I’m writing today out of frustration.

Frustration over the lack of compassion. The lack of creative problem-solving. And, perhaps most frustrating, the lack of willingness to think beyond a script or a set of predetermined answers.

My frustration stems from helping care for my mom following a stroke. My sister and I have navigated some frightening moments, celebrated Mom’s recovery, and learned to adapt to her ongoing needs. There is so much to be thankful for, but the journey has also opened my eyes to just how difficult everyday tasks can become when life changes in an instant.

Mom is 85. She’s fun-loving, strong-willed, and resilient. She’s also living with limitations that make some things we take for granted much more difficult. Technology isn’t her strong suit. She doesn’t even have an email address, and using a cell phone is challenging, particularly when she has only one fully functional hand.

So, imagine spending more than 3.5 hours on the phone with her supplemental insurance company trying to resolve an issue. Imagine making repeated calls because the company specifically instructed you to call back the following week. Then imagine being told you’re calling repeatedly because you’re fishing for a different answer.

That was my experience.

I requested the opportunity to speak with a leader who could help evaluate the situation, or better yet, the person who had written the letter offering the instructions I was attempting to follow. My request was denied, and eventually, the call was disconnected.

I did my best to remain calm, keep my tone warm, and approach the situation constructively. Yet we remained trapped in a cycle of scripted responses and rigid processes, with no apparent path to someone empowered to consider the circumstances and help find a solution.

I’ll leave the specifics of the dispute between us. The details aren’t the point. The experience is.

When did we become so focused on following the process that we forgot to serve the person?

We live in a world increasingly driven by technology, automated decision trees, standardized responses, and efficiency metrics. Those tools have their place. But they should support good customer service, not become barriers to it.

A script cannot replace judgment. A decision tree cannot account for every circumstance. And a frontline employee should not be left without a path to escalate a situation that requires thoughtful consideration.

Sometimes, the answer isn’t immediately obvious. Sometimes, the solution requires asking another question, involving someone with greater authority, or simply taking the time to understand what the person on the other end of the phone is actually experiencing.

That isn’t asking for special treatment. That’s asking for customer service with compassion, patience, and empathy.

Throughout my career, I’ve seen firsthand how much the way we treat people matters. An injured worker navigating a claim may be dealing with pain, uncertainty, financial stress, family responsibilities, and a future that suddenly looks very different. The last thing that person needs is to feel like another number in a system that has no room for their circumstances.

We talk about compliance, efficiency, processes, and outcomes. We invest in technology and develop procedures to ensure consistency. We should absolutely do those things.

But we cannot allow the process to become more important than the person it was designed to serve. Experiencing that lack of compassion and advocacy during my lengthy phone call was frustrating enough. But having spent years working to instill those very values in the team I led, experiencing their absence firsthand made it all the more frustrating.

My post-retirement goal has been to influence positive change in an industry of which I care deeply. That means continuing to challenge ourselves to do better, even when the conversation is uncomfortable.

Here’s my plea, whether you work in workers’ compensation or any industry that serves people:

• Lead with empathy. You rarely know the full story of the person on the other end of the phone or counter.
• Listen to understand, not just to respond. The answer may be hidden in the details your script doesn’t ask about.
• Empower your people. Give employees the training, judgment, authority, and escalation pathways they need to resolve problems.
• Think beyond the checklist. Consistency matters, but so does recognizing when a situation requires a different approach.
• Treat every interaction as an opportunity to help. Even when you cannot give someone the answer they want, you can still treat them with dignity, explain their options, and help them understand the next step.

We may not always be able to say yes. We may not always be able to change an outcome. But we can choose how we treat people along the way.

My mom and I felt backed into a corner, with no clear path forward and no one willing to help us find one.

We can do better than that.

Listen with compassion, not judgment. Think beyond the script. And never forget that behind every call, every claim, and every customer service interaction is a human being who deserves to be heard.

That’s the kind of service our industry needs. And it’s the kind of service we should all expect from ourselves.

What one young Gen Z leader made me think about the future of workers’ compensation.

One of the things I took away from ELEVATE came from a place I didn’t expect. It wasn’t something said by one of the industry’s most experienced leaders. It came from the youngest person on the panel during the session “Confronting the Talent Cliff in Workers’ Compensation and Insurance.”

Her name is Kaylee Bamfield. Kaylee is a college student from Colorado, an accomplished student-athlete and emerging leader who has already been recognized for both academic excellence and leadership. She has a passion for service, personal growth and developing the next generation of leaders. She was on that stage not simply as a representative of Gen Z, but as a young person who is already thinking seriously about the kind of leader she wants to become and the kind of world she wants to help create.

That made me listen differently.

Because Kaylee wasn’t asking us how to make young people fit into the insurance industry we have built. She was asking questions that made me wonder whether we are giving her generation enough opportunity to help shape the industry they are going to inherit.

We talk a lot about the “talent cliff” in workers’ compensation and insurance. We talk about an aging workforce, the number of experienced professionals who will retire, and the enormous amount of knowledge that could leave with them.

Those are very real concerns.

But as I listened to Kaylee talk about entering this industry, I found myself wondering if we’re looking at the problem from the wrong direction.

We keep asking how to get the next generation into our industry? Maybe we should also consider what we willing to let the next generation change about it because that distinction matters.

Kaylee talked about initially seeing insurance as boring. She had grown up around the industry and still didn’t really understand what her father did or the possibilities that existed within insurance.

During the session she asked questions about career paths, mentorship, development and whether an employer was genuinely investing in her or simply trying to fill an open position.

Those questions struck me because they weren’t really questions about a job, but they were questions about belonging.

Is there a place for me here? Can I grow here? Will you invest in me? Will you listen to me? And will there be room for me to become something different than the people who came before me?

That last question may be the one we don’t ask often enough.

