Over the past couple of years, the number of AI presentations and vendors at industry conferences has been almost overwhelming. Deciding which ones to attend feels a bit like my first visit to VooDoo Doughnut—so many choices, each with a different topping or filling. Are they all the same, just with different packaging? Or does one have something truly unique to offer? Will I pick the right one?

Yet, despite the excitement generated by the AI presentation titles, I often leave these events feeling unfulfilled by what I’ve learned—at least when it comes to AI’s impact on workers’ compensation. But why? A simple internet search revealed part of the problem. I asked Google, “What role does artificial intelligence have in workers’ compensation claims?” The responses were promising:

• Identifying patterns, predicting risks, and streamlining claims processing
• Supporting informed claims management decisions
• Improving medical and financial outcomes

Good stuff! But I wanted more. Looking deeper, I confirmed that most AI applications in workers’ compensation focus primarily on medical treatment and disability management. For example, AI is used to assess the likelihood of surgery, analyze the impact of co-morbidities, predict opioid misuse risks, evaluate access to care issues, and estimate treatment duration and the probability of permanent impairment. These insights are valuable, but they miss an important opportunity—leveraging AI to better understand the human side of workers’ compensation.

Unstructured Data: The Missing Piece

Consider how we currently segment claims and assess initial complexity. Predictive analytics, an established science, typically relies on structured data—medical diagnoses, demographic information, and worker characteristics gathered at claim intake. But artificial intelligence could go a step further by analyzing unstructured data from claim manager notes, recorded phone conversations, medical reports, correspondence, and emails from claim parties (workers, employers, and medical providers).

Why does this matter? Because long-term disability is often driven by non-medical factors—psychosocial risks, workplace dynamics, cultural or family influences, and employer-employee relationships. Structured data alone doesn’t capture these nuances. By analyzing unstructured data, AI could help claims professionals gain a deeper understanding of a worker’s motivations, fears, and barriers to returning to work. And identify situations where the employer is a barrier to return to work. This information would allow for more targeted interventions—sometimes as simple as having a conversation with an at-risk worker, guiding them and their employer through the complexities of the claims and return-to-work process, and providing the support they need to move forward.

The Challenge for the Industry

I recognize that analyzing unstructured data is more complex than predicting cost and duration based on ICD codes and age. But the long-term value—improved outcomes and reduced costs—makes it a challenge worth pursuing. As an industry, we should start asking AI vendors: When will this be part of your service offerings?

The future of AI in workers’ compensation shouldn’t just be about streamlining processes; it should also be about supporting the people behind the claims.

In my June 27, 2023 article, Trauma-Informed Practices and Workers’ Comp…, I mentioned motivational interviewing (MI) as another health-related intervention that can also improve outcomes for workers and employers in the workers’ compensation system. In other words, another tool to prevent or mitigate unnecessary work disability. 

MI is a counseling approach that can support a shift in the culture of our industry. Claim professionals can use MI to activate customers, particularly injured workers, facilitating their recovery and return to work.  

Below, I’ve outlined just a few key elements of MI for you to consider in your daily work or in any situation where you’re supporting someone’s progress toward their goals or behavior change – hmmm….any of you have teenagers?? 

• Collaboration. MI is grounded in a collaborative and respectful relationship between you and the worker. Establishing trust is crucial for workers who can feel vulnerable and a lack control of their claim and outcomes. Collaboration requires empathy, partnership, being an effective listener. 
• Focus on Change. MI is intended to utilize an individual’s own motivation for change. This can mean actively engaging them in the process, being open to their goals in developing return-to-work strategies. 
• Empowerment and Autonomy. Through MI, workers are encouraged to make their own choices and to become active self-advocates in their rehabilitation. When someone feels empowered, they are much more likely to follow their treatment and return-to-work plans. 
• Goal Setting. In my view, this is at the core of work disability prevention and mitigation. MI involves working with the individual to set realistic and obtainable goals; achieving those goals (or simply next steps), then setting the next goal (and continuing to repeat) in order to move forward with recovery and return to work. It’s a way of providing clear targets based on the worker’s own goals and motivations, and helping them see measurable progress. 
• Addressing Resistance. MI is designed to work with, rather than against, a worker’s resistance. This means identifying and acknowledging their fears and concerns, taking steps to address them, rather than dismissing or challenging them.  

