There is a moment at every social gathering that those of us in this industry have learned to dread.

Someone asks what you do.

Now, regarding that question I normally provide the answer that is my stock in trade: As little as possible. But then you have to get serious. You have to say it.

And you watch yourself do the thing. You start with “insurance,” which is already a concession, because you can see the light behind their eyes begin its slow dimming. Then you add “workers’ compensation,” and they nod the way people nod at a diagnosis. And then, because you cannot help yourself, you spend the next forty seconds explaining that it is more interesting than it sounds, which is a sentence that has never once in human history made anything sound more interesting.

Somewhere around second thirty they excuse themselves to check on something in the other room. There is nothing in the other room.

I have watched this happen at weddings, at neighborhood cookouts, and once, memorably, at a funeral, which I want to be clear was not my fault.

We are, by a considerable margin, the worst storytellers in the American economy. And I have come to believe that this is not a public relations problem or an image problem. It is our single largest workforce problem, and it is entirely self-inflicted.

We named ourselves after the accounting.

Take a moment with that. Of all the things happening in this system, of all the possible descriptions available to us, we chose the one that describes the money moving. Firefighters did not name their profession “Municipal Combustion Response Funding.” Paramedics did not go with “Emergency Transport Cost Allocation.” We looked at an industry whose entire purpose is putting broken people back together and we called it compensation, which is a word from a ledger.

Then we built everything else on that foundation, and we did it with commitment. Our job titles are Claims Examiner and Adjuster, both of which describe filing. Our trade press headlines are about rate filings and combined ratios. Our conference names sound like tax seminars. Our industry’s dominant aesthetic is beige, and I say that as a man who has personally spoken in more beige ballrooms than I can count.

And then there are the job postings. I want to share a specimen, lightly composited from several real ones, because it demonstrates the problem in a form so pure it belongs in a museum:

Claims Examiner II. Responsible for management of assigned caseload in accordance with established protocols and jurisdictional requirements. Requires 3 to 5 years experience.

There is not one human being in that paragraph. Not one. There is a caseload, there are protocols, there are jurisdictional requirements, and there is a person who is apparently supposed to already have three years of experience doing a job that no employer will let them start without three years of experience. We have constructed a profession that can only be entered by people who are already in it, and then we hold panels asking why nobody new shows up.

The answer is that we have hidden the door, and also we did not tell anyone there was a building. And god forbid we should tell them the building is both noble and cool.

Here is what we do instead of recruiting.

We hire each other. An adjuster leaves a carrier for a TPA, a TPA person goes to a broker, a broker’s risk manager moves to a self-insured employer, and everyone congratulates everyone on LinkedIn about their exciting new chapter. Somebody’s headcount problem is solved and somebody else’s headcount problem is created, and the total number of people in workers’ compensation goes down by one every time a person retires.

We are not building a talent pipeline. We are passing the same people back and forth and calling the motion growth. It is musical chairs, except we remove a chair every time someone turns sixty-five, and nobody is adding new players to the game.

And I want to be fair here, because there are real efforts underway. There are risk management degree programs. There are apprenticeship pilots. There are companies doing genuinely thoughtful work on early-career development, and they know who they are because I have been loudly complimenting them for years. Mine is one of them, which you may consider disclosed. But the honest scale of it is a handful of programs against an industry of hundreds of thousands, and hope is not a workforce strategy.

Everything above is the joke. Here is the thing underneath it, and I am going to drop the routine for a few paragraphs.

The people outside this industry believe we manage files and litigate claims. That is genuinely what they think we do. They think we are the people on the other end of the phone who say no, and the reason they think that is that we have never once made a serious effort to tell them otherwise.

But when this system works, and it does work, far more often than our critics admit and far less often than we should accept, here is what actually happens.

A man falls off a roof on a Thursday morning. In the space of about four seconds, everything he had is gone. His income, his ability to pick up his daughter, his sense of himself as the person in his family who handles things rather than the person who needs handling. That is a shattered life. Not a claim. A shattered life, with a file number stapled to it.

And then a system built for exactly this moment picks him up. It pays his mortgage while he cannot work. It buys him a surgeon and a physical therapist and a case manager who calls to check on him. It fights with his employer about modified duty and wins. And eighteen months later he is back on a roof, or he is doing something else entirely because we paid to retrain him, and he is whole. Not the same. Whole.

We did that. That is the actual product. Somebody gets their life back, and a family that was headed for the financial cliff does not go over it.

Multiply that by every workplace injury in America and you get the second thing we never talk about, which is that this system is load-bearing for the entire employment economy. Employers can operate because their catastrophic exposure is predictable. Workers can take physically demanding jobs because the floor beneath them is real. That bargain is the reason a construction economy exists in a country where a single injury could otherwise bankrupt both the worker and the company he works for.

And it was first. Before Social Security, before unemployment insurance, before Medicare, this was America’s original social insurance program. We invented the idea that a country takes care of the people its economy breaks. We were the prototype for all of it.

Nobody knows that. Not one person under thirty knows that, and the fault is not theirs.

We just suck at selling ourselves.

So here is my modest proposal, and it does not require anyone to change a statute.

Stop recruiting for the job and start recruiting for the purpose. There is a generation entering the workforce that is famously, sometimes exhaustingly, insistent on doing work that means something. We have spent fifteen years complaining about that generation at conferences. They are not the problem. They are the single best-matched labor pool our industry has ever been handed, and we are advertising to them with the phrase “management of assigned caseload in accordance with established protocols.”

We are sitting on one of the great untold stories in American working life and we have chosen, apparently as a group, to describe it in the language of a bank statement.

I have argued for years that we should call this Workers’ Recovery, and people tend to treat that as a branding preference, a bit of harmless Cluttered Desk eccentricity. It is not. The word you use to describe your work determines who wants to do it. Compensation attracts people who are comfortable processing transactions. Recovery attracts people who want to fix something. We have been running the wrong advertisement for a hundred years and then acting surprised at who answered it.

The next time someone at a party asks what you do, try this instead. Tell them you put people’s lives back together after their worst day.

Then watch what happens. Nobody has ever walked away from that sentence to go check on something in the other room.

Dr. John F. Burton, Jr. died on August 12th at the age of 91. If that name does not immediately register with you, and you work in this industry, I would gently suggest that is a gap worth closing. Give me a few hundred words and I will try to close it.

Let me start with the part of the story I own, because it is the only part where I get to be the fool.