My generation has spent decades building careers in this industry. We have systems, processes, traditions and ways of doing things that were shaped by the circumstances of our time. Many of those things exist for very good reasons. And we have an enormous responsibility to pass along what we have learned.

Passing along knowledge doesn’t have to mean passing along everything exactly as we found it. There is a difference between giving someone a foundation and giving them a blueprint they are expected to follow.

I think the next generation deserves the foundation, but they should have a hand in drawing the blueprint. That means we must be willing to let them influence the space they are entering.

They may communicate differently than we do. They may think differently about flexibility, technology, hierarchy and career progression. They may question processes that we’ve accepted for years. Those questions and the uncomfortableness that comes with them also make the system stronger.

Our willingness to explore their perspective doesn’t mean we abandon everything we’ve learned. Quite the opposite. Experience still matters. Institutional knowledge matters. The lessons earned through decades of dealing with difficult claims, injured workers, employers, regulations, relationships and changing markets matter enormously.

But that experience, again, should be a foundation, not a fence.

Perhaps our role as the more experienced generation is to open the door, share what we know, explain why things became the way they are, and then step back enough to let the next generation decide what still belongs in the room.

I was especially struck by the conversation about mentorship.

Mentorship shouldn’t simply be about teaching younger professionals how to do things the way we did them. It can be a two-way exchange.

We teach judgment, context, history and the lessons that aren’t found in a manual. The new generation teaches us what the future looks like from where they are standing.

That is a pretty powerful exchange when we’re willing to listen, and perhaps that is one of the opportunities hidden inside the talent cliff.

Yes, we need to recruit. Yes, we need to retain experienced professionals and transfer institutional knowledge. Yes, we need to make insurance a more visible and attractive career choice, but we also need to make room for new ideas, different approaches, questions, and technology. We need to allow existence for a successful career to be redefined, and perhaps most importantly, room for the next generation to leave its fingerprints on an industry that they will eventually lead.

As I watch a new generation step into this industry, I don’t think our responsibility is simply to make them fit into the world we built. Our responsibility is to give them the knowledge, relationships and confidence to build something we couldn’t yet see.

I felt the calling to return the blog to my horses.  So, for this week, nostalgia wins!

My horse trainer and I have spent countless hours since Lattie passed in April pounding the pavement in search of Harry Trotter’s next best friend. I use “best friend” a little tongue-in-cheek because Lattie was never particularly fond of Harry. Harry, for his part, was perfectly willing to be friends. Their relationship was, at best, a one-sided friendship that Lattie reluctantly tolerated.

What I’m learning through the shopping adventure is that finding the right horse is a long, arduous process. I could have another horse in our pasture tomorrow. It wouldn’t necessarily take a lot of effort, and it certainly wouldn’t have to cost an arm and a leg. What keeps me from taking the easy route is knowing that you get what you put into it. And when you’re talking about a 1,000-pound animal with a mind of its own, taking shortcuts can be extremely dangerous for everyone involved.

You might be asking yourself what this has to do with workers’ compensation or leadership. My response is: everything.

The more time I spend looking for Harry’s next pasture mate, the more I realize how remarkably similar this process is to finding the right employee.

Just as with a job description, I had to define what I’m looking for. What characteristics does the horse need to have? What physical capacity does he need? What experience is important? And what are the things that are non-negotiable?

Then the real search begins. Ads are posted, responses come in, and videos are scrutinized for everything from movement and training to behavior and soundness. If a prospect makes it through that first round, we hit the road to meet him in person. We watch him under saddle, looking for signs of lameness, how he moves, whether he is soft and responsive, how he handles himself and, yes, whether he has good manners. If all of that looks promising and we feel safe, we may climb aboard ourselves. And when we think we may have found the right match, there is still one more box to check: the pre-purchase veterinary exam. It is our version of a background check before making the final commitment.

Think about how much goes into that decision. We are considering the horse’s physical ability, experience, temperament, history and behavior. But there is another consideration that may be just as important: how will this horse fit into the herd that is already there?

It isn’t enough for me to like the horse. A chosen horse has to be right for me AND Harry. A horse can be beautiful, well-trained, experienced and physically sound and still not be the right horse for us.

That realization made me think about how we approach people in the workplace.

With a horse, we readily recognize the associated physical danger. If we choose poorly, someone could literally get hurt. The risk is obvious, so we tend to take the time to evaluate it carefully. We don’t skip the vet check because we’re excited about a particular horse. We don’t overlook concerning behavior because he’s pretty or because we’ve already spent a lot of time looking. We don’t say, “Well, he’s available, and we need another horse, so let’s just make it work.”

Yet bringing the wrong person onto a team can be just as consequential, even if the impact isn’t as immediate or visible. An under-qualified employee or someone who is simply a poor fit can contribute to turnover, conflict, poor communication, low morale and lost productivity. Managers may spend enormous amounts of time compensating for the situation, while other employees absorb the additional workload and the effects on trust and culture. Eventually, good employees may decide the best solution is to leave.

A horse may hurt you in an instant. A poor fit on a team can take months or even years for the full impact to become visible.

And that brings me back to the herd.

When we’re evaluating a horse, we don’t just ask, “Do I like this horse?” We also ask, “How will this horse fit with the horses already in my pasture?” Every herd has its own personalities, boundaries and relationships. Adding a new horse changes that dynamic, even when the newcomer is perfectly capable and well-trained.

Teams are no different.

We spend a lot of time talking about workplace culture, but how much attention do we give that culture when there is a vacant desk and work that needs to be done? The pressure to fill the position can be tremendous. Someone looks good on paper, has the right experience and can start Monday. Suddenly, the empty chair is no longer empty.

But filling the chair and finding the right person aren’t necessarily the same thing.

I’m not suggesting we spend six months interviewing every candidate for an open position. I’m suggesting that we pause long enough to consider the whole picture. Are we simply filling a vacancy, or are we choosing someone who will strengthen the team that is already there?