By incorporating these elements in our daily work, we can better support workers (and employers) in navigating the challenges of recovery and workplace reintegration. And, at the end of the day, we can go home knowing we had a positive impact on someone’s life and livelihood.     

The workers’ compensation and health care industries are partners in many ways – when medical and mental health services are well delivered, our customers, both workers and employers, benefit. So why not look to some important changes in the culture and practices of medical and mental/behavioral health professionals as we seek to continually improve the delivery of our services? For example, consider trauma-informed practices and motivational interviewing (the second being a topic for a future article here) and how they’re applicable to workers’ compensation. 

First, why do trauma-informed practices matter? According to the National Council for Mental Wellbeing, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. When someone is hurt on the job, the accident itself may be quite traumatic. So, chances are high that workers’ compensation claim managers and others are dealing with someone who is suffering from trauma.  

The National Council says “Trauma occurs when a person is overwhelmed by events or circumstances and responds with intense fear, horror, and helplessness…” If you’ve been in this industry for a while, you’ve dealt with helpless workers who seem ‘stuck’ in our system and processes and/or who have significant fears of returning to work. The resulting inertia, which may be a sign of trauma, is the enemy of work disability prevention.    

So what are “trauma-informed practices” or “trauma-informed organizations”? A simple outline available on the CDC website provides six guiding principles to a trauma-informed approach:  

• Safety 

• Trustworthiness and transparency 
• Peer support 
• Collaboration and mutuality 
• Empowerment voice and choice 
• Cultural, historical, and gender issues 

Consider how these guiding principles align with ways we should engage our worker customers so that their claim results in the best possible outcome for everyone (the worker, the employer, the claims professional, and the insurer). Whether we call the approach worker centric, whole person, claims advocacy or vocational recovery, the basic concepts are the same:  

• Build a relationship of mutual trust and respect (aligns with “trustworthiness and transparency”) 
• Include the worker’s perspective regarding decisions on their claim (aligns with “collaboration and mutuality”) 
• Recognize the value for the worker to have some locus of control (aligns with “empowerment and choice”)  

Does this apparent alignment with the guiding principles of trauma-informed practices mean we’re already there? Hardly. Being a trauma-informed industry that consistently applies these practices takes constant attention to ensure they become part of our culture. And it isn’t just about how we treat workers who are hurt on the job. For those who are employers in workers’ compensation, your staff need to experience the same sense of safety and support within the organization. Consider starting there. From you, your supervisors and managers, your staff can learn how to treat customers in a way that recognizes they are likely dealing with trauma. And you’ll benefit from improved employee morale, customer experience, and claim outcomes! 

I hope many of you had the opportunity to attend or listen to the recording of the recent webinar “Claims Advocacy: What It Is and What It Isn’t” offered through WorkCompCollege.com. (If not, you can access the recording here).  The time of the webinar conflicted with a meeting on my calendar – coincidentally, with other members of the Survey Council for the national Workers’ Compensation Benchmarking Study, a group that tirelessly supports the claim advocacy model.

Since I wasn’t able to attend, you all are lucky enough to get to read the comments I would have added to the great points in the webinar chat! 

Perhaps most importantly, at least to me, is that “claim advocacy” is not about claim professionals (please stop calling them/us adjusters!) advocating for workers. It’s about empowering workers to advocate for themselves. To continue moving toward their recovery and return-to-work goals by breaking the barriers for them that exist in workers’ compensation – complicated processes and rules, unnecessary delays, confusing pathways to return to work. It’s about listening to the worker to identify their concerns and fears and collaborating on steps they can take to work through them, even if the steps seem small. It’s about understanding that the worker is the one to ultimately make the decision to return to work – the employer can offer, the medical provider can approve, but the worker will decide. Claim advocacy is, in part, about making it easy for the worker to do so.