In 2015, Robert Aurbach, then the editor of the IAIABC Journal, asked me to write a piece called “The Case for Workers’ Recovery.” Then he sweetened it. He had invited a second author to lay out a competing vision for the future of workers’ compensation. We would each write our article, then each critique the other’s, and all four pieces would run together as a point-counterpoint debate. I thought this was a terrific idea. I accepted immediately. Only then did I ask the question I should have asked first, which was who I would be debating.

Aurbach’s answer was two words. John Burton.

My response was one word, and it was not a word I put in blog headlines.

Here is why. Burton chaired the National Commission on State Workmen’s Compensation Laws, appointed to that post by President Nixon in 1972. He was the founding dean of the School of Management and Labor Relations at Rutgers, professor emeritus there and at Cornell’s ILR school, a law degree and a doctorate in economics from Michigan. The National Academy of Social Insurance called him one of the nation’s foremost scholars on workers’ compensation, and that was not a courtesy title. At the time of that assignment, I was a website guy who had backed into this industry sideways, with four years of blogging under my belt and a college transcript best described not as Magna Cum Laude but more along the lines of “Thank You Dear Laude.”

We both wrote our articles. We critiqued and responded to each other’s work. Then I waited. It would be four long months before the four articles were published and I could see his response. I spent a fair amount of that time imagining the public thrashing headed my way.

It never came. He was, in his response, remarkably generous to me. He was also entirely unconvinced. Burton read my argument for renaming and reorienting the system around recovery, acknowledged that we were after many of the same improvements, and then explained why he would go a different way. His ideal program put its primary emphasis on minimizing an injured worker’s actual loss of earnings, driven by hard economic incentives rather than by good intentions. He wrote that my approach relied to a large extent on admonitions to decision makers to do the right thing, and that as an economist his reaction to the likely effect of such pleas was skepticism.

That line stung a little. It also stuck. He was not wrong that a system does not change because someone asks it nicely, and much of what I have written in the decade since has been an attempt to answer him. He wanted incentives. I wanted a name and a purpose that people could actually understand, on the theory that you cannot build incentives toward a goal nobody has bothered to define. We were arguing about the route, not the destination.

That exchange is where Workers’ Recovery stopped being an idea I liked and became an idea with a structure. Being forced to defend it against a mind like his did more for the concept than a hundred friendly conference sessions ever could have. The soul of an idea got a body. Everything I have written on the subject since, including a book that exists largely because of that exercise, traces back to those four articles.

A year later, Judge David Langham and I organized the 2016 Workers’ Comp Summit, held in three meetings, in Dallas, New Orleans, and Orlando. It was an invitation-only gathering meant to kick off a genuine national conversation about where this industry was headed. Burton came. He did not have to. He had been having that conversation since before most people in the room were born, and he had every right to conclude that another one would not accomplish much. He came anyway, and he did in Dallas what he did everywhere, which was bring data into a room full of people largely arguing from anecdote.

Because that was the real work. The 1972 Commission report is what he is known for, and it deserves the attention. It found the protection then furnished to American workers to be, in its own words, inadequate and inequitable. It issued 84 recommendations and flagged 19 as essential. It gave the states until July 1, 1975, to comply and told Congress to act if they did not. The states moved, and some of what a claims professional today treats as unremarkable baseline, the medical benefit without a dollar cap, the death benefit that follows the survivor, exists because a young economist told fifty legislatures to fix it or lose control of it.

Congress never acted. And according to Burton friend and longtime legal advocate Jon Gelman, that is where Burton’s harder, longer, less celebrated work began. He understood that fifty separate programs with no federal floor would drift unless somebody kept score, so for the next five decades he kept score. He edited John Burton’s Workers’ Compensation Monitor, then the Workers’ Compensation Policy Review. He helped produce the National Academy of Social Insurance’s annual benefits, coverage, and costs report, still the only reliable national picture of what this system pays and what it costs. He put the full 1972 report on his own website and gave it away, because he wanted people to read the thing rather than cite it secondhand. Fifty four years on, no state complies with all nineteen essential recommendations. He made sure nobody could pretend otherwise.

I disagreed with John Burton in print, which remains one of the more improbable lines on my resume. I would disagree with him again today on the mechanism. But I never once disagreed with the question he spent his life asking, which was whether the injured worker ends up whole. He would not accept the machinery of the system as a substitute for its purpose. Neither will I.

He gave my idea its shape by refusing to accept it on faith. That is the highest compliment a serious person can pay you, and I did not fully appreciate it at the time.

Rest well, Dr. Burton. The fight will continue, and even though the route may be different than you envisioned, the destination remains the same.

We measure everything in this industry.

We measure lag time, closure ratios, average duration, medical spend per claim, litigation rates, attorney involvement, reserve accuracy, and the number of days between the injury and the first indemnity payment. We have dashboards. We have benchmarking studies. We have entire conference tracks devoted to measuring things, and then a networking reception afterward where we talk about what we measured.

Every one of those numbers is taken from our chair.

There is another chair. It is usually vinyl, it is usually in a waiting room, and the person in it has a shoulder that no longer works and a mortgage payment due on the first. Nobody benchmarks that chair. There is no dashboard for it. And it is the only chair in the entire system where the actual product of workers’ compensation gets delivered.

So let us sit in it for a few minutes.

You got hurt on a Tuesday. You told your supervisor, who said he would “take care of it,” which turned out to mean he told somebody else, who was at lunch.

You went to a clinic where a person you have never met asked you to explain the accident four separate times to four separate people, each of whom typed while you talked and none of whom looked up. You signed nine pages. You read none of them, partly because of the pain medication and partly because nobody reads nine pages.

Then you went home and waited.

That is the part we do not measure. The waiting. Somewhere in a building a file was opened, a diary was set, a form was transmitted to the state, and by every internal metric we were performing beautifully. From the vinyl chair, nothing happened at all. For six days, the sum total of the workers’ compensation system’s communication with the injured human being at its center was a letter that began “Please be advised that pursuant to.”

Meanwhile that same person can open an app and learn that Kevin is four minutes away with a burrito. He can watch Kevin’s little car icon turn left. Kevin will text if there is a delay. Kevin, who is delivering a burrito, has a communication protocol more responsive than the one attached to a herniated disc.

I am not suggesting we need a claims tracker with a tiny animated adjuster driving toward your house. Although I have thought about it, and I would look at that dashboard.

Here is the thing that surprised me most in the decade I spent working on my book. When you ask injured workers what made their experience a good one, almost nobody talks about the money. They talk about how they were treated. The list is remarkably consistent, remarkably human, and remarkably cheap.

Somebody called, fast, and that somebody was sorry. Not “I am calling to obtain a recorded statement.” Just a human voice within a day saying this happened, that stinks, I am the person who is going to help you, here is my direct number. The recorded statement can wait a week. Nobody has ever recovered faster because we got the statement on Thursday instead of the following Tuesday.