After all, I’m willing to spend considerable time making sure the next horse in our pasture is safe, sound, level-headed and a good fit for Harry. Maybe we should bring some of that same thoughtfulness to the people we invite into our teams.

My career has been blessed with some wonderful mentors who shared lessons I’m grateful to pay forward. One of the unexpected gifts of my horsemanship journey has been discovering many of those same leadership lessons from a completely different, yet remarkably applicable, perspective.

Lattie taught me when to hold on and when to let go.

Harry Trotter may be teaching me patience, composure, and perseverance.

One of the sessions I attended at the WCI Conference in Orlando was a Workers’ Compensation 101 panel featuring Judge Melissa Jones, Stuart Colburn, Mark Pew and Bob Wilson. The session covered a lot of ground, beginning with the history of workers’ compensation and eventually landing on a question that I think is worth asking ourselves today: Have we become so busy working within the system that we sometimes lose sight of what the system was designed to accomplish?

The history was fascinating. We learned that the idea of compensating workers for workplace injuries goes back much further than most of us probably realize. The panel took us from ancient injury schedules to pirates, the Industrial Revolution, and the devastating Triangle Shirtwaist Factory fire on March 25, 1911 that was the impetus for the development of workers’ compensation in the United States.

But the history wasn’t really the point.

The point was that workers’ compensation evolved because there was a need to find a better way to take care of injured workers while also protecting employers from the uncertainty of civil litigation. That balance became what we know as the Grand Bargain.

Over the years, however, we have built a very complicated industry around that original bargain.

As the panel pointed out during the session, the people in 1911 could never have imagined a conference like WCI, with thousands of people, hundreds of exhibitors and representatives from across the country coming together to talk about workers’ compensation.

And that complexity can create a problem of its own.

The session included a football analogy that I thought was particularly effective. The claims professional is the quarterback, coordinating all the different players (the attorneys, the providers, the case managers, etc.) making sure the right person is involved at the right time. Everyone has a role, but sometimes we lose sight of the bigger picture. We forget how all of those roles fit together, and we fail to respect the consequences if someone drops the ball.

So, what’s the play? The play isn’t simply to close the claim. The play is to help the injured worker recover.

And that led to one of the most important points of the presentation for me.

The goal isn’t simply to return to work; the goal is to return to life. 

Of course, returning to work is important. But an injured worker also wants to get back to their family, their community, their activities and the things that make their life their own. The panel made the point that if we focus on returning someone to function, returning to work becomes part of that recovery.  The distinction is subtle but screams loudly of importance.

The presentation also brought communication into the conversation. They discussed the importance of meaningful first contact with an injured worker within 24 hours, not simply leaving a voicemail to complete the task. They also emphasized how the employer’s response in those first few minutes after an injury can set the tone for everything that follows.

That makes sense when you put yourself in the injured worker’s position.  Step into your imagination with me.  

You have been hurt at work. You don’t know what happens next. You may be worried about your health, your paycheck and your family. Then someone from an insurance company or third-party administrator calls, and you don’t know who they are or whether they are calling to help you or challenge you.

An adjuster’s communication in that moment isn’t just a claims function.  That action is a vital component of the recovery process and leaves a first impression.  When the conversation ends, my hope is that the adjuster is beaming with pride for a job well done.

The panel also talked about the role of family members and the impact an injury can have beyond the person who was hurt. That was another good reminder that we aren’t really dealing with a claim. We are dealing with a person whose life, and often whose family’s life, has been disrupted.

I respect how easy it is to get caught up in the mechanics of the workers’ compensation process.  There will always be another claim to manage, another regulation to interpret, another medical issue to address and another deadline to meet.

But occasionally, we need to step back and look at the whole field, read the defense, identify the barriers, and call the correct play.

Why are we here? What are we trying to accomplish? And are all the pieces of our complicated system working to help the injured worker get back to life while providing the employer with the protection of the Grand Bargain?

We may have built a much bigger and more complicated system around that idea, but perhaps we shouldn’t let the complexity obscure the purpose.

That was my biggest takeaway from the session.

I have been in workers’ compensation for more than 30 years, and somehow, this year was the first time I attended WCI.

I’m still asking myself, what took me so long?

Before heading to Orlando, I knew WCI was a big conference. I had heard about the thousands of attendees, the hundreds of educational sessions and the enormous exhibit hall, but I don’t think you can really appreciate the magnitude of it until you walk through the doors. There were so many people to see and so many sessions to choose from that, at first, I wasn’t quite sure how I was going to navigate it all.

As it turned out, I didn’t need to worry about it nearly as much as I thought I would.

One of the things that surprised me most was how quickly a conference of that size began to feel familiar. I knew quite a few people already, and everywhere I turned, I seemed to run into another familiar face. With Mark Pew and Bob Wilson by my side, I met a lot of people I had never crossed paths with before, and those conversations quickly turned into connections and, in some cases, new friendships.

WCI is certainly a large conference, but the workers’ compensation community is still surprisingly small. You can walk into a room with thousands of people and discover that you know someone, have mutual friends with the person sitting beside you or have worked with someone in the room at some point over the last 30 years. It didn’t take long for me to realize that the people were going to be every bit as important as the sessions.

That realization probably shouldn’t have surprised me. After all, relationships have always been one of the things I value most about this industry. We may work for different companies, represent different sides of a claim or have very different perspectives on how the system should work, but there is a shared connection that comes from spending years in workers’ compensation.

At WCI, I saw that connection everywhere.

I also found myself thinking about how much this industry has changed during the 30-plus years I’ve been part of it. Technology has changed. The way we communicate has changed. The complexity of the system has certainly changed. And yet, the importance of people and relationships remains.

If anything, a conference like WCI reinforces how important they are.