During the webinar, Licia Thompson with Macy’s said claims advocacy is about recognizing someone who is hurt on the job is a human first, who has rights. Well said, Licia! One of those rights is the locus of control. Or, as I recently saw this described, holding the keys to their fate. Claims advocacy should give the worker back their locus of control – something workers’ compensation regulations, policies, communications, often take away. 

Why is this so important? Because locus of control impacts an individual’s motivations and behaviors. 

To reinforce how important locus of control can be, I’m reminded of a study of those who have used Oregon’s Death With Dignity Act to obtain lethal medications. The study found that uncontrolled pain was rarely the reason given (although I think many of us assume that’s why someone would want to end their life). Rather, the three most common reasons related to quality of life, dignity, and autonomy. In fact, one-third of those who obtained the drugs didn’t actually use them – perhaps it was enough to know that they had regained some locus of control. Although not related to claims advocacy, during the webinar, Bob Wilson described claim managers (again, not adjusters!) as ‘redheaded stepchildren’ of the workers’ compensation industry. (It’s not uncommon for Bob to say something in a webinar that has little to do with the subject at hand, but those little surprises are why his webinars can be a treat to watch!) As someone who is both a redhead and a stepchild, I’m proud to say I’m a member of this elite group of professionals who have the opportunity to make a difference in people’s lives. But, as Bob would say, I digress….  

It seems the workers’ compensation and health care industries are always changing – what might be ahead as both clinical and non-clinical best practice research continue to evolve? There are some significant opportunities on the horizon to identify and mitigate psychosocial risk factors and social determinants of health – considerations unique to a worker that compound needless work disability. These issues are often misunderstood or lumped together as though they are the same. They’re not, but both can influence whether or when an injured worker chooses to return to work – the gold standard outcome for a workers’ compensation claim. 

In recent years, workers’ compensation insurers and employers have come to understand psychosocial issues that are most common to someone hurt on the job – fear and avoidance, catastrophic thinking, perceived injustice, and perceived disability – and have begun taking steps to address them. While more is needed, the historic fear among policyholders that acknowledging anything related to psychology will increase claim duration and costs has finally dissipated in many jurisdictions. In fact, many workers’ compensation payers are acknowledging and using certain “CPT” or billing codes that were developed by the American Psychological Association specifically to support the treatment of psychosocial issues without the need for a diagnosed psychiatric condition (and the labeling of a patient that comes with such a diagnosis). The CPT codes are used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies (including workers’ compensation regulators and insurers), and accreditation organizations. 

So, what’s next? The workers’ compensation industry is just beginning to talk about social determinants of health (SDOHs) that can influence an injured worker’s recovery and return to work. These differ from psychosocial factors that occur or develop ‘between the worker’s ears’. SDOHs are more external; for example, inadequate housing, food insecurities, the availability of community resources, neighborhood crime, lack of family support, and education. But they can also include the threat of job loss, discord with the employer, and issues that can trigger or magnify psychosocial risk factors (catastrophic thinking or fear and avoidance, for example).   

The more recent International Statistical Classification of Diseases and Related Health Problems (ICD) codes now include “Z” codes that allow medical professionals to flag SDOHs. ICD codes differ from CPT codes: the first identifies a problem that treatment or interventions should aim to resolve while the second refers to the treatment being given. Although Z codes are still rarely used, workers’ compensation industry leaders and technology solutions should prepare for future policy decisions that may include the need to accommodate these codes, related advancements, and ultimately design evidence-based system interventions. For example, there is already a website called Neighborhood Atlas that uses zip codes to create awareness of whether an injured worker’s address is in a disadvantaged neighborhood. Understanding this can allow a claim manager or other professional to have a more holistic picture of the worker’s environment and issues that can impact their individual resiliency, recovery, and decisions regarding return-to-work opportunities. In the future, workers’ compensation carriers may be using zip codes to flag a claim as at-risk for SDOHs, weak labor markets, or other factors needing early intervention to prevent work disability and the needless human harm and financial costs associated with it. 