They believed me. This is the big one, and it is the one we are structurally worst at. We built an entire posture around the small percentage of claims that are fraudulent and then applied it to everyone, which is a bit like greeting every customer at the door with a metal detector and then wondering why they seem tense. The injured worker can feel suspicion. They can hear it in the questions. And nothing radicalizes a reasonable person faster than being treated like a liar about something that actually happened to them.

They told me what would happen next, and then it happened. Not a promise of a good outcome. Just a sequence. You will hear from the doctor’s office by Friday, I will call you Monday either way, the first check should arrive the following week. Certainty is medicine. Uncertainty is the thing that keeps people awake at two in the morning building elaborate theories about what we are up to.

I had one name and one number. Not a queue. Not a general mailbox. Not a claim number that gradually replaced my actual name in every piece of correspondence I received.

They spoke English. Actual English. Not MMI, IME, TTD, PPD, UR, and IMR delivered in a rapid burst to a person with a ninth grade reading level, a concussion, and no earthly reason to know what any of that means. Somewhere out there is a worker who spent three weeks believing MMI was a diagnosis.

The money came when they said it would. Financial panic is not a side issue that runs parallel to the medical claim. It is part of the medical claim. A person worried about the electric bill heals slower than a person who is not, and there is a growing pile of research saying exactly that. On-time indemnity is clinical care that happens to be paid out of a different bucket.

My employer called me. About me. Not about the paperwork, not about when I am coming back, not about whether I remembered to drop off the form. Just called. The number of injured workers whose lasting bitterness traces back to a simple and total silence from the place they gave fifteen years to is genuinely staggering. It costs a phone call. We spend more than that on the pens.

By the way, if you are an employer, go back and read that last part again. It will be worth your time.

Somebody told me I was going to get better. Early, out loud, and with conviction. Expectation of recovery is one of the strongest predictors of actual recovery in the literature, and we routinely say nothing at all, which the person in the vinyl chair reasonably interprets as bad news we are too polite to share.

Somebody asked me what I thought. Not told. Asked. About the job I could do, about what hurts, about what I am worried about. People who feel like participants in their recovery do better than people who feel like cargo.

The Uncomfortable Math

Read that list again and notice what is on it.

A phone call. Some plain language. A schedule that gets honored. An expression of sympathy that costs nothing and takes eleven seconds. Not one item on that list requires legislative reform, a rate filing, a new platform, or a task force, which regular readers will recognize as my four favorite ways of not solving something.

Now price out the alternative. Price out the attorney, the litigated file, the additional eighteen months, the surgery that might have been avoided, the worker who never returns to the labor force at all. We will spend eighty thousand dollars fighting about a claim rather than spend forty minutes preventing the fight.

This is the argument at the center of Thank You For Holding, and it is why the title is what it is. “Your call is important to us” is the precise sound the system makes while it is doing nothing. Thirteen chapters and roughly one hundred jokes later, the conclusion is embarrassingly simple. We are extremely good at managing claims. We were never asked to manage claims. We were asked to help hurt people get better and get back to living, and somewhere in the last century we quietly swapped the second job for the first because the first one is easier to put on a dashboard.

One last thing about the chair: The people who do this well are already among us. I meet them constantly. They are the adjusters who call on day one, the nurses who explain things twice without making anyone feel stupid, the employers who send somebody to the hospital and then keep showing up. They are not following a special protocol. They are mostly just behaving the way a decent person behaves toward someone having a rotten month.

That is the whole secret. It is not a technology problem, and it is not a compliance problem.

It is a chair problem. We have simply been sitting in the wrong one.

Every organization in workers’ compensation has a succession plan.

I know this because I have asked. Repeatedly. At conferences, on panels, in the hallway outside the ballroom where the coffee is somehow both burnt and cold. And to their credit, people always have an answer for me.

The answer is usually a name.

Somewhere in your organization there is a woman named Diane. She may be named Patti, or Sharon, or Denise, or in rare and notable cases, Gary. But for our purposes today, she is Diane. Diane has been here since before the current claims system, and before the one that preceded it. Diane knows why the Ohio files are handled differently. Diane knows which employer actually means it when they say light duty is available and which one means “we have a chair by the door.” Diane knows the fax number still works because Diane is the reason it still works.

And Diane is sixty-three.

That is your succession plan. Her name is Diane, and she is sixty-three, and everyone in your building has quietly agreed not to think about it.

Now, some organizations have documented their succession strategy, and I want to give credit where it is due. Having reviewed the field, I can report that the following models are currently deployed across our industry:

The Two-Week Overlap. The incoming person shadows Diane for ten business days, four of which Diane spends burning her remaining PTO, and one of which is a mandatory compliance training on a topic neither of them has ever encountered. Thirty-one years of institutional knowledge, transferred at a rate of roughly one anecdote per hour.

The Shared Drive. There is a folder. It is called “Procedures.” It was last modified in 2014. It contains four documents, two of which are the same document, and a photograph of someone’s dog. The dog has also retired.

The Emergency Un-Retirement. Diane leaves. Three weeks later, someone discovers what Diane was doing. Diane returns as a consultant at a rate that would have been cheaper as a raise. Everyone agrees this arrangement is temporary. Diane buys a boat. And pays off her mortgage.

The Flattening. Rather than replace Diane, you distribute her responsibilities across four people who already had full-time jobs. This is presented in the all-hands meeting as an exciting opportunity for cross-functional growth. It is called “flattening the org chart,” which is also an accurate description of what happens to the people in it.

The Software Solution. Surely the platform will know. Surely somewhere in the implementation, the vendor will capture why the venue in that one county requires a different approach entirely. The demo was very impressive. There was a dashboard and everything.

The Faith-Based Model. Diane seems healthy. Diane likes it here. Diane’s husband is not really a hobbies person. This is not written down anywhere, but it is load-bearing.

I want to be clear that I am not making fun of anyone in particular. I am making fun of virtually everyone, which I find to be a more defensible position.

Here is the problem with all of this, and it is the reason I keep circling back to a topic that does not lend itself to punchlines.

We are not losing headcount. We are losing judgment. And it’s called brain-drain.

Process can be documented. Anyone can write down the steps for setting a reserve, filing a form, scheduling an IME. That is the easy part, and it is the part every organization does, because it is checkable and it produces a binder.

What does not go in the binder is why. Why Diane calls that particular nurse case manager for that particular kind of shoulder. Why she reads a certain adjuster’s reserves as reliably optimistic and adjusts accordingly, without ever having said so out loud to anyone. Why she picks up the phone on day three of a claim that looks routine on paper, because something in the injury description does not sit right, and she has been wrong about that feeling maybe four times in three decades.