There is something pretty special about being surrounded by people who understand the strange language we speak every day. You can start a conversation with someone you’ve never met, mention a workers’ compensation issue that would make most people’s eyes glaze over, and suddenly you’re solving our world’s problems. You don’t have to explain why it matters because they already understand.

I went to WCI thinking I would come home with new ideas and information, and I certainly did. But I also came home with new relationships, look forward to continued conversations , and a renewed appreciation for the people who make up this industry.

After returning home, I kept coming back to the same question: Why did it take me more than 30 years to attend this conference?

I still don’t have a particularly good answer, but I feel the need to hang my head in shame over my faux pas.

I came to WCI expecting to be overwhelmed by the size of the conference, and I was. What I didn’t expect was how quickly that feeling would be replaced by a sense of connection. I was reminded just how much knowledge and experience exists within this industry, but I was equally reminded that the real value of a conference like WCI isn’t just what you learn in a session. It’s the people you meet, the conversations, the old friends you reconnect with and the new relationships you begin.

After 30 years in this industry, I thought I had a pretty good understanding of the workers’ compensation community. My first WCI reminded me that there is always more to learn, more people to meet and more stories to hear.

I’m already looking forward to going back.

And next time, I’ll have a much better idea of where I’m going and plan enough time for the ad hoc conversation on the way there.

After my last two blogs, Adjusters Are People, Too and AI Should Give Me Time, Not More Claims, I felt the need to address this from the carrier’s and third-party administrator’s perspective, too.  My experience running the workers’ compensation program for The University of Texas System (UT System), who was defined by law as the insurance carrier for the institutions within the system, taught me the carrier perspective.  I understand the hurdles faced but have also reaped the benefits inserted advocacy into a program can deliver as described in the Transforming Workers’ Compensation through Claim Advocacy: A Case Study of The University of Texas System white paper I wrote.

Let’s be honest. Insurance carriers and third-party administrators are businesses. They have shareholders, owners, employees, operating expenses, performance expectations and, yes, a responsibility to make money. They are expected to do more with less. They are expected to manage claims efficiently, control costs, maintain appropriate reserves, meet regulatory requirements and deliver results. I respect that UT System’s program was slightly different. Our goal wasn’t to make a profit, but we were also trying to lower costs to reduce rates charged to our institutions to run the program. That commonality existed with us, too.

To me, profit and compassion aren’t mutually exclusive. I would argue they are intrinsically connected.

What If We Stop Looking at Advocacy as an Expense?

I see the advocacy traints differently. I see them as risk management tools that mitigate the loss of time, unnecessary expenses, and protect reputational risks.

Think about what happens when an injured worker doesn’t understand the process. They become frustrated, call repeatedly, and may begin to distrust the employer, the carrier or the adjuster.

Communication breaks down, a dispute develops, an attorney gets involved, and the claims process becomes more complicated. The injured worker may lose confidence in the system, while the carrier potentially spends more money and more time managing a claim that might have been resolved differently with better communication at the onset.

The Grand Bargain

Let’s reflect on our history. Workers’ compensation was built on a fundamental tradeoff, referred to as the Grand Bargain. Injured workers gave up the right to pursue most workplace injuries through traditional litigation in exchange for a system designed to provide timely, predictable benefits without having to prove fault. Employers, in turn, received greater certainty and protection from potentially costly lawsuits.

Over time, layers of complexity, delays, and distrust have pulled us further away from that original purpose. When communication breaks down and disputes become the norm, the Grand Bargain starts to feel less like a system built around recovery and more like a system built around defending positions.

Maybe it’s time to clear some of that fog. My aspiration is to have advocacy return us to the original intent of the Grand Bargain.

The Cheapest Claim Is Not Always the One You Deny

Saying “no” is not always the best financial decision an adjuster can make. At the onset, a denied claim, through smoke and mirrors, looks cost effective.  Unfortunately, that nasty tail can slap you across the face with reality when the denial is overturned after countless hours defending your case.  The result is increased attorney fees and lump sum payments due with interest and countless hours wasted.  Hours that should have been given to the injured employees quietly suffering in an endless maze of confusion.

Imagine having the time to understand why the claim is becoming difficult. Time to explain why an injured employee’s treatment was denied or what happens next. Time to recognize the injured employee is worried about losing their job and experiencing financial problems that are ultimately impacting successful recovery.

I’ve come to understand the workers’ compensation law roadmaps the minimum requirements to be delivered. The law and rules don’t prevent a carrier or any system participant from offering resources beyond those minimums. 

Look Beyond the Workers’ Compensation Check

One of the most effective lessons from my experience with the UT System was learning to look at the resources that already existed outside the workers’ compensation program. For the benefit of the employees we supported and the institutions we served as employers, our team learned to capitalize on the employee assistance (EAPs) and return-to-work programs, modified-duty opportunities, outplacement services, and medical resources available.

Let me give you a real-life example. At UT System, we didn’t just talk about return-to-work. We developed a way to quantify the financial value of the modified-duty accommodations. The metrics allowed us to report to executives that accommodating light-duty restrictions avoided $2 million in wage-replacement benefits that would have otherwise been due. Those opportunities also maintained the relationship with the injured employee’s work family as they recovered.

Many employers and communities have similar resources that don’t necessarily cost the workers’ compensation program more money but help bring solutions and remove barriers to recovery that build profit by eliminating unnecessary expenses.

This philosophy is not simply compassion, it’s cost containment.

Communication Has a Price Tag, Too

We often measure the cost of adding something to a claim.  Maybe we should also measure the cost of not doing something early enough.

A phone call isn’t an expense. A phone call can also be an investment. A conversation before a denial isn’t an unnecessary courtesy. It can be an opportunity to explain, listen and prevent a misunderstanding from becoming a dispute.

The numbers from the UT System experience are compelling. After adopting a formal claim advocacy philosophy in 2015, claim counts and costs continued to decline even as the covered workforce grew significantly.

