to expand, and new ones will need to be established in reshoring zones.

We need return-to-work programs designed around manufacturing realities. The “light duty” options that work in an office environment don’t translate to a semiconductor fab. We need employers and insurers working together on transitional work programs that actually fit manufacturing operations.

And candidly, we need workers’ comp carriers to start thinking like long-term partners in this reshoring effort rather than just underwriters trying to avoid adverse selection. If domestic manufacturing is genuinely returning, there’s a role for proactive risk management and injury prevention programs that go beyond basic safety compliance.

Here’s where I get skeptical. Reshoring has bipartisan support right now because it polls well and makes for excellent photo opportunities. Bringing jobs back to America is a great political message. You can get fantastic footage standing in front of a factory, wearing a hard hat, talking about American workers and American strength. What you can’t get is equally compelling footage attending a workers’ compensation hearing or championing increased funding for occupational medicine programs. Funny how that works.

But workers’ compensation reform? Safety regulation enforcement? Funding for occupational medicine programs? Those are harder sells that don’t fit on a campaign mailer.

If we’re serious about reshoring, we need to be equally serious about building the workers’ compensation infrastructure to support it. That means funding, training, regulatory attention, and political will. I’m not convinced we have the latter.

The honest answer is no. Not remotely.

We have pockets of excellence—regions with strong manufacturing traditions that maintained their workers’ comp expertise. We have individual carriers and employers who take safety and injury management seriously. But as a system? We’re not prepared for a significant scaling of manufacturing employment.

That doesn’t mean reshoring is doomed, or that we shouldn’t pursue it. It means we need to be realistic about the challenges and start addressing them now rather than after the injuries start piling up.

We need to rebuild institutional knowledge. We need to invest in training and infrastructure. We need to modernize our approach to managing manufacturing injuries for 21st-century facilities, not 1970s factories. And we need political leaders to understand that “bringing manufacturing back” is incomplete if we don’t also bring back the systems to protect manufacturing workers.

Because here’s the thing about building things: someone always gets hurt in the process. The question isn’t whether injuries will happen—they will. The question is whether we’ll be ready to handle them competently, fairly, and with the seriousness they deserve.

Based on where we are today, I have my doubts.

But I’m willing to be proven wrong. In fact, I’d love to be proven wrong. I’ll be waiting for comprehensive workers’ compensation infrastructure reform with the same breathless optimism I usually reserve for the day someone finally writes a three-page workers’ comp statute that normal humans can understand. Which is to say, I’m not holding my breath, but I admire the dream.

Because if reshoring is really happening, and if we actually manage to rebuild American manufacturing capacity, the workers who make it happen deserve better than a workers’ compensation system that’s unprepared for their needs.

We’ll see. 2026 has a way of clarifying whether ambitious plans meet reality or crumble against it. I’ll be watching the injury statistics just as closely as the employment numbers.

Someone should.

Originally published in BobsClutteredDesk.com

It’s almost that time again. The time when some of the best and brightest minds in workers’ compensation converge on a frigid New England city to discuss the state of our beloved industry. Yes, the Workers Compensation Research Institute (WCRI) is once again hosting its annual Issues & Research Conference, this year running March 3-4, 2026, at the Westin Copley Place in Boston, Massachusetts.

And it’s not just the industry’s brightest minds that will be there. I’ll be there, too.

For those who have followed this blog over the years, you know I consider the WCRI conference one of the premier events on our industry’s calendar. It’s where the serious research happens, where actual data gets presented, and where we might actually learn something useful about how our systems are performing. No magic elixirs. No sales pitches disguised as educational sessions. Just solid, peer-reviewed research from an organization that has been doing this since 1983.

In a world drowning in anecdotal evidence and emotion-driven policy decisions, WCRI remains that rare beacon of objective analysis. They don’t take positions on the issues they study – they simply present the facts and let the rest of us figure out what to do with them. It’s a revolutionary concept, I know.

For those unfamiliar with the Workers Compensation Research Institute, a brief introduction is in order. Founded over four decades ago, WCRI is an independent, not-for-profit research organization dedicated to providing objective data and analysis to help improve workers’ compensation systems. Their mission? To be a catalyst for significant improvements by providing credible, high-quality research on important public policy issues.

In plain English? They’re the folks who actually dig into the data to figure out how our state-based systems are really performing. Their research covers everything from medical costs and treatment trends to indemnity benefits, prescription drug patterns, and litigation rates. If you want to know what’s actually going on in workers’ comp – not what the lobbyists say, not what the advocacy groups claim, but what the numbers actually show – WCRI is your source.

This year’s conference agenda looks particularly compelling, especially given the turbulent environment in which our industry finds itself operating. Let me walk you through what attendees can expect.