That is not process. That is pattern recognition built out of thirty years of consequences, most of them somebody else’s. And it walks out the door with a sheet cake and a card that everyone signed but nobody read.

The surveys all say the same thing about our average age, and I do not need to quote them here, because you have seen them and because you can also just look around the room at your next chapter meeting. We built a profession on people who fell into it accidentally in 1994 and then discovered they were good at it and could not leave. That is not a talent pipeline. That is a trap that happened to work, and the trap has stopped catching people.

I am contractually obligated at this point to offer solutions, so here are a few, delivered with the confidence of a man whose own succession plan involves a laptop and a cluttered desk, a place at which he will most likely die of old age.

Document the reasoning, not the steps. Sit Diane down and ask her to talk through the last ten files she had a bad feeling about. Record it. That recording is worth more than your procedures folder and the dog picture combined.

Overlap measured in months, not in Diane’s remaining vacation. Yes, it costs money to have two people in one seat. It costs considerably more to have zero people in it while you figure out what the seat did.

Pay for mentorship. Put it in the job description. Put it in the compensation. Right now we ask our most experienced people to train their replacements as a volunteer activity performed on top of a full caseload, and then we act surprised when it happens at the depth of “call me if you get stuck.”

Show people the ladder. Nobody’s kid announces at Thanksgiving that they want to adjust claims. Fine. But people stay in this industry once they find it, and they find it faster when someone can articulate what year eight looks like instead of just year one.

Educate deliberately. I have some professional interest in this one, so discount accordingly, but the alternative to structured education is thirty years of trial and error, and we no longer have thirty years.

Ask Diane. Radical, I realize. She has thought about this more than you have. She has thought about it every time someone asked her a question only she could answer, and she has almost certainly noticed that she is the only one who could answer it.

The uncomfortable truth is that Diane already knows she is the succession plan. She has known for years. She has watched the organization build its continuity strategy on the assumption that she will remain healthy, employed, and disinclined toward boating, and she has said nothing, because saying something would sound like a threat and she is not that kind of person.

She is, however, sixty-three.

The good news is that this is one of the very few problems in workers’ compensation that does not require legislative reform, a rate filing, or a task force. It requires somebody deciding it matters before it becomes urgent.

The bad news is that we are historically not great at that particular sequence.

There’s a line in Chapter 11 of my book, Thank You for Holding. Your Injury Is Important to Us, that makes some readers wince. It goes something like this: impairment is a fact, disability is a choice. People hear that and immediately assume I’m about to tell injured workers to rub some dirt on it and walk it off.

I’m not. If anything, that line is the opposite of tough love. It’s the most hopeful thing I know how to say. But it comes with a catch that lands squarely on the desks of the claims professional, so let’s talk about it.

A workers’ compensation claim file is a remarkable set of documents. It records the diagnosis, the treatment plan, the work restrictions, the impairment rating, the wage calculation, and roughly forty-seven forms describing the same unfortunate Tuesday from slightly different angles. It is exhaustive. It is thorough. And it is missing the single most important piece of information about whether this worker is going to get better.

It never records what the worker thinks is going to happen to them.

That’s not a small omission. Across every domain of medicine and rehabilitation, patient engagement is the strongest predictor of a good outcome. Stronger than the treatment protocol. Stronger than the physician. Stronger than how fast your claims process runs. A worker who believes recovery is possible, and who is willing to do the hard and frequently unpleasant work of getting there, will beat the projections almost every time. A worker who has quietly concluded they are permanently broken will miss those projections with the same reliability. Not because they’re lazy or gaming the system, but because what the mind believes, the body tends to follow.

Here’s the uncomfortable part for those of us on the industry side. That mindset didn’t form in a vacuum. It often gets built, input by input, by the very system we operate. The employer’s first phone call. The tone of the adjuster’s voice. The waiting room. The denial letter. The medical delays while awaiting approval. The silence where a return call should have been. By the time a worker is sitting on the couch at 10:14 on a Tuesday morning staring at a phone that isn’t ringing, dozens of system inputs have shaped what they now believe about their future. Most of those inputs were negative, and a fair number of them were free to fix.

If you’re a claims professional, it would be easy to read all of that as “the worker’s attitude is the worker’s business.” I’d like to not-so-gently push back on that, because it isn’t true and it costs you money.

The worker’s mindset is a shared responsibility. You cannot engage on their behalf; nobody can recover for someone else. But you have enormous influence over the conditions in which their engagement either grows or dies. Every interaction you have is, whether you intend it or not, a mindset intervention. You’re either building the psychological foundation for recovery or quietly chipping away at it.

This is where partnership stops being a warm and fuzzy word and starts being a strategy. The adjusters and case managers who consistently get better outcomes are not the ones with the sternest denial letters. They’re the ones who treat the worker as the driver of the recovery and themselves as support crew. They provide the vehicle, fuel it, maintain it, and map the route. Then they do the genuinely hard thing, which is to let the worker steer while making it as easy as possible to actually go somewhere.

Partnership is not a poster in the break room. It’s a set of habits.

It’s calling back when you said you would, because reliability is the cheapest trust you’ll ever buy. It’s explaining what’s happening in plain English instead of the clinical shorthand that leaves people more frightened than informed. It includes being empathetic when the news is not the best. It’s noticing when a worker’s mindset is starting to become a barrier and responding with support rather than suspicion. Suspicion is expensive. It hardens people, and hardened people don’t recover on schedule.

And at times, it is brutal honesty about a new reality and convincing the worker that it is in their interest to accept that point and rebuild from there. Ultimately that acceptance could mean the difference between recovering with impairment or being damned by disability.

Consider the moment of Maximum Medical Improvement. In too many files it arrives as an administrative surprise, a letter telling someone their condition has “stabilized,” which is a clinical word that explains absolutely nothing about how to live the rest of your life. Compare that to the doctor who treated a young surfer named Bethany Hamilton after she lost an arm. He told her he’d give her a list of things she could no longer do, and it would be very short. Then he’d give her a list of things she could still do, and it would be much, much longer. That doctor didn’t have a magic protocol. He had a frame. He handed her a future instead of a limitation.

A true partnership prepares the injured worker for the reality of a likely outcome. Simply “adjusting a claim” does not.

You can do a version of this. You may not deliver the medical prognosis, but you set the tone around it. You decide whether the worker walks away from that conversation oriented toward what’s gone or toward what’s still possible. That is a partnership move, and it produces partnership results.