When I retired in 2024, our fully retained workers’ compensation program covered over 145K employees. The program’s overall average rate ultimately dropped from $0.80 per $100 of payroll in 1993 to $0.085 in 2024, an 89% reduction.

I’m not suggesting that advocacy alone produced every one of those results. The program evolved over decades, and there were multiple strategies involved. But the data certainly challenges the assumption that human-centered claims management and financial performance are opposing goals.

Here’s my final thought for you. Let’s not just ask “How much is this going to cost?” Let’s also consider, “How much is it costing us when we don’t act?”

What does one avoidable dispute cost? What’s the cost of an unnecessary attorney, one delayed return to work, one claim that continues to linger because no one had the time to pick up the phone and understand what was really happening? We have become very good at measuring the cost of benefits, but let’s also find a way to measure the cost of barriers, poor communication and missed opportunities to help someone recover.

Sometimes the most expensive claim isn’t the one where we paid too much. It’s the one where we did too little, too late.

Part 2: What Happens When Technology Gives the Adjuster Time Back?

Last week, I introduced you to Sarah. Sarah is completely fictitious, but the workload isn’t.

Sarah represents the adjusters sitting behind desks all over the country, trying to balance claim inventories, deadlines, medical records, phone calls, emails, metrics and an injured person who needs more than a claim number.

At the end of Part 1, we left Sarah with a question: What happens if technology can give her some of that time back?

That’s where artificial intelligence enters the conversation.  Let’s get back to my imaginary friend, Sarah.

AI Should Give Me Time, Not More Claims

I’m not afraid of AI. I’m actually pretty excited about it.

If AI can help me summarize a stack of medical records, identify missing information, organize my workload, draft routine correspondence, flag inconsistencies or help me find something buried in a file, that’s valuable. Every minute I don’t spend digging through information is a minute I could potentially spend talking to someone.

But here’s where I think we need to be careful.

AI should not become an excuse to give me twice as many claims.

If technology saves me two hours a day and the response is: “Great! Now you can handle 50 more files.” We’ve missed the point, a point with very real consequences.

The goal shouldn’t be to turn adjusters into claim-processing machines. The goal should be to give those two hours back to the adjuster.

Give me time to make the phone call. Give me time to listen, time to explain, time to recognize that the person on the other end of the phone isn’t just an injured shoulder, a back strain or a knee injury.  Give me time to understand the person behind all that.  The person hurting. The person I sincerely want to help.

What If AI Actually Made Claims More Human?

That may sound counterintuitive.

We often talk about technology making things less personal, but what if we use it differently?

What if AI handles some of the administrative work that consumes an adjuster’s day, while the adjuster uses that time for the work technology can’t replace?

Technology can’t successfully replace a heartfelt conversation with an injured worker or a call to an employer.  AI can’t thoughtfully review what’s happening in the life of the person behind the claim to decipher why treatment isn’t progressing.

AI can process information. It can organize, summarize, and identify patterns. It can help us find the needle in the haystack, but it doesn’t replace the human judgment required to understand why the needle matters.

And that’s an important distinction.

The Diagnosis Isn’t the Whole Story

As discussed in Part 1, I’ve seen claims that looked simple become complicated. I’ve also seen complicated claims resolve beautifully because someone took the time to understand what was really happening.

I’ve seen two people with the same injury have completely different barriers to recovery. One may be worried about money and how to support a family depending on them while another is terrified of getting hurt again and simply needs to understand what happens next.

The diagnosis might be the same, but the person isn’t.

AI may be able to tell me that two injured workers have similar diagnoses.  AI may even help me identify patterns in their claims, but it can’t make the decision that one person needs reassurance, another needs a return-to-work conversation, and a third needs someone to slow down and explain what’s happening.

That’s still our job, and honestly, I think that’s the part of the job we should want to protect.

The Risk of Making Efficiency the Finish Line

We love efficiency, and we should. There is tremendous value in eliminating unnecessary work, reducing duplication, finding information faster and making the claims process more efficient. But efficiency is a tool, not a destination.

If we use every technological advancement to simply increase productivity, increase inventory and close more files, we may create a very efficient system that still doesn’t produce better recovery and better outcomes.

We need to ask a different question.

What could an adjuster accomplish if we gave them back the time we’re currently asking them to spend on administrative work?

That question changes everything.

Maybe the adjuster could make the phone call they didn’t have time to make. Maybe they could identify a barrier to an earlier recovery which ultimately saves claim costs. Maybe they could communicate more effectively with the employer to brainstorm unique solutions specific to an individual claim.

Maybe an adjuster could recognize that an injured worker isn’t being difficult, they’re simply scared, frustrated, and shutdown due to mistrust.  Mistrust that could be resolved with a sincere, unscripted conversation.

Understanding those whys can change a claim.

Maybe the Future Adjuster Isn’t Less Human

Maybe the future adjuster is actually more human.

Imagine an adjuster who has technology working alongside them. An adjuster who doesn’t spend hours searching for information that could be surfaced in seconds.

Imagine an adjuster who has help with competing priorities. An adjuster who can spend less time documenting every mundane yet important administrative step and more time thinking about the claim.

Imagine an adjuster who has the training to recognize what matters, and the time to act on it. The vision in my mind brings a smile to my face, but there’s one more piece to the perfect puzzle.

Technology or AI alone won’t fix an overloaded claims environment.  Training alone is not the answer, nor is just a reduced claim load.   

The answer is all three together.

Train adjusters well. Give them reasonable claim loads and use technology to eliminate administrative burdens rather than eliminate the human connection.

So, What Do We Do With the Time?

That’s the million-dollar question, right? If AI gives an adjuster two hours back every day, what should we do with those two hours?

I hope the answer isn’t: “Give the adjuster more claims.”

I hope the answer is more along the lines of: “Give the adjuster the opportunity to do the job they were hired to do.” 