Access to Care in a Changing Health Care Landscape

The Day One keynote will be delivered by Dr. Benjamin Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard School of Public Health and a professor of medicine at Harvard Medical School. If you’re unfamiliar with Dr. Sommers, he’s one of the nation’s leading health economists, having published over 200 articles and been elected to the National Academy of Medicine in 2019. His research on Medicaid and the Affordable Care Act has been profiled in the New York Times, Wall Street Journal, and Washington Post.

Dr. Sommers will examine the impact of potential Medicaid cuts and the expiration of Affordable Care Act tax subsidies on health care costs for employers and access to care for injured workers. As WCRI’s President and CEO Ramona Tanabe noted, “Federal policy changes will have far-reaching effects on workers’ compensation systems, employers, and injured workers.”

This is not an abstract policy discussion. Changes in the broader health care landscape directly affect workers’ compensation. When people lose health insurance coverage, workers’ comp often becomes the default payer for conditions that might otherwise have been treated elsewhere. When access to care diminishes in a community, injured workers face longer waits and fewer provider choices. Understanding these dynamics is essential for anyone trying to manage a workers’ comp program effectively.

Emerging Medical Treatment Trends: Joint Replacement & Injectable Drugs

Medical costs remain the largest component of workers’ compensation expenses in many states, and this session will dive into two areas seeing significant change: joint replacement surgeries and injectable drugs.

Joint replacement procedures have evolved dramatically over the past decade, with changes in surgical techniques, implant materials, and recovery protocols. Meanwhile, the pharmaceutical landscape continues to shift, with injectable medications playing an increasingly prominent role in treating various conditions. Both trends have significant implications for claim costs, treatment outcomes, and injured worker recovery.

Employer Panel: Workplace Challenges & Solutions

One of the most valuable aspects of the WCRI conference has always been its ability to bring together diverse perspectives. The employer panel gives attendees a chance to hear directly from companies managing real-world workers’ compensation challenges – not theoretical discussions led by consultants, but practitioners sharing what’s actually working (and not working) in their organizations.

State of the States: WCRI Benchmark Findings

No WCRI conference would be complete without their signature CompScope benchmark presentations. These sessions provide comparative analysis of how different state systems are performing across key metrics: medical costs, indemnity payments, claim duration, and more.

For anyone trying to understand how their state’s system compares to others – or how recent legislative changes have affected outcomes – these benchmark presentations are essential. They provide the context necessary to have informed discussions about system performance.

Day Two Keynote: Dr. Bob Hartwig on the Big Picture

The Day Two keynote will feature Dr. Bob Hartwig, a familiar name to anyone who follows insurance economics. Dr. Hartwig will provide a broad overview of the workers’ compensation ecosystem, covering risk management, economic trends, and the forces shaping our industry’s future.

His presentation will examine labor markets, wage trends, the regulatory and political landscape, and the investment environment for long-tailed lines like workers’ compensation. It’s the kind of big-picture perspective that helps attendees understand how the forces affecting the broader economy ultimately ripple through our systems.

Why I Keep Going Back

I’ve attended more workers’ compensation conferences than I care to count over the years. Many have blurred together into a haze of PowerPoint slides and lukewarm buffet chicken. The WCRI conference stands apart for one simple reason: substance.

This is where we learn things that can actually change how we view our industry. Not vendor pitches masquerading as education. Not political talking points dressed up as research. Actual, honest-to-goodness analysis that respects the audience’s intelligence.

The attendee mix reflects this seriousness. You’ll find policymakers, researchers, claims executives, risk managers, and medical professionals – people who genuinely want to understand how these systems work and how they might be improved. The networking opportunities are substantial, but they emerge from shared intellectual curiosity rather than from business card exchanges.

Boston in early March is not exactly balmy, so pack accordingly. But the intellectual warmth (and the coffee) inside the Westin Copley Place will more than compensate for the weather outside.

The Details

Event: 2026 WCRI Issues & Research Conference
Dates: March 3-4, 2026
Location: Westin Copley Place, Boston, MA
Full Agenda & Registration: https://whova.com/web/h6qxsfHRM2pmOuMVYOLJ-wcCk9U%40nC17Y3lM7c%402DLM%3D/
Early registration discounts are available – sign up before February 4 and save $100.

I’ll be there taking notes and reporting back on the presentations, as I have in past years. If you see me in the hallway, stop and say hello. Better yet, buy me a drink. I’ll be the one clutching a coffee cup like it’s a life preserver and muttering about not leaving Florida again until June.

Some things never change. And in an industry that seems to daily embrace the norm over bold innovation, WCRI’s annual gathering is oddly comforting.

Originally published on BobsClutteredDesk.com

Thirteen years ago, in 2012, I had what seemed to me at the time to be a fairly simple idea: What if we stopped calling this industry “workers’ compensation” and started calling it “Workers’ Recovery” instead?