I know the objection. This all sounds lovely, but you have a caseload measured in the hundreds and a phone that rings like a smoke alarm. Fair. So let me put it in terms the actuaries appreciate.

Chapter 11 features three people worth knowing. Warren, a double above the knee amputee, decided he was going to be the man he was and now leads young people up Kilimanjaro. Bonnie lost a leg at four and went on to win Paralympic medals and serve in a presidential administration. Erik lost a leg in a forklift accident, fought a system that kept sending him back to the same clinic for the same useless prosthetic refit, forced his way to a proper solution, and today works for the prosthetics firm helping new amputees adjust. Three significant impairments. Three people I would never call disabled.

The difference between an Erik and a claim that spirals into permanent disability is rarely the severity of the injury. It’s whether someone in the system partnered with the worker or fought them. Erik got there in spite of the system. Imagine the file where he got there because of it. That’s a shorter claim, a lower reserve, a return to productivity, and a human being with their life back. Those goals are not in tension. They are the same goal.

Impairment doesn’t negotiate. It is what it is. But disability, meaning how a person carries that impairment through the rest of their life, is not fixed at the moment of injury. It’s shaped by every interaction that follows, and you are one of those interactions. And a very important one, at that.

The system cannot recover for the worker. That part is genuinely theirs. But the system decides whether the better choice is even available. Make it available. Partner with the person on the other end of the file, and you’ll find the numbers you care about tend to follow the person you helped.

The best vehicle in the world sits in the driveway if nobody wants to drive it. Your job isn’t to drive. It’s to make the road look worth traveling.

________________________

More information on Bob’s book can be found at https://WorkersRecovery.com.

People sometimes ask me why we called it WorkCompCollege. It’s a fair question. The word “college” carries certain expectations like ivy-covered buildings, tenured professors, four-year degrees. We don’t have any of those things.

What we do have is a belief that stuck with me for years before it finally became an organization: the workers’ compensation industry had an education problem, and until we solve it, nothing else we try will work as well as it should.

That’s why we built this. Not to add another training vendor to an already crowded market, but to fill a gap that nobody else seemed to recognize as the gap – the missing foundation beneath all the other problems we keep trying to solve.

Workers’ compensation is one of the most fragmented industries I’ve ever encountered. Fifty-plus different state systems. Thousands of employers with wildly varying approaches. Carriers, TPAs, and self-insured operations all doing things their own way. Medical providers who interact with comp sporadically and often reluctantly. Attorneys on all sides with competing incentives. Regulators trying to oversee a system that looks different in every jurisdiction.

Into this fragmented landscape, we drop new adjusters with minimal preparation and expect them to figure it out. We hire claims professionals and give them a procedure manual instead of an education. We sometimes promote supervisors based on their individual performance without developing their leadership capabilities. We assume that experience alone will somehow transform task processors into skilled professionals.

And then we wonder why outcomes vary so dramatically. Why some adjusters connect with injured workers while others alienate them. Why some organizations build great cultures while others churn through staff. Why the industry struggles to attract and retain talent.

The answer isn’t complicated: we never built the educational infrastructure that a mature profession requires.

Consider virtually any other profession that deals with consequential decisions affecting people’s lives. Medicine has medical schools, residencies, board certifications, and continuing education requirements. Law has law schools, bar exams, and mandatory CLE. Accounting has degree requirements, CPA exams, and professional standards bodies. Engineering has accredited programs, licensing exams, and professional ethics requirements.

These professions invested in education not because they enjoy bureaucracy, but because they recognized that competent practice requires more than on-the-job training. They built systems to ensure that practitioners understand not just the mechanics of their work, but the principles underlying it.

Frankly, with the exception of a few limited licensing requirements, workers’ compensation never built that system.

We have some excellent training programs, to be fair. Many individual carriers and TPAs invest in their people. Industry associations offer valuable conferences and seminars. Specialty certifications exist in various niches. But there’s no coherent educational pathway for someone entering this industry. No common body of knowledge. No shared standards for what a competent claims professional should know and be able to do.

The result is exactly what you’d expect: highly variable quality, reinvention of wheels across organizations, and an industry that has trouble articulating its own professional identity.

When we started thinking about WorkCompCollege, we weren’t thinking about courses and certifications. We were thinking about infrastructure.

What if the industry had a common foundation – a shared understanding of what workers’ compensation is actually trying to accomplish and how competent professionals achieve it? Not just the procedural knowledge of how to process a claim, but the deeper understanding of why we do what we do and how to do it well?

What if adjusters entered the field with a genuine education in the biopsychosocial nature of injury and recovery, rather than learning it – if they learn it at all – years into their careers? What if supervisors were developed as leaders before they were promoted, rather than being left to figure it out through trial and error? What if the industry had clear professional standards that meant something – that signaled to employers, injured workers, and the public that certified professionals had demonstrated real competence?

This isn’t idealistic dreaming. It’s what every other serious profession has done. We’re just late to the realization that we need to do it too.

The Missing Link

Over the past month, I’ve written about restoring the human element to workers’ compensation. About why legislative reform keeps falling short. About how culture and leadership determine outcomes more than policies and procedures.

All of those pieces connect here.

You can’t restore humanity to a system staffed by people who were never taught why humanity matters. You can’t achieve meaningful reform by changing statutes while leaving unchanged the professionals who implement them. You can’t build great cultures without developing the people who comprise them.

Education is the missing link. It’s the intervention that makes all the other interventions work. Without it, we’re trying to build a house without a foundation – and then wondering why the walls keep cracking.

This is what WorkCompCollege exists to provide. Not just training, but education. Not just skills, but understanding. Not just compliance, but competence.

When I say we’re on a mission, I mean it literally. WorkCompCollege isn’t a business strategy dressed up in inspirational language. It’s an actual mission – a commitment to transforming this industry through education because we believe the industry is worth transforming.

That mission asks something of all of us.

It asks adjusters to see themselves as professionals worthy of genuine education, not just task workers who need enough training to follow procedures. It asks them to invest in their own development, to pursue credentials that mean something, to embrace the identity of a skilled professional rather than accepting the limitations of a claims processor.

It asks employers to invest in their people; really invest, not just check the training box. To recognize that education compounds over time, that developing professionals pays dividends for years, that the best adjusters will stay where they’re valued and leave where they’re not.

It asks industry leaders to think beyond their own organizations. To contribute to building the shared infrastructure that benefits everyone. To support the development of professional standards that elevate the entire field rather than just competing for a slice of the existing pie.

It asks all of us to believe that workers’ compensation can be better than it is. That injured workers deserve a system staffed by genuine professionals who understand what they’re doing and why it matters. That this fragmented, inconsistent, often frustrating industry can become something we’re all proud to be part of.