Because the ultimate goal of workers’ compensation isn’t just to move claims through a system as efficiently as possible, it’s to help injured people recover and return to healthy, productive lives.

The beauty of it all is that technology can help us get there, but we have to recognize that  technology isn’t the recovery model.

People are.

I’m Sarah. I’m still fictitious, but maybe now you recognize others out there like me.

The adjuster who is trying to do the right thing while staring at a screen full of numbers, notifications and deadlines.

Maybe the best thing we can give her isn’t another metric, but more time.  Time to think, listen, and care.  Time to recover the human side of workers’ compensation.

Remember, every claim tells a story, and every story deserves enough time to be heard.

National Workers’ Comp Adjuster Day was August 17. Maybe today is a good day to remember that behind every claim is an adjuster who is a person, too.

Part 1: The Person Behind the Claim

An entirely fictitious story. The workload, however, may feel painfully familiar.

My name is Sarah.

I’m a workers’ compensation adjuster. Well, at least that’s what my business card says.

I was hired because someone told me I was organized, good with people and could learn quickly. Apparently, that was enough.

On my first day, I was handed a computer, a password, a stack of files and a brief explanation of where to find the coffee.

Then someone said, “Don’t worry. You’ll get the hang of it.”

I’m still getting the hang of it.

I have more claims than I can reasonably remember. More emails than I can read. More phone calls than I can return. More forms, deadlines, reports, notes, payments, medical records, requests, meetings and metrics than I ever imagined existed.

And somewhere in all of that, I’m supposed to help an injured human being recover.

To me, that’s the most important part, but it’s also the part I sometimes feel least able to do.

The Numbers

Every morning, I look at my dashboard.

How many claims are open? How many contacts did I make? How many bills did I process? How many files did I close? How quickly did I respond? How does my inventory compare with everyone else’s?

I understand why we measure these things. Someone has to make sure claims are moving and costs are warranted.

But sometimes I wonder what happens when the measurement becomes more important than the person behind the claim. Because I can make a claim file look like it is moving without actually helping the person attached to it improve.

And those are two very different things.

The Claim I Almost Missed

A few weeks ago, I had a claim involving a warehouse employee who injured his back.

The medical records said one thing, and the employer said another. The injured worker wasn’t returning my calls, and I had a dozen other claims demanding my attention.

So I left another voicemail. Eventually, he answered.

He wasn’t avoiding me because he didn’t care about his claim. He was scared. He was worried about his job and paying his mortgage. He didn’t understand what was happening with his medical treatment and, frankly, he didn’t trust the system.

That conversation lasted almost 30 minutes. Thirty minutes I wasn’t supposed to have, but it was probably the most important 30 minutes I spent that week.

For the first time, I wasn’t managing a claim.

I was talking to a person.

And once we talked, things started to change. He understood what was happening. I understood what he needed. His employer understood where the communication had broken down.

The claim started moving in the right direction. Those 30 minutes reminded me why I became an adjuster in the first place.

Then I looked at my workload, and reality came rushing back.

Here’s the Part Nobody Wants to Say Out Loud

I can’t give every claim 30 minutes. Not with my current workload.

I can’t call every injured worker just to see how they’re doing. I can’t always dig deeply enough into the medical records to understand the whole story.

I can’t always stop and ask: “What is really keeping this person from getting better?”

Sometimes I am simply trying to get through the day without something falling through the cracks, and I don’t think I’m alone.

There are adjusters sitting at desks all over the country who genuinely want to do a good job. Some are experienced. Some are brand new. Some received excellent training.

Others were handed a desk and told to figure it out.

Most are trying. Really trying, but good intentions don’t create more hours in the day.

Maybe We’ve Been Asking the Wrong Question

I’ve heard the question: How can an adjuster handle more claims?

Maybe the better question is: How can we give an adjuster more time to handle the claims they already have?

That’s where training matters.

A well-trained adjuster doesn’t just know how to process a claim. They know how to recognize red flags. They understand the workers’ compensation system and the importance of communication. They know that pain isn’t always visible. They know an injured worker’s behavior may be telling them something.

A well-trained adjuster can recognize when a claim needs a phone call instead of another letter, and they understand that two claims with the same diagnosis can have completely different recovery paths.

Training doesn’t just make adjusters more technically competent. Training gives adjusters the confidence to handle the human side of the claim.

Because Every Claim Is Different

I’ve seen simple claims become complicated.

I’ve also seen complicated claims resolve beautifully because someone took the time to understand what was really happening.

Two people can have the same injury and completely different barriers to recovery.

One may be worried about money. Another may be concerned about losing their job. Someone else may be afraid of getting hurt again, struggling to support a family, navigating a language barrier or simply not understanding what happens next.

The diagnosis might be the same, but the person isn’t.

That’s why every claim deserves to be treated as an individual story.

And that’s hard to do when an adjuster is buried beneath a mountain of files.

Maybe the Answer Isn’t More

Maybe the answer isn’t more claims, more metrics, or another dashboard.

Maybe, just maybe, the secret sauce is three fairly simple things:

Train adjusters well.

Give them reasonable claim loads.

Use technology to eliminate administrative burdens, not eliminate the human connection.

Imagine what could happen.

An adjuster who isn’t constantly playing catch-up and who has time to pick up the phone.

An adjuster who understands the system well enough to recognize when something isn’t right and who has the time to listen instead of rushing to the next task.

The result?

An injured worker who feels heard instead of processed.

And, perhaps most importantly, a claim that moves toward a quicker recovery instead of simply moving through a costly workflow.

I’m Sarah. Remember, I’m completely fictitious, but if you work in the world of workers’ compensation, you probably know people like me.

Maybe the next time we talk about improving claims outcomes, we should remember that the injured worker isn’t the only human being in the claim.

There’s another one sitting behind the desk who needs training, more time, and a little help.