In a prior article, I wrote about “The Difference Between Workers’ Compensation and Workers’ Recovery ” and I said that words matter. They do, but as we consider what’s ultimately important, let’s not overthink it.

“Workers’ compensation” or “workers’ recovery?”  To help answer this continuing question, perhaps we should first consider the history of our industry and where the term “workers’ compensation” likely started.  Workers’ comp laws replaced cumbersome, expensive and litigious tort systems as the means of compensating those seriously hurt at work.  So the name “workman or workers’ compensation” made sense at the time.  But, as I said before, many of us recognize that our industry needs to rebrand itself. We need to change the narrative so consumers of our services believe that we share their goal of returning workers and employers to productive lives and livelihoods after an injury.  But a “narrative” is just words – it is actions and behaviors that matter. How we engage workers and employers is where we can be guilty of overthinking the impact of words.

Take the concept of a “workers’ recovery professional” certification: the name is a significant shift from the longstanding job titles of those who handle worker claims.  They (we) are often called claim managers or claim specialists or, heaven forbid, claim adjusters (a job title that I think is a discredit to our work).  As we wring our hands over the recruitment crisis in our industry, have we considered whether young workers who want careers in human-centered work will aspire to be a claim adjuster?  Or will their passion for helping others be better triggered by the idea of being a workers’ recovery professional?  In either case, a professional title doesn’t mean a lot unless those who hold the certification actually support workers through their healing to an ultimate recovery and return-to-work outcome whenever possible.

Then there’s the debate about whether a more empathetic, customer-centric service model should be labeled worker recovery, claim advocacy, return to work, worker-centric, or something else.  But does it really matter?  The point of any of these terms is to message that the industry intends to and is changing.  That we are paying attention to current evidence and implementing best practices.  That we are engaging and activating workers and employers.  Again, that we reinforce work as part of the recovery process.

Ultimately, when a worker is hurt on the job and needs our support, our coaching, our active listening, their behavior and outcomes won’t be influenced by the job title we hold.  They won’t focus only on recovery simply because the person they talk with is called a “worker recovery specialist” rather than a “return-to-work professional”.  What will matter is whether they trust us, whether we partner with them and their employer, whether we work to eliminate confusion and fears, follow through with our commitments, avoid unnecessary delays, and address their needs to the best of our ability.  

No more rhetoric.  Actions will always speak louder than words.

An excerpt from “Curing” Work Disability….an “Expert’s View” article published on July 29, 2021 on WorkersCompensation.com

“Work Disability”….a new term to you? A term you’ve just recently heard used? Or a condition that you’re a subject matter expert in?

If you have a role – any role – in a workers’ compensation system, you should be striving for the latter. Understanding work disability, what it is and how to prevent it, is critical to claims and medical management, and to identifying appropriate non-clinical interventions to improve return-to-work outcomes.

Why are you just hearing about “work disability”? Those of us who’ve worked with people injured on the job have known work disability, but the condition wasn’t really named until 2013. How many relatively minor injuries have you seen that became long-term, complex cases? How often do we hear that medical interventions and surgeries in workers’ compensation result in longer duration and more permanent disability than the outcomes for non-work injury cases? What’s the cause? Poor medical treatment specific to workers’ comp? That’s silly. Doctors don’t perform better or worse, depending on which systems or insurers are involved.

The problem is “work disability,” as described by Loisel and Anema in the 2013 Handbook of Work Disability Prevention and Management: occurs “when a worker is unable to stay at work or return to work because of an injury or disease. Work disability is the result of a decision by a worker who for potential physical, psychological, social, administrative, or cultural reasons does not return to work. While the worker may want to return to work, he or she feels incapable of returning to normal working life. Therefore, after the triggering accident or disease has activate a work absence, various determinants can influence some workers to remain temporarily out of the workplace, while others return, and others may finally not return to work at all.”