I’ve been in workers’ compensation for a long time. Long enough to have seen fads come and go (big data, anyone?). Long enough to be skeptical of anyone claiming to have all the answers. Long enough to know that real change happens slowly, through sustained effort, one professional at a time.

That’s what we’re building at WorkCompCollege, a community of professionals committed to their own development and to improving this industry. People who believe that education matters. Who invest in becoming better at what they do. Who understand that how we treat injured workers reflects who we are as professionals and as people.

We’re building this community one student at a time. One certification at a time. One organization at a time. It’s not fast. It’s not flashy. But it’s real, and it’s growing.

The Workers’ Recovery Professional certification. The MSP College programs. The AI programs focused on workers’ comp. The partnerships we’re developing with organizations that share our vision. The content we create to push the industry’s thinking forward. All of it serves the same mission: building the educational infrastructure this industry has always needed but never had.

I don’t know what brought you to this article. Maybe you’re an adjuster looking for something more than another compliance training. Maybe you’re a leader trying to figure out how to develop your team. Maybe you’re just curious about what this WorkCompCollege thing is all about. Or you just stumbled in looking for the bathroom (down the hall and to your right). 

Whatever brought you here, I want to extend an invitation.

Join us.

Not because we have all the answers. We don’t. Not because transformation happens overnight – it doesn’t. But because you believe, as we do, that this industry can be better. That injured workers deserve better. That the professionals who serve them deserve better. That education is how we get there.

We built a college for workers’ comp because we believed the industry needed one. What we’re learning is that the industry was ready for one. Professionals across the country are hungry for a better way, not just knowledge, but purpose. Not just credentials, but community. Not just training, but transformation.

That’s the mission. And it has room for you.

Every claims organization has a handbook. Procedures are documented. Protocols are established. Best practices are laminated and posted in break rooms. From a compliance standpoint, most operations have their bases covered.

And yet, if you pulled ten random claim files from ten different organizations – all following the same state statutes, all subject to the same regulations – you’d find dramatically different experiences for the injured workers involved. Same rules. Same processes. Wildly different outcomes.

The difference isn’t in the handbook. It’s in the culture.

We spend enormous energy in this industry ensuring compliance. Regulators audit files. Quality assurance teams score calls. Supervisors review correspondence. Technology flags deviations from established protocols. From a process perspective, we’ve never been more monitored.

But here’s what I’ve learned after years of observation and discussion: you can comply your way to mediocrity, but you cannot comply your way to excellence.

Trust me. I’ve tried. Sort of.

Compliance tells an adjuster what they must do. Culture tells them what they should do how they go about it. And more importantly, culture shapes what they want to do. Compliance governs the actions that get measured. Culture governs everything else, which turns out to be most of what actually matters.

When an adjuster picks up the phone to call an injured worker, compliance might dictate the timing of the call. Culture determines the tone of the conversation. Compliance might require that certain information be communicated. Culture determines whether that information is delivered with empathy or indifference.

The adjuster who treats every injured worker with dignity isn’t doing so because it’s in the procedure manual. They’re doing it because that’s who they are in an organization that has made clear that’s who they should be.

This is a factor in every business. I’ve seen offices where the atmosphere is heavy, and effort seems tedious. In insurance offices with a poor culture, you are likely to find adjusters hunched over desks, watching the clock, processing files as fast as possible to meet metrics that reward speed over substance. Supervisors will be circling like hall monitors, looking for violations. Every conversation is tinged with defensiveness.

Of course, there are also claims departments where the energy is entirely different. Adjusters engaged in their work, genuinely trying to help the people on the other end of the phone. Supervisors serving as resources rather than enforcers. A sense that everyone is working toward the same goal rather than just trying to survive another day.

Same industry. Same basic work. Completely different cultures.

The difference, almost without exception, traces back to leadership.

Leaders set the weather in any organization. They clearly set priorities and expectations, as well as determine whether the climate is one of fear or trust, suspicion or support, transaction or purpose. And that climate, more than any policy or procedure, determines how work actually gets done.

When leaders emphasize metrics above all else, adjusters learn to optimize for metrics, even when doing so conflicts with good outcomes. When leaders emphasize human outcomes, adjusters learn to prioritize the injured worker, and the metrics tend to follow.

Care to guess who is getting better outcomes and more satisfied customers?

This isn’t about being soft or ignoring performance standards. The best claims operations are rigorous about results. But they measure the right results, and they create environments where people are empowered to achieve them.

I’ve spoken with many claims professionals and have heard the same themes repeated across organizations and geographies. They want to do good work. They entered this field, most of them, because they wanted to help people. Somewhere along the way, many of them lost that sense of purpose – not because they changed, but because their organizations, and the industry focus demanded it.

What adjusters need from leadership isn’t complicated:

Clarity about what matters. Not fifty competing priorities, but a clear understanding of the outcomes that actually count. If helping injured workers recover is the mission, say so, and then align everything else around that mission.

Permission to be human. Adjusters need to know that taking an extra few minutes on a difficult call isn’t going to get them flagged for productivity issues. They need to know that using judgment is valued, not punished. They need space to be people helping people, not processors processing claims.

Support when things get hard. Claims work is emotionally demanding. Adjusters deal with people in pain, people who are scared, people who are angry. They need leaders who recognize that burden and provide resources to manage it; not leaders who treat burnout as a personal failing.

Development, not just monitoring. The best adjusters want to get better at what they do. They want training that actually helps them serve injured workers more effectively. They want feedback that makes them grow, not just scores that rank them against their peers.

Recognition that matters. Not pizza parties and gift cards, but genuine acknowledgment when they’ve made a difference in someone’s life. The adjuster who helped an injured worker navigate a complex situation and return to work successfully is an adjuster that should know that their effort was seen and valued.

None of this requires a budget increase or a new software system. It requires leadership that understands what actually motivates people to do their best work.

Here’s what happens when culture is right: good adjusters stay. They don’t burn out and leave the industry. They don’t become cynical and disengaged. They grow into mentors who teach the next generation what good claims handling looks like.

And the injured workers they serve? They have better experiences. They recover faster. They return to work sooner. They’re less likely to hire attorneys. They’re more likely to speak positively about their employers. Every interaction ripples outward.

The opposite is equally true. Toxic cultures drive out good people. The adjusters who care the most are often the first to leave, because they can’t reconcile their values with what they’re being asked to do. What remains is a workforce that has learned to keep their heads down and process files. The injured workers they serve experience exactly the kind of impersonal, transactional system that generates friction and extends claims.