That’s where our conversation gets interesting.

Technology, particularly artificial intelligence, is rapidly becoming part of the claims process.

The question isn’t whether AI can help an adjuster, but rather what we will do with the time it gives back?

Next week: Part 2, “AI Should Give Me Time, Not More Claims.”

Last week, I shared how my own definition of success changed over the course of a career in workers’ compensation. Like many claims professionals, I began by measuring success through closed files, favorable outcomes, and cost savings. Over time, I came to realize that behind every claim number is a person with fears, responsibilities, and a life that has been unexpectedly interrupted. I also discussed how the demands of our profession can unintentionally shift our focus from people to processes, leaving injured workers feeling unseen.

This week, I’d like to explore what the research tells us about that experience and why leading with empathy, communication, and whole-person recovery isn’t just compassionate. It’s one of the most effective ways to improve recovery outcomes.

Before the injury, this wasn’t “Claim #24-3817.”

It was a father coaching Little League. A mother caring for aging parents. A young employee saving for a first home. A veteran beginning a second career. A single parent wondering how next month’s rent will be paid.

The injury didn’t erase those responsibilities. It magnified them.

Recovery isn’t simply healing a shoulder, a knee, or a back. Recovery means restoring confidence. Reducing fear. Maintaining identity. Protecting financial security. Helping someone believe that life will eventually feel normal again.

Medical treatment is only one part of recovery. Human connection is another.

The Science Behind Seeing the Person

Research increasingly confirms what many compassionate claims professionals have always known.

How people experience the claims process influences how they recover.

A landmark study involving more than 10,900 injured workers found that workers who reported positive experiences with the workers’ compensation system were significantly more likely to achieve successful return-to-work outcomes, even after accounting for injury severity and other factors. The researchers concluded that improving the injured worker’s experience is not simply good customer service. It is associated with better recovery outcomes.

More recent rehabilitation research has reinforced this message. A 2024 qualitative study found that injured workers consistently identified supportive supervisors, caring coworkers, frequent communication, and feeling genuinely valued as some of the most important factors influencing successful recovery and return to work. Participants described emotional support as being every bit as important as medical care.

The science extends beyond relationships.

When people experience uncertainty, isolation, or feel ignored after an injury, the brain remains in a heightened state of stress. That stress can amplify pain, reduce trust, increase anxiety, and make recovery more difficult. Conversely, empathy, clear communication, and psychological safety help injured workers focus their energy on healing rather than navigating fear and uncertainty.

Perhaps most striking, an analysis of approximately 540,000 workers’ compensation claims found that although fewer than 3% of claims involved documented behavioral health concerns, those claims accounted for roughly 35% of total claim costs and resulted in workers remaining off work nearly three times longer than other injured workers.

The lesson is difficult to ignore. Treating the whole person isn’t simply compassionate. It’s effective.

The Worker Recovery Difference

This is why the Worker Recovery concept matters.

Worker Recovery is not about being “nice.” It is not paying benefits that aren’t owed. It is not sacrificing objective investigation. It is not abandoning sound claims management.

Instead, Worker Recovery begins with a different question.

Rather than asking, “How do I process this claim?” we first ask, “How do I help this person recover?”

That subtle shift changes everything. It changes how we communicate. It changes how quickly we respond. It changes how we explain difficult decisions. It changes how employers remain connected with injured employees. It changes how providers coordinate care. It changes how adjusters define success.

The claim is still investigated. Benefits are still administered. Medical care is still managed. Compliance still matters. But every action is viewed through the lens of helping a human being move forward.

The claim becomes more than a file. The claim becomes someone’s recovery journey.

Every System Participant Has a Choice

Every phone call presents a choice. Every email presents a choice. Every delay, every approval, every denial, every conversation present a choice, or better yet an opportunity to serve another human in need.

We can reinforce the feeling of being another file waiting in a queue, or we can remind someone that they still matter.

Sometimes the smallest moments leave the deepest impressions. Returning a phone call, explaining why a decision was made, something as simple as using someone’s name can make a difference. Checking in before asking for information, listening for what isn’t written in the medical report.

Those actions rarely appear on a performance dashboard, yet they often determine whether an injured worker feels supported or abandoned and can significantly impact the outcome of their recovery.

Seeing the Person Again

The workers’ compensation system was created because society recognized that when someone is injured while earning a living, they deserve medical care, wage protection, dignity, and support.

That mission hasn’t changed. Only our pace has.

The next time you open a claim file, pause for just a moment. Imagine that person sitting across from you instead of existing as rows in a computer system.

Imagine hearing these words:

“I am not a number. I am not a claim. I am a human being. A human being who needs help.”

If we truly hear those words, something remarkable happens. The claim doesn’t become less important. It becomes more meaningful. Because every claim represents a person whose life was unexpectedly interrupted. Every file represents someone’s spouse. Someone’s parent. Someone’s child. Someone’s friend. Someone’s future.

Perhaps that is where genuine recovery begins. Not with the first payment. Not with the first medical appointment. But with the first moment an injured worker realizes:

“They don’t just see my claim. They see me.”

A Final Thought

Every claim is an opportunity to make a decision. Will we simply administer a process? Or will we help restore a life?

The Worker Recovery movement begins with a simple belief: when we intentionally lead with advocacy, empathy, and whole-person recovery, everyone benefits. Injured workers feel seen. Families find hope. Employers regain valued employees. Claims professionals rediscover the purpose that drew them to this profession in the first place.

If this message resonates with you, I invite you to join a growing community of professionals committed to changing the conversation around workers’ compensation. Becoming a Workers’ Recovery Professional (WRP) through WorkCompCollege.com is more than earning a certification. It is embracing a mindset that recognizes every claim as a person, every interaction as an opportunity, and every recovery as a chance to make a lasting difference.

Because in the end, our greatest success won’t be measured by the number of files we close.

