Workers’ compensation was built for injuries that show up on an X-ray. A fracture can be imaged. A torn rotator cuff can be repaired. PTSD doesn’t show up on any scan, and state legislatures are increasingly asking whether that should matter.

In September, NCCI published its 2026 Legislative and Regulatory Trends Report, examining the issues occupying state legislatures and regulatory bodies across the country. As usual, there were as many commonalities as differences.

Several familiar subjects appear. Marijuana (cannabis) legalization and reimbursement continue to generate debate, as do psychedelics and their potential therapeutic applications. Worker classification and portable benefits are receiving increased attention as the gig economy challenges traditional employment relationships. Workers’ compensation alternatives and AI are also on the radar.

I’ve written about most of these subjects over the years. Their presence in this report did not surprise me. In my experience, most of what shows up in work comp starts somewhere else first. But one trend deserves particular attention as we approach 2027.

Mental injuries are becoming increasingly difficult for the workers’ compensation system to ignore.

Even chronic pain, for all its complexity, usually starts with a physical complaint we can identify. Psychological injuries often don’t. Post-traumatic stress disorder (PTSD), anxiety, depression, and other mental health conditions don’t necessarily produce the objective findings we’ve traditionally relied upon. Their causes can be complicated, their symptoms are unique per person, and their compensability can be difficult to establish. Yet the absence of a visible injury doesn’t make the suffering imaginary.

NCCI identifies mental injury legislation as a continuing trend, with most proposals still focused on first responders. In 2026, lawmakers concentrated on three questions:

• Who qualifies for coverage?
• Which conditions qualify?
• Which medical professionals can diagnose them?

Several states considered extending mental injury or PTSD coverage to additional workers, though mostly to roles adjacent to first response: coroners and death investigators in Idaho and Washington, emergency dispatchers in Vermont, correctional workers in Washington, and mine rescue teams in West Virginia. None of those bills advanced. Maryland, Minnesota, and New York considered expanding which practitioners can diagnose qualifying conditions. Minnesota’s bill became law, adding psychiatric mental health nurse practitioners, and New York’s passed both chambers. Collectively, they show legislatures reconsidering where the boundaries of compensability should be drawn.

However, trauma isn’t exclusive to those occupations.

Consider a retail employee assaulted during a robbery. A healthcare worker threatened by a patient. A teacher witnessing violence. An employee whose physical injury produces significant depression and anxiety during a prolonged recovery. I wrote about several of these scenarios in my October blog about our National Comp panel on workplace violence.

But expanding eligibility for mental injury benefits doesn’t automatically expand our ability to manage those claims effectively.

A claims professional accustomed to evaluating musculoskeletal injuries may suddenly need to understand psychiatric diagnoses, psychological testing, preexisting conditions, causation, treatment approaches, and the relationship between mental health and functional recovery.

Managing these claims also requires recognizing that mental injuries rarely exist in isolation. Biological, psychological, and social factors interact in ways that can either support recovery or complicate it. A diagnosis alone doesn’t tell us everything we need to know about someone’s ability to function.

It’s one reason I was one of the early voices for a biopsychosocial treatment model in work comp in 2010. The whole person affects the injured part. It wasn’t a popular position at the time. The pushback I heard most was, “We don’t want psych becoming a compensable diagnosis.” The good news is that the mind-body connection is more widely accepted today.

Legislation can change much faster than professional competence develops. That gap has real consequences for injured workers, employers, and the claims professionals trying to make defensible decisions.

It’s exactly why we built the Workers’ Compensation Mental Injury Claims Specialist (WCMICS) program at WorkCompCollege.com. Education won’t solve every problem. Whether your team learns this through us, another provider, or a seasoned colleague down the hall matters less than whether they learn it before these claims arrive.

It’s difficult to foresee which mental injury proposals will become law next year. Local politics, much of it behind the scenes, can send proposals down unpredictable paths. NCCI’s report, reflecting legislative activity through July 31, is a useful indicator of policy attention but not necessarily a forecast of becoming law. Still, its prominence in this report deserves our attention before New Year’s Day.

Speaking of which, the upcoming holidays usually bring a little downtime. Use some of it to ask a few honest questions about your team:

• Do our adjusters understand the differences among psychological injury categories?
• Can they evaluate a psychiatric diagnosis, causation, and preexisting conditions with confidence?
• Do our provider networks include appropriate mental health expertise?
• Do our return-to-work strategies account for psychological, not just physical, function?

During that process, resist two assumptions: that every psychological complaint is automatically work-related, and that an injury isn’t legitimate because we can’t see it. Neither serves the injured worker nor protects the integrity of the system.

Legislatures will decide which injuries we’re required to recognize. Whether we’re prepared to manage the ones we can’t see is up to us.

Roger Federer won almost 80% of the 1,526 singles matches he played as a professional. He won only 54% of the points.

Let that sink in. A man with 20 Grand Slam titles and 310 weeks ranked number one in the world lost nearly half the points he played. (In baseball, failing 70% of the time at the plate can get you into the Hall of Fame.)

During his 2024 commencement address at Dartmouth College, Federer explained why that statistic matters. In tennis, you must give everything to the point you’re playing. Once that point is over, win or lose, you have to move on. Whether you hit an incredible winner or made an embarrassing mistake, neither should dictate how you approach the next point.

As he put it, “When you’re playing a point, it is the most important thing in the world. But the truth is, whatever game you play in life, sometimes you’re going to lose.”

His comments caused me to think about something much bigger than tennis.

How often do we allow yesterday to determine what we’re willing to attempt today?

We’ve all experienced failure. A bad decision, a missed opportunity, a relationship that didn’t work, or an effort that fell short of expectations.

Those experiences can teach us valuable lessons but can also convince us that trying again isn’t worth the risk. We begin anticipating failure before we’ve even started.

Failure whispers, “Don’t try that again.”

Interestingly, success can create a similar problem. When something has worked well in the past, we can become convinced it will always work. We stop questioning assumptions, resist new approaches, and gradually become complacent.

When I first started warning about dangerous opioid prescribing and the need for a biopsychosocial treatment model, I heard the whispers. “We’ve always done it this way.” Polypharmacy was routine. Claims were financial transactions.

Success whispers, “Don’t change anything.”

Now think about an injured worker who has had a terrible workers’ compensation experience, or watched a coworker go through one. Perhaps an adjuster didn’t return phone calls to explain why the indemnity check was late. Maybe a physician dismissed legitimate concerns. It’s possible the employee felt like everyone involved was more interested in closing the claim than helping them recover.

Now that employee suffers another workplace injury.

Before the first appointment or conversation with an adjuster, they’