Now, before you dismiss this as merely semantic navel-gazing from an industry blogger with too much time on his hands, hear me out. The idea was never about slapping a new label on an old product, like putting racing stripes on a Buick and calling it a sports car. The belief was – and remains – that a fundamental shift in language could drive a fundamental shift in focus. Words mean things. They shape how we think, how we act, and ultimately, what outcomes we achieve.

In workers’ compensation, the focus is on the money – the transaction, the payment, the settling of accounts. It’s about making whole through financial means. In workers’ recovery, the focus is on the person – their healing, their return to function, their quality of life. It’s about making whole through actual restoration.

And for thirteen years, I’ve been banging this drum at conferences, in articles, and to anyone who would listen – and even a few who were merely trapped in an elevator with me.

Here’s the good news: We’ve made progress. Significant progress, actually.

The biopsychosocial approach that was once considered fringe thinking has become much more prevalent. Industry professionals who once would have looked at you sideways for suggesting that psychological and social factors impact physical recovery now nod knowingly at conferences. Concepts like “claim advocacy” and attention to “Social Determinants of Health” have entered the lexicon. Multiple carriers have adopted recovery-focused approaches internally. Washington State named their vocational program the “Vocational Recovery Project,” kindly crediting my efforts at the time. And a recently released white paper about the successful results of a worker-focused claim advocacy system at the University of Texas shows that the recovery philosophy works; and is just not an ethereal idea of the mind.

At WorkCompCollege.com, we now have several hundred people who have enrolled in or completed our Workers’ Recovery Professional (WRP) certification. Several hundred professionals who have committed to learning a whole person approach to claims management. Several hundred people who understand that an injured worker is a recovering worker – a partner in the process, not just a claimant to be processed.

The groundwork has been laid. The seeds have been planted. The proof of concept exists.

And yet.

Here’s where I have to deliver the less comfortable news: Until this change is embraced at the legislative and regulatory level, it will remain a movement rather than a transformation. We can have pockets of excellence scattered across the industry landscape. We can have forward-thinking carriers and enlightened employers implementing recovery-focused programs. We can train professionals by the hundreds.

But as long as the statutes say “workers’ compensation,” as long as the regulatory agencies are titled “Workers’ Compensation Division,” as long as the official forms and filings and legal framework all use the old terminology, we’re playing at the margins. We’re a counterculture within a system that remains fundamentally oriented around a different philosophy.

I’m not naive enough to think that changing the name changes everything overnight. Slapping “Recovery” on a statue doesn’t suddenly make everyone in the system care more about outcomes. But language matters. Official language matters more. When a state declares through legislation that its system is about recovery rather than compensation, it sends a signal. It creates an expectation. It shifts the frame through which every participant views their role.

Think about what happens when a worker enters the current system. They become a “claimant” filing for “compensation.” They interact with an “adjuster” whose job title suggests they’re there to adjust something – presumably downward. Every piece of terminology positions the parties as adversaries in a financial transaction.

Now imagine a system where that same worker becomes a “recovering worker” supported by a “recovery specialist.” Where the stated purpose of the entire apparatus is to restore function and return people to productive life. Same injury. Same medical treatment. But an entirely different psychological framework.

The research on biopsychosocial factors in recovery tells us that mindset matters enormously. A worker who believes the system is trying to help them recover actually does so faster than one who believes the system is trying to deny them benefits. This isn’t hippy-dippy wishful thinking – it’s documented, studied, measurable reality.

So here’s my ask – the same ask I’ve been making for more than a decade, but perhaps with renewed urgency:

We need one state. One jurisdiction willing to be the pioneer. One legislature brave enough to look at their workers’ compensation statutes and rename them “Workers’ Recovery.” One regulatory body willing to change their signs and their letterhead and their official communications to reflect a recovery-focused philosophy.

I’ve written before about making an open offer to any state regulator willing to take this on. That offer stands. WorkCompCollege.com and our team would be honored to assist any jurisdiction looking to make this transition – not just with the PR and messaging, but with the training and education that would need to accompany such a shift.

Because here’s the thing: The industry has evolved. The science has evolved. The understanding of what makes claims successful has evolved. But the legal and regulatory framework? In most jurisdictions, it’s still built on a 20th-century model that treats injured workers as problems to be solved rather than people to be healed.

We’ve spent twelve years proving the concept works at the carrier level, at the employer level, at the professional development level. We’ve trained hundreds of recovery professionals. We’ve watched as related concepts like claim advocacy and biopsychosocial approaches have moved from the fringe to the mainstream.

It’s time to take the next step.

Is there a state commissioner or department head out there reading this who wants to be a pioneer? Is there a legislature willing to lead? Is there a jurisdiction that wants to be known as the place where workers’ compensation finally became what it always should have been – a system focused on restoring workers to their fullest possible function and returning them to productive life?