It will be measured by the number of lives we help reopen.

References

Collie, A., Di Donato, M., Iles, R., et al. (2019). The relationship between injured workers’ experiences of the workers’ compensation claims process and return to work outcomes. BMC Public Health, 19, 104. This study of more than 10,900 injured workers found that positive claims experiences were significantly associated with successful return-to-work outcomes.

Frontiers in Rehabilitation Sciences. (2024). Factors influencing return to work after workplace injury: Perspectives of injured workers. Participants consistently identified supportive supervisors, frequent communication, psychological safety, and feeling valued as critical components of successful recovery.

Sentry Insurance. (2024). Behavioral health and workers’ compensation claims analysis. Analysis of approximately 540,000 claims found that fewer than 3% of claims involved documented behavioral health conditions, yet those claims represented approximately 35% of total claim costs and significantly longer disability durations.

Gray, S. E., et al. (2019). Concerns About Claiming, Postclaim Support, and Return to Work Planning. Journal of Occupational and Environmental Medicine. The study found that emotional support from employers was among the strongest predictors of successful return-to-work outcomes.

Workers Compensation Research Institute (WCRI). Multiple studies on early intervention, communication, return-to-work practices, and psychosocial factors consistently demonstrate that timely communication and worker engagement improve recovery and claim outcomes.

National Council on Compensation Insurance (NCCI). Research briefs on return-to-work, behavioral health, and psychosocial factors in workers’ compensation emphasize the importance of whole-person recovery and early engagement in improving outcomes.

Over the next two weeks, I’d like to share a reflection that has shaped the way I view workers’ compensation. In Part 1, I share my own journey from measuring success by closed claims to understanding that every claim represents a human life. Next week, in Part 2, I’ll explore what research tells us about recovery and how a Worker Recovery mindset can improve outcomes for everyone involved.

“I am not an elephant. I am not an animal. I am a human being. I am a man.”

When John Merrick utters these unforgettable words in The Elephant Man, he isn’t asking for sympathy.

He’s asking to be seen. Not as a spectacle. Not as a diagnosis. Not as an inconvenience.

Simply as a human being.

Those words have stayed with me for years, and they challenge me in a deeply personal way.

I have a confession to make.

When I first entered the workers’ compensation profession as a young claims adjuster, I often viewed claims handling as a competition. I measured success by closing files, winning disputes, and saving dollars. Every favorable outcome felt like a victory. Every compliment from a supervisor validated that I was doing my job well.

As I write those words today, I want to hide beneath the Elephant Man’s hood, not because of how the world sees me, but because I am humbled by how I once saw the world.

Because that isn’t who I am. And thankfully, it isn’t who I became.

Experience has a remarkable way of changing our definition of success.

Over the course of more than three decades in workers’ compensation, I witnessed thousands of injured employees and their families navigating some of the most difficult moments of their lives. I learned that behind every claim number was a story I couldn’t see. Behind every dispute was a person carrying fears that never appeared in the claim file. Behind every delayed return to work was a family trying to hold life together.

The day I retired from The University of Texas System, as I crossed the threshold and walked out of the building for the final time, I wasn’t proud of the dollars I had saved or the disputes I had won.

I was proud that somewhere along the journey, my definition of success had changed.

Success had become helping people recover. Success had become listening before deciding. Success had become leading with empathy and creating a psychologically safe environment for people to be heard.

That lesson continues to deepen through my work with Kids’ Chance of Texas.

I’ve had the privilege of meeting families whose lives have been forever changed by catastrophic workplace injuries and fatalities. I’ve seen spouses suddenly carrying the weight of an entire household. I’ve watched children quietly wonder whether college was still possible after a parent was killed or permanently disabled at work.

Then comes the moment that changes everything.

They hear one simple word.

“Yes.”

Yes, you’ve been awarded a scholarship. In an instant, tears replace uncertainty. Hope replaces fear. A future that seemed to be slipping away suddenly feels possible again.

Those moments remind me that workers’ compensation has never been about claims. It has always been about people. Perhaps that’s why wonder what an injured worker might say if they could borrow John Merrick’s words.

“I am not a number. I am not a claim. I am a human being. A human being who needs help.”

Perhaps those words should be printed on every claim file, every adjuster’s desktop, every employer’s first report of injury, and every workers’ compensation computer screen. Because somewhere along the way, many claims stop being about people. They become events.

Tasks, workflows. diary notes, reserve reviews, medical authorizations, litigation, metrics, numbers. Every one of those activities is necessary to administer a workers’ compensation claim. But none of them is the reason workers’ compensation exists.

Workers’ compensation exists because someone was hurt. Someone whose life changed in an instant. Someone who needs help finding their way back.

Nobody Enters This Profession to Lose Their Empathy

Let’s be fair. Claims professionals don’t wake up in the morning determined to treat injured workers like claim numbers. Employers don’t intentionally forget that an employee is scared. Nurses don’t choose paperwork over compassion. Attorneys don’t begin their careers hoping conflict becomes the norm. Most people in this industry genuinely care.

The problem isn’t a lack of caring. The problem is volume. Too many files, too many emails, too many deadlines, too many phone calls, too many competing priorities.

When people are expected to manage workloads beyond what time reasonably allows, survival instincts take over. The focus naturally shifts from people to processes. Efficiency replaces connection. Checklists replace conversations. The goal becomes getting through today’s work rather than connecting with today’s people.

Psychologists describe this as depersonalization, one of the hallmarks of professional burnout. It isn’t intentional. It isn’t a character flaw. It’s a coping mechanism.

But while the system participant is coping with overwhelming demands, the injured worker experiences something very different. They experience silence, distance, and indifference.

To them, it feels like no one cares.

This conversation doesn’t end here. Next week, in Part 2, we’ll look at the science behind recovery and examine why the way we communicate, connect, and lead can have a measurable impact on both people and outcomes.