We’ve all heard leaders from within workers’ compensation advocate that our industry should be re-labeled to appropriately address the outcome for anyone hurt on the job: recovery, not compensation. And, while words matter, it’s more than that. Workers’ recovery is about recognizing that return to work is part of the recovery process and, therefore, an important goal of an ideal system. It’s about eliminating delays and complexities of our systems, making it easier for workers to choose to return to work, for employers to offer return to work, and for medical providers to both approve and support return to work.

But it’s even more than that…

I recall a quote from another workers’ comp expert who said, “at industry conferences, seminars, and webinars during the last few years, there has been increasing talk about a more compassionate, worker-centric approach for treating injured workers, but there seems to be little movement.” I disagree. The statement fails to acknowledge those who have or are doing it, even if in the minority. 

Although many insurers and systems don’t yet understand what it means to be “worker-centric” or “customer-centric” (employers have important roles here, too), there are those that have successfully implemented such a model. For example, despite the challenges unique to an exclusive State Fund, we did it in Washington State, and the Saskatchewan Workers’ Compensation Board is currently working toward a culture of work disability prevention and mitigation – including a worker- or customer-centric approach. I would argue that this shift may be even easier for private insurers and third-party administrators who can decide who their customers may be, along with individual employers who have control of their work environments.  

“Worker-centric” recognizes that the easiest path to return to work is by engaging the worker who ultimately chooses to return to work. We all want control of our lives, yet many workers’ comp systems try to force return to work on the worker, rather than collaborating with them, and ultimately with their employer and medical provider, to achieve return to work. Using motivational interviewing techniques, identifying the worker’s goals and barriers, and nudging them through goal setting and goal attainment is the most efficient and effective path to return to work. This is to the benefit of everyone involved: workers, employers, systems, families, and communities.

After more than 50 years in workers’ comp, I’ve become a true believer that a worker-centric model to prevent and mitigate work disability is just what this industry needs to rebrand itself and “change the narrative” as many would say. If the system is truly about “recovery” not “compensation” then the easiest path is through the worker. We will all be better for it.

By Vickie Kennedy

For those of you who don’t know me, you’re probably asking yourself how “Missives from the Queen” have anything to do with workers’ compensation? While the catchy title may have gotten your attention (as hoped!), there really is more to it than that.

As history, when I was in my early teens, I learned that I share my birthday with Queen Victoria. Interestingly, the family story (perhaps a myth) is that my mother had no idea of this when she landed on the name. Either way, lucky for me that she prevailed in the naming…another story is that my father wanted to name me after a state…Oklahoma, I believe. The potential nicknames for that one are endless…but, as Bob Wilson would say, I digress…!

Over time, the nickname “Queen” started to stick, perhaps because I started my workers’ compensation journey at the age of 18 (Queen Victoria was crowned at 18).  Or maybe because we share certain characteristics. The Queen has been described as “warm-hearted, lively, and occasionally a bit naughty”. I think at least one of those might describe me…

But the reference to “Queen” is more likely a polite reaction to the years I’ve committed to this industry. While referring to me as “Queen Victoria” started around the time I completed my 30^th year, perhaps I finally earned the title when I achieved (survived?) more than 50 years of hard knocks, lessons learned, and a few successes in helping workers and employers achieve the best possible outcomes after an on-the-job injury or occupational disease. Having recently retired from my work in the Washington State system, my career goal now is to coach and advise others on ways to ensure the culture of their organization supports workers’ health and vocational recovery, hopefully exiting their system with the gold standard outcome: return to work.

I hope you read my missives with this perspective in mind: how can you use lessons and messages from my 50 years to better focus your work, your policies, and tasks on supporting workers to make the decision to return to work, employers to offer return to work, and medical providers to approve the return to work? And consider this quote from (the original) Queen Victoria: “We will not have failure – only success and new learning”!