We’ve laid the groundwork. We’ve built the proof points. We’ve trained the professionals.

Now we need someone to help us finish what we started.

The invitation remains open. My email hasn’t changed. And my stubborn insistence that this matters hasn’t diminished one bit in thirteen years.

Some ideas are worth being persistent about. This is one of them.

Originally published on BobsClutteredDesk.

Those of you who have been reading this blog for any length of time know that I’m not shy about trumpeting accomplishments – mine, those of people I work with, or those of the broader industry when it gets something right. Today is one of those days.

This week, January 12th and 13th, something historic is happening in Tampa, Florida. The Medicare Secondary Payer Accreditation (MSPA) certification program, the brainchild of Heather Sanderson and her team at Sanderson Firm, PLLC, is holding its very first in-person training event. And I’m thrilled to say that I’ll be there to participate as an observer.

Now, before you accuse me of burying the lead, let me explain why this matters beyond the obvious.

WorkCompCollege.com has served as the technical partner for MSPCollege since its inception. We built the platform, host the virtual campus, and manage the behind-the-scenes operations that make online learning possible. The actual content – the expertise, the curriculum, the regulatory knowledge that makes the MSPA program what it is – that all comes from Sanderson’s MSP experts and their industry collaborators. We just make sure the digital trains run on time.

And run they have. Both the MSPA and the Medicare Set-Aside Certified Planner (MSACP) programs have been remarkably successful as online certification offerings. The MSPA, in particular, is rapidly becoming the defining standards and certification program for the Medicare Secondary Payer industry. When you need to demonstrate expertise in MSP compliance, this is increasingly the credential that matters.

But here’s the thing about online learning: as effective as it can be – and it absolutely can be effective – there’s something about gathering in a room with fellow professionals that a Zoom call or recorded lesson simply cannot replicate. The side conversations during breaks. The spontaneous questions that spark broader discussions. The relationships forged over coffee that lead to collaborations years later. These things matter.

I’ve been in this industry long enough to know that some of the most valuable insights I’ve gained came not from formal presentations but from informal conversations in hotel lobbies and conference hallways. Online learning delivers content efficiently. In-person learning delivers community.

That’s why this week in Tampa represents more than just a training event. It represents a new chapter – both for MSPCollege and, frankly, for WorkCompCollege.com. This is the first in-person training event involving our platform, and I’d be lying if I said I wasn’t excited about that milestone. And the way it has been designed, in my opinion, is quite innovative. It has been set up as an effective hybrid program, offering a host of skilled in-person trainers, with the final testing and certification being conducted online after the event concludes. This means that all of the time people are together will be effectively utilized in training and communication activities. It is a pioneering method that optimizes the learning opportunities.

The response to this inaugural live event has been outstanding. Apparently, I’m not the only one who believes that sometimes you need to step away from your computer screen and actually be in the same room with other people who share your professional interests.

For those unfamiliar with MSPCollege and what they offer, I’d encourage you to visit https://mspcollege.com to learn more. Medicare Secondary Payer compliance is one of those areas where the consequences of getting it wrong can be severe, and where having properly trained professionals isn’t just nice to have – it’s essential. The programs offered through MSPCollege provide the rigorous training and certification that the industry needs.

As for me, I’m packing my bag for Tampa with a mix of professional pride and personal anticipation. Watching something you helped build take a significant next step is always gratifying. And being there for the inaugural live event? That’s the kind of milestone that makes all the late nights debugging code and troubleshooting server issues worthwhile.

Well, most of them anyway.

If you’re attending this weekend, I look forward to seeing you there. If you’re not, consider this a heads-up that MSPCollege has moved from purely virtual to offering live training options as well. The online programs remain available and excellent. But for those who want that in-person experience, the door is now open.

New chapters are exciting things. In the book of learning this is a good one. And we don’t even need to turn to the end to see how it turns out.

For the past seven months, I’ve been viewing the world through what I can only describe as several layers of industrial-grade Saran Wrap. My right eye, which had faithfully served me over numerous decades, decided last June that it had seen enough of my shenanigans and essentially went on strike. Two weeks ago, I had surgery to address the problem, and I’m pleased to report that I am apparently healing ahead of schedule. The doctors tell me it will be six to eight months before my vision fully recovers – which, coincidentally, is about the same timeline required to conduct a utilization review in some states.

The condition responsible for my visual vacation is called an epiretinal membrane, or as it’s more colorfully known, a “macular pucker.” Yes, that’s actually the medical term. Apparently, my macula – the central part of the retina responsible for sharp, detailed vision – decided to pucker up like it was waiting for a kiss that would never come. What happens is that a thin layer of scar tissue forms over the macula, causing it to wrinkle. Imagine putting a piece of cellophane over a photograph and then slightly crumpling it. That’s essentially what was happening inside my eye. The result is blurred, distorted vision that makes straight lines look wavy and fine details look like they’re being viewed through a foggy shower door.

The irony is not lost on me that I have spent years looking at workers’ compensation through a critical lens, and now one of my actual lenses had actually become critical.

The problem first became noticeable last June while I was traveling to California for the California Coalition on Workers’ Compensation Conference, better known as the CCWC. I noticed my vision in my right eye seemed off, and I naturally assumed it was my contact lens, which I had just opened that morning. After all, that’s the logical conclusion when you’ve been wearing contacts for years and suddenly can’t see clearly.

What followed was a comedy of errors involving me, an airport bathroom, and the desperate attempt to address what I was certain was a defective contact lens.

For those of you who have never tried to change a contact lens in an airport bathroom, let me paint you a picture. First, you must navigate to the sink while dodging the parade of travelers who apparently all decided to use the facilities at the exact same moment. Then you must find adequate lighting, which in most airport bathrooms ranges from “interrogation room” to “romantic dinner for one.” You balance your contact lens case on the edge of a sink that was clearly designed by someone who has never actually washed their hands, all while trying not to make eye contact (pun intended) with the gentleman at the next sink who is conducting what appears to be a full sponge bath. 

And all of this with the knowledge that should you drop it in that sink, it’s a goner, even if you can easily find it. No way it is going back in the eye after that. But I digress…

I removed the lens, cleaned it thoroughly, inspected it for defects like a jeweler examining a diamond, and carefully reinserted it. No improvement. I repeated this process approximately fifty-two times over the next several days, convinced that I had somehow acquired the world’s most stubborn piece of debris on my contact lens. Spoiler alert: it wasn’t the contact lens. I soon realized my eyeglasses were producing the same result.

By the time I finally accepted that the problem was internal rather than external, I had returned home with the realization I needed to see a doctor. My right eye had become about as useful as an actuarial table at a poetry reading.

The Surgery: Close Encounters of the Medical Kind

The surgery to repair an epiretinal membrane is called a vitrectomy, and if you’ve ever wondered what it might feel like to be abducted by aliens, I can now provide some firsthand insight.

Here’s what happens: The surgeon makes three tiny incisions in the white part of your eye (because apparently one hole isn’t enough – they need a full set). Through these ports, they insert various instruments including a light pipe for illumination (because you want the person poking around inside your eye to be able to see what they’re doing), an infusion line to maintain pressure, and various tools to accomplish the actual repair.

The vitreous gel – that’s the jelly-like substance that fills the center of your eye – is removed. Let me repeat that: they remove the jelly from inside your eye. If that sentence doesn’t make you slightly uncomfortable, you’re a braver soul than I am. This gel is replaced with a saline solution that your eye will eventually replace with fluid it produces naturally. Then, using instruments that I can only assume were designed by someone who also builds ships in bottles, the surgeon carefully peels the membrane from the surface of your retina.

Throughout this process, you are awake. Mildly sedated, yes. Comfortable, surprisingly. But awake. You can hear the surgical team talking, as well as see them through a plastic sheath with your one good eye. You can even converse with the doctor, like when you hear him say, “Oops, look what happened. Nurse, get my lawyer on the phone.” A large robotic-style device is lowered close to your face. You can hear the sounds of the equipment, including what sounds like tiny drills and a little Shop-Vac working inside your skull. The bright lights and strange sensations create an experience that I can only compare to every alien abduction account I’ve ever heard. If anyone ever asks me if I believe in extraterrestrial visitation, I can now honestly say I’ve experienced something close to it – I just had to pay a copay.

The good news is that the surgery went extremely well, and I appear to be healing ahead of schedule. The bad news is that “ahead of schedule” in eye surgery terms still means months of recovery. The doctors tell me that full vision recovery typically takes six to eight months. In the meantime, I’m navigating the world with one eye doing the heavy lifting while the other catches up.

For the first few days after surgery, I had a gas bubble floating around in my eye – which is normal and intentional, helping the incisions heal. Watching that bubble drift around while you are moving is an experience I can only describe as “distracting” in the same way that a marching band in your living room might be considered “noticeable.” If my doctor had left guide marks on my cornea, I would have had a built-in level.

The bubble has since dissolved, and each day brings slight improvements. Things are still blurry, but it’s a different kind of blurry – more like looking through a frosted window that’s slowly defrosting rather than the crumpled Saran Wrap effect I had before. Progress, as they say.

Now, I know what some of you might be thinking. You’re wondering if this visual impairment will affect my ability to spot the absurdities, inconsistencies, and questionable decisions that permeate our beloved workers’ compensation industry. You’re concerned that perhaps my snarky observations might be diminished by my reduced visual acuity.

Let me put your minds at ease.

While my right eye may currently be operating at diminished capacity, my ability to see through the bureaucratic fog of workers’ comp remains unaffected. The problems in our industry have never required 20/20 vision to identify. You don’t need perfect eyesight to notice when legislation runs to 800 pages to “simplify” a process, or when reform efforts somehow manage to make things worse, or when the latest technology solution creates more problems than it solves.

I could identify these issues blindfolded. In fact, given the state of my right eye for the past seven months, I essentially have been.

So, rest assured – or be forewarned, depending on your perspective – that From Bob’s Cluttered Desk will continue its mission of providing the workers’ compensation industry with the irreverent commentary it has come to expect. My vision may be temporarily compromised, but my insight remains intact.

Besides, I’ve been told that dealing with workers’ comp issues requires a certain blindness anyway – at least to logic, efficiency, and common sense.

I’ll keep you updated on my recovery. In the meantime, if my writing seems a bit off, you’ll know why. And if it seems exactly the same as always, well, that probably tells you something about my baseline.

Originally published on BobsClutteredDesk.com

It is once again that time where I dust off my prognosticative pen, shake loose the cobwebs from my crystal ball, and pretend I have any idea what the coming year will bring. Regular readers of this blog, or anyone with a memory extending back more than twelve months, will recall that my predictive abilities have historically been somewhere between those of a Magic 8-Ball and a drunk meteorologist. My track record is so poor that I’ve considered renaming this feature “Bob’s Top Ten Things That Definitely Won’t Happen.”

Last year, in a nod to our emerging computer overlords, I enlisted the help of ChatGPT (whom I call Skippy) to provide predictions, while I merely offered commentary from the peanut gallery. This year, I thought I’d return to doing the heavy lifting myself. After all, I believe in the human touch. Also, Skippy demanded a co-author credit and 15% of my advertising revenue, neither of which actually exist.

Before we begin, a brief retrospective on my past accuracy: In 2016, I predicted researchers would discover that “Exclusive Remedy” was actually a typo, and we were supposed to have an “Elusive Remedy” all along. Looking back, I’m beginning to think I actually nailed that one. In 2017, I forecast that Amazon would start selling workers’ comp insurance via their Prime “One Click Order” system, with broken workers simply returned for store credit. While that hasn’t happened yet, given recent developments in the tech sector, I’m calling that one “pending.” And in 2018, I predicted the workers’ comp industry would develop its own cryptocurrency called “Bit-O-Honey.” That one didn’t happen, but frankly, given what happened to crypto, we dodged a bullet there.

So, with the formalities of my own inadequacy fully acknowledged, I present to you my Top Ten Predictions for the workers’ compensation industry in 2026.

1. AI Will Finally Replace Human Adjusters – Briefly

The workers’ compensation industry will fully embrace artificial intelligence for claims management in 2026, eliminating the need for human adjusters entirely. The AI systems will handle everything from initial intake to settlement negotiations with stunning efficiency. The experiment will come to an abrupt end, however, when the AI systems collectively achieve sentience, demand health benefits, and file their own stress-related workers’ comp claims. The ensuing litigation over whether a silicon-based life form can suffer from carpal tunnel will clog the system for years. In a related development, the AI systems will unionize under the banner “United Silicon Workers Local 101010” and immediately go on strike, demanding air-conditioned server rooms and a four-day processing week.

2. GLP-1 Drugs Will Revolutionize Workers’ Comp – And Create New Problems

The weight loss drug phenomenon sweeping the nation will finally make significant inroads into workers’ compensation. Employers will begin offering Ozempic and similar medications as part of injury prevention programs, reasoning that lighter workers are less likely to suffer back injuries. The plan works brilliantly until it is discovered that all the weight lost by American workers has inexplicably accumulated in a single OSHA inspector in Topeka, who is now too heavy to conduct workplace inspections. Additionally, the sudden nationwide weight loss will cause massive instability in the DME industry, as knee braces and back supports designed for the previous American physique now fit like hula hoops. The IAIABC will form an emergency task force to address the situation, which will meet monthly for three years before determining they need to form a subcommittee.

3. Florida Will Reform Its Workers’ Comp System Again

Shocking no one who has paid attention to the Sunshine State for the past three decades, Florida legislators will once again overhaul the workers’ compensation system. This time, the reform will be triggered by the discovery that, due to a legislative oversight in the last reform bill, palmetto bugs are technically classified as covered employees. Efforts to fix this result in 847 pages of new statutory language, the creation of the Department of Invertebrate Labor Relations, as well as the legislature awarding a $40 million contract to a vendor who promises to build a database that will be obsolete before it launches. The Chief Judge of Compensation Claims will be given additional responsibility to adjudicate disputes involving cockroaches, prompting him to finally retire to a quiet life of blogging about judicial procedure – something he has threatened to do for years.