There is an oft-heard complaint that says, “What if I train my people and they leave?” To which the only appropriate response should be, “What if you don’t train them, and they stay?” The difference is culture; culture of transparency, culture of priorities, and a culture of concern.

Culture isn’t soft. Culture is strategy. It determines whether you keep your best people or lose them to competitors – or worse, keeping them; a poorly trained, highly stressed, disgruntled workforce. It determines whether injured workers become advocates for your organization or adversaries against it.

Litigation anyone?

Culture doesn’t happen by accident. Left unattended, it drifts, usually in the direction of whatever behaviors are being rewarded, explicitly or implicitly. If you reward speed, you get speed. If you reward closure, you get closure. If you reward humanity, you get humanity.

The leaders who build great claims cultures do so intentionally. They think carefully about what they measure and how they measure it. They hire for values, not just skills. They invest in development that goes beyond compliance training. They create feedback loops that capture the human outcomes, not just the operational ones.

Most importantly, they model the behavior they expect. Adjusters watch their leaders closely. When a supervisor takes the time to genuinely help a struggling employee, that sends a message. When an executive takes a call from an injured worker and treats them with dignity, that sends a message. When leaders admit mistakes and focus on learning rather than blame, that sends a message.

The message is always being sent. The only question is whether it’s the message you intend.

Training your claims team isn’t an expense. It’s an investment – and like all good investments, it compounds over time.

An adjuster who understands the biopsychosocial model of recovery handles claims differently than one who was simply taught the procedure manual. An adjuster who has been trained to communicate with empathy creates different outcomes than one who learned by imitation. An adjuster who understands why the human element matters, not just what the rules require, becomes a fundamentally different professional.

That professional stays longer, performs better, and influences everyone around them. They become the culture you’re trying to build.

This is why we do what we do at WorkCompCollege.com. We’re not just teaching adjusters how to process claims. We’re helping them understand why their work matters and how to do it in a way that serves both the injured worker and the organization. We’re giving them tools that go beyond compliance, tools that help them become the kind of professionals who do right when no one is watching.

Because ultimately, that’s what culture is. It’s what people do when the supervisor isn’t looking, when the call isn’t being recorded, when no one would ever know if they cut a corner. It’s the thousand small decisions that add up to either a claims operation that changes lives or one that just processes files.

Leadership determines which one you build.

If you’ve been in workers’ compensation long enough, you’ve developed a particular twitch. It activates whenever someone announces that comprehensive reform is coming to your state. Your eye starts to flutter. Your blood pressure ticks up. You begin mentally cataloging all the systems, forms, and procedures you’re about to relearn.

Welcome to reform fatigue. It’s the unofficial condition affecting everyone who has survived multiple rounds of legislative overhaul only to discover that the fundamental problems remain stubbornly intact.

I’ve watched this cycle repeat itself across decades and dozens of states. A crisis emerges, costs are too high, benefits are too low, employers are fleeing, workers are suffering. Task forces convene. Stakeholders testify. Legislators negotiate. Eventually, a massive reform bill passes with great fanfare. Everyone declares victory.

And then, a few years later, we do it all again. We reform the reforms of previous reformers.

Let’s not forget the definition of insanity…

There’s a reason the old quote about doing the same thing and expecting different results resonates so deeply in our industry. We have become remarkably skilled at reforming processes while leaving the underlying problems untouched.

We tinker with fee schedules. We adjust benefit formulas. We create new dispute resolution mechanisms. We mandate electronic filing. We restructure medical provider networks. We add layers of utilization review. We implement pharmaceutical formularies. We simplify process with hundreds of pages of new legislation and regulatory code.

These aren’t bad ideas. Many of them produce measurable improvements in specific areas. But they share a common limitation: they’re all designed to optimize a system that was built on assumptions about injured workers that may never have been accurate and certainly aren’t serving us well today.

We keep reforming the machinery while ignoring the people the machinery is supposed to serve.

Here’s what I’ve observed after watching reform efforts in state after state: the legislation that gets passed reflects the interests that show up at the table. Employers want lower costs. Insurers want predictability. Medical providers want fair reimbursement. Attorneys want access to the system. Each group advocates for changes that address their particular pain points.

You know who rarely has a seat at that table? Injured workers.

Oh, their interests are discussed. Their benefits are debated. Their experiences are referenced in testimony. But the actual human beings who wake up one morning as productive employees and go to bed that night as claimants navigating a system they never expected to encounter, their voices are largely absent from the rooms where reform gets written.

Is it any wonder that reform after reform fails to address what actually frustrates them?

When I talk with injured workers – and I’ve talked with many over the years – they rarely complain about the specific provisions of their state’s workers’ comp statute. They don’t express opinions on medical fee schedule conversion factors or the appropriate threshold for permanent partial disability ratings.

What they talk about is feeling lost. Feeling ignored. Feeling like a number in a system that nobody ever explained to them. Feeling suspected of fraud when they’re actually in pain. Feeling like getting better is somehow in conflict with getting compensated.

No reform bill I’ve ever seen has included a provision requiring the system to treat people like human beings. Apparently, that’s not something you can legislate.

I’m not suggesting that legislative reform is pointless. There are genuine structural problems in workers’ compensation that require statutory fixes. Benefit adequacy, cost containment, dispute resolution, these are legitimate areas where law and regulation play essential roles.

But we’ve reached a point of diminishing returns on process reform. We’ve optimized the system to within an inch of its life. We’ve added technology, removed friction, streamlined procedures, and automated decisions. By almost any operational measure, workers’ compensation has never been more efficient.

And yet.

Injured workers still report feeling dehumanized by the process. Employers still view comp as a necessary evil rather than a safety net that protects both them and their workforce. Adjusters still burn out under impossible caseloads. Medical providers still complain about administrative burden. Attorneys still find plenty of dissatisfied clients to represent.

Efficiency isn’t the same as effectiveness. Processing claims faster doesn’t mean we’re processing them better.

This is where I think the conversation needs to shift. The next wave of meaningful change in workers’ compensation isn’t going to come from a 500-page reform bill. It’s going to come from a fundamental reconsideration of what we’re actually trying to accomplish.

Are we trying to minimize costs? Process claims? Adjudicate disputes? Or are we trying to help injured workers recover and return to productive lives?

The answer should be obvious, but our systems don’t reflect it. We’ve built an industry around managing claims rather than helping people. And until we address that foundational disconnect, no amount of legislative tinkering is going to solve what ails us.

Real advocacy in workers’ compensation means advocating for a different set of priorities. It means pushing for outcomes that matter to human beings, timely medical care, clear communication, dignity throughout the process, support for return to work; rather than outcomes that matter to spreadsheets.