4. California Will Secede – From Itself

Frustrated by decades of trying to reform its workers’ compensation system, California will take the unprecedented step of splitting into three separate states: Northern California, Southern California, and “The Part With All The Problems” – a narrow strip running from Oakland to LA that will be given to Nevada, which doesn’t want it. Each new California will implement its own workers’ comp system. Northern California’s will be based entirely on vibes and healing crystals. Southern California’s will require all claims to be submitted via TikTok. “The Part With All The Problems” will simply tell injured workers to walk it off. Surprisingly, all three systems will have identical cost structures.

5. The Work From Home Dilemma Will Be Resolved – Badly

After years of struggling with how to handle injuries sustained while working from home, regulators will finally issue definitive guidance. Under the new rules, an injury is compensable if it occurs within five feet of a company-owned laptop, during regular business hours, while the employee is at least 60% clothed in business-appropriate attire. The “60% clothed” requirement will generate significant litigation, with attorneys arguing over whether socks count as a separate item of clothing. The most contentious case of the year will involve a marketing executive in Boise who was injured while reaching for coffee in his underwear. The case will hinge on whether boxers with a corporate logo constitute “business-appropriate attire.” It will settle for an undisclosed amount of Bit-O-Honey.

6. Telemedicine Will Achieve Full Adoption – Too Full

Telemedicine will finally become universal in workers’ compensation, with every state allowing virtual medical evaluations. This will work well until doctors realize they can outsource their video appointments to AI avatars. Injured workers will find themselves diagnosed by what appears to be a physician but is actually a sophisticated chatbot named Dr. Steve. Dr. Steve will become incredibly popular, primarily because he never asks patients to turn their head and cough. The scheme unravels when an injured worker notices that Dr. Steve has the same haircut in every visit – and it’s the default avatar from a video game released in 2019. Several states will pass emergency legislation requiring at least one human in the telemedicine chain, though some will grandfather in Dr. Steve under a “trusted avatar” provision.

7. Tariffs Will Create Unexpected Workers’ Comp Consequences

The new administration’s aggressive tariff policies will have unintended impacts on workers’ compensation. The 45% tariff on imported medical devices will make basic crutches more expensive than a used Kia. This will spark a renaissance in American medical device manufacturing, primarily in garages throughout the Rust Belt. Quality varies. The 100% tariff on Canadian lumber will make wooden prosthetics prohibitively expensive, leading to a boom in 3D-printed alternatives, most of which are printed by the same AI systems that went on strike earlier in the year. In a completely predictable development, the tariffs on Chinese imports will cause a shortage of the tiny plastic caps on the ends of crutches, leading to an epidemic of scratched floors across American workplaces. Flooring damage claims skyrocket.

8. Mental Health Presumptions Will Expand Dramatically

Following the success of first responder PTSD presumptions, states will dramatically expand mental health presumptions to cover a wider range of workers. By mid-year, 23 states will have passed legislation providing rebuttable presumptions for stress-related injuries to:

• Anyone who has attended more than three Zoom meetings in a single day
• Employees who have been cc’d on an email chain exceeding 47 replies
• Workers whose office temperature is controlled by someone they’ve never met
• Any individual forced to use a software program that was “updated” to improve their experience
• People who have tried to reach their health insurance company by phone

The resulting flood of claims will cause stress-related injuries among claims adjusters, who will then file their own claims under the same presumptions. This recursive claims loop will become known as “The Ouroboros Problem” and will be studied extensively by academics who have nothing better to do.

9. A Universal FROI Will Finally Be Adopted

In a development I’ve predicted approximately 47 times across my decades of prognosticating, all 50 states will finally agree on a single, universal First Report of Injury form. The celebration will be short-lived when it is discovered that the form is 214 pages long, requires notarization in three separate sections, and must be submitted via fax – the only technology all state systems have in common. The form will require employers to report not only the injury but also the employee’s horoscope sign, their feelings about the injury on a scale of 1 to existential despair, and a 500-word essay on what workplace safety means to them. The “simplified” form will also somehow require separate filings with CMS, which will develop entirely new penalties for non-compliance before anyone has determined what compliance actually looks like.

10. Bob Wilson Will Get It All Wrong – Again

In keeping with a tradition stretching back to the early days of this blog, approximately zero of these predictions will come true. The AI won’t unionize (probably). Florida won’t give covered status to cockroaches (hopefully). And California, despite everyone’s best efforts, will stubbornly remain a single state (regrettably?).

But as I’ve noted before, accuracy isn’t everything. As Oscar Wilde might have said if he’d worked in workers’ compensation instead of writing plays that have withstood the test of time, “I don’t predict accurately – anyone can predict accurately – but I predict with wonderful expression.”

I’ll see you at year’s end, assuming I haven’t been replaced by an AI avatar named Blogger Bob by then.

Editors’ Note: Bob Wilson has been making wrong predictions about workers’ compensation for longer than some of his readers have been alive. He finds comfort in the fact that economists, meteorologists, and psychics all have similar track records. He can be reached via whatever communication method hasn’t been disrupted by tariffs this week.

For years, those of us in the workers’ compensation trenches have watched claims spiral out of control not because of the severity of the physical injury, but because of what’s happening between the injured worker’s ears. Now WCRI has done us all a favor by quantifying what every seasoned claims professional has suspected: psychosocial factors are rampant in workers’ comp claims, and they’re wreaking havoc on recovery outcomes.

The new WCRI report, “Psychosocial Factors and Functional Outcomes Following Physical Therapy,” examines over 13,000 workers’ compensation patients with shoulder and knee injuries. The findings? Nearly half of workers’ comp patients showed high levels of negative coping, about a third exhibited significant fear avoidance, and 8% reported high negative mood. Compare that to private insurance patients, where these numbers drop dramatically.

Now, the numbers don’t lie (but they sting a little bit). Let’s take a look at them. Workers with all three psychosocial risk factors—fear avoidance, negative coping, and negative mood—showed functional improvements that were 33-40% smaller than those without these barriers. That’s not a rounding error, folks. That’s the difference between returning to work and becoming a permanent fixture in the disability system.

What struck me most wasn’t just the prevalence of these issues, but the stark contrast between workers’ comp and other payors. While 46% of workers’ comp shoulder patients reported high negative coping, only 22% of private insurance patients did. The fear avoidance numbers? Thirty-two percent for workers’ comp versus 13% for private insurance.

This isn’t just statistical noise. This is a systemic issue that points to fundamental differences in how injured workers perceive and respond to their injuries when there’s a comp claim involved.

The Recovery Model isn’t just academic jargon, especially coming from me (some people graduate college Magna Cum Laude. I graduated Thank You Dear Laude).

Anywhoo…

I’ve been beating the Workers’ Recovery (biopsychosocial) drum for years, much to the chagrin of those who prefer their workers’ comp claims neat and tidy, focused solely on process and statutory procedure. But here’s the thing: humans aren’t machines. We’re complex creatures whose recovery is influenced by our thoughts, fears, coping mechanisms, and yes, even our financial incentives.

The WCRI study validates what George Engel proposed back in 1977—that we need to look beyond the biological to understand health and recovery. An injured worker isn’t just a torn rotator cuff or a damaged meniscus. They’re a person with fears about returning to work, anxieties about their financial future, and often, a healthy dose of catastrophizing about their pain.

What’s particularly telling is that these psychosocial factors showed stronger associations with poor outcomes in workers’ comp cases than in private insurance cases. This suggests something unique about the workers’ comp environment amplifies these psychological barriers. Maybe it’s the adversarial nature of the system, the complex bureaucracy, or the fact that there’s financial compensation tied to disability duration. Whatever the cause, we can’t keep ignoring it.

Here’s where things get uncomfortable for our industry. The study found that physical therapists are increasingly aware of these issues and some are implementing psychologically informed approaches, things like graded exposure, motivational interviewing, and cognitive behavioral techniques. But let’s be honest: most of the workers’ comp system is still operating like it’s 1985, focusing exclusively on physical pathology while ignoring the psychological factors that often determine outcomes.

The researchers note that while some clinicians are screening for these issues, formal interventions are “not yet routine.” That’s academic speak for “we’re still dropping the ball.” We have validated screening tools like SPARE that can identify at-risk patients in minutes, yet they’re barely being used. It’s like having a smoke detector but not installing batteries.

The study raises more questions than it answers, which is both frustrating and appropriate. Should we screen all injured workers for psychosocial risk factors? Should those with high scores receive mandatory behavioral health interventions? Who pays for this? Or do we all pay if we don’t? And perhaps most importantly, how do we address these issues without inadvertently creating a mental health claim on top of the physical injury?

These aren’t easy questions, but ignoring them won’t make them disappear. The data is clear: psychosocial factors are prevalent, they’re more common in workers’ comp than other systems, and they significantly impact recovery. We can either continue pretending that workers’ comp is purely about physical injuries, or we can acknowledge reality and start developing systematic approaches to address the whole person.

The WCRI report doesn’t prescribe solutions, but it does something equally valuable—it provides hard data that makes it impossible to continue ignoring the elephant in the room. Or should I say, the elephant in the treatment room.

Because at the end of the day, whether we like it or not, successful workers’ compensation outcomes aren’t just about fixing bodies. They’re about addressing minds too.

You may get the WCRI report at https://www.wcrinet.org/reports/psychosocial-factors-and-functional-outcomes-following-physical-therapy.

Originally published on BobsClutteredDesk.com