It means training adjusters to be advocates for recovery rather than processors of paperwork. It means educating employers about their role in supporting injured workers rather than just their obligations under the statute. It means building cultures within organizations that value the human outcomes as much as the financial ones.

None of this requires new legislation. It requires new thinking.

I’ll be honest: I’m skeptical that the next round of reform will be any different from the last dozen. The same interests will show up at the same tables and advocate for the same incremental adjustments. Some costs will shift. Some processes will change. And the fundamental experience of being an injured worker in America will remain largely the same.

But I’m not without hope.

What gives me hope is the growing recognition, among adjusters, employers, carriers, and even some regulators, that we’ve been optimizing for the wrong things. The conversations I’m having today are different from the ones I was having a decade ago. More people are asking the right questions. More organizations are willing to experiment with approaches that prioritize the human element.

The change won’t come from a state capitol. It will come from claims departments that decide to answer phones differently. From employers who support injured workers rather than suspecting them. From adjusters who see their role as helping people rather than managing files. From an industry that finally recognizes that injured workers aren’t the problem to be managed, they’re the reason we exist.

That’s the reform that matters. And unlike legislation, it doesn’t require a single vote.

The workers’ compensation industry doesn’t need another reform bill. It needs a reformation, a fundamental shift in how we think about the people we serve. If you’re ready to be part of that conversation, I invite you to connect with us here at WorkCompCollege.com and explore the community we’re building around a different vision for this industry.

Originally published on BobsClutteredDesk.com

There’s a moment in every workers’ compensation claim where a human being becomes a file number. It happens almost imperceptibly – somewhere between the first report of injury and the assignment to an adjuster’s caseload. One minute, Maria is a shipping clerk who slipped on a wet floor and is scared about how she’s going to pay her rent while her ankle heals. The next, she’s Claim #WC-2026-047821, one of 150 open files competing for attention on an overworked adjuster’s desk.

I’ve spent decades in this industry, and we’ve seen this transformation happen many times. It’s not malicious. It’s not even intentional. It’s simply what happens when we build systems designed to process volume rather than serve people.

The workers’ compensation system has become remarkably efficient at processing claims. We’ve developed sophisticated algorithms for reserving, automated systems for bill review, and streamlined processes for everything from initial intake to settlement negotiations. From a purely operational standpoint, we’ve never been better at moving paper.

The problem is that injured workers aren’t paper.

When I wrote Thank You For Holding: Your Injury Is Important To Us, I wasn’t trying to indict the entire industry. I was trying to hold up a mirror. The title itself came from countless hours spent listening to injured workers describe their experiences with the system, the endless hold times, the form letters, the feeling of being processed rather than helped. That automated message we’ve all heard a thousand times; “Your call is important to us,” has become the unintentional motto of an industry that has forgotten how to demonstrate that importance through action.

Here’s what the data consistently shows us, and what common sense should have told us all along: when injured workers feel like they’re being treated as human beings rather than claim numbers, outcomes improve. Across the board.

Workers who feel heard and respected return to work faster. They’re less likely to hire attorneys. They report higher satisfaction with medical care. They’re more likely to comply with treatment protocols. Their claims close sooner and cost less.

This isn’t soft science or wishful thinking. This is what happens when you treat people like people.

The inverse is equally true. When injured workers feel ignored, dismissed, or processed, they dig in. They become adversarial. They seek legal representation not because they need it, but because they feel they need protection. What could have been a straightforward claim becomes a contested battleground, with costs multiplying at every turn.

We’ve created a system that often generates the very friction it then struggles to overcome.

For years now, we’ve been talking about the biopsychosocial model of injury and recovery. The concept is simple: a person’s recovery from a workplace injury isn’t determined solely by the physical nature of the injury itself. Psychological and social factors play enormous roles, stress, fear, financial anxiety, relationships with supervisors, perceptions of fairness.

An injured worker who believes their employer cares about them, who trusts that the system will treat them fairly, who feels supported rather than surveilled, that worker heals differently than one who feels abandoned, suspected, or processed.

We know this. The research is overwhelming. And yet our systems continue to be designed as though injuries happen to bodies rather than to people.

The good news is that restoring humanity to workers’ compensation doesn’t require burning down the existing system and starting over. Often, it requires remarkably small changes that yield disproportionate results.

A phone call instead of a form letter. Using someone’s name instead of their claim number. Asking “How are you doing?” before asking for documentation. Explaining the next steps rather than just processing them. Following up to ensure someone understood their benefits rather than assuming they did.

These aren’t revolutionary concepts. They’re basic human courtesies that have somehow become casualties of our drive for efficiency.

I’ve talked with adjusters who tell me they want to provide this kind of personal attention but feel crushed by caseload expectations. I’ve heard from managers who say they’d love to emphasize humanity but are measured solely on cycle times and closure rates. I’ve sat with executives who genuinely care about injured workers but have built organizations that inadvertently do the opposite. I’ve chatted with regulators that recognize the issue, but are saddled with legislative guidelines that were created with process in mind rather than outcomes.

The system didn’t become impersonal because bad people designed it. It became impersonal because we optimized for the wrong things.

This is why, for more than a decade now, I’ve been advocating for a shift in how we think about what we do. We don’t just compensate workers for their injuries. We help them recover; physically, financially, and psychologically – from events that have disrupted their lives.

The difference isn’t semantic. It’s foundational.

When our goal is compensation, we focus on processing the claim correctly and closing the file. When our goal is recovery, we focus on helping a human being return to wholeness. The processes may look similar on the surface, but the outcomes differ dramatically.

Workers’ Recovery isn’t a new program or a branded initiative. It’s a philosophy, a reminder that behind every claim number is a person with fears and hopes, a family depending on them, a life that has been disrupted by something they didn’t choose.

I’m not naive. I understand the pressures facing adjusters, employers, and carriers. I know that caseloads are high, margins are thin, and everyone is being asked to do more with less. Telling people to “just be more human” isn’t a strategy.

But I also know that the current approach isn’t working as well as it should. We’re spending enormous resources on litigation that wouldn’t exist if people felt heard. We’re extending claim durations through adversarial relationships that could have been prevented with early communication. We’re paying for problems we created.

Restoring the human element isn’t just the right thing to do, it’s the smart thing to do. It’s how we reduce friction, improve outcomes, and build a system that actually serves its intended purpose.

It starts with recognizing that every claim number has a name. Every file has a face. Every injured worker is someone who woke up that morning expecting to come home at the end of their shift the same way they left.

They deserve better than “Thank you for holding.”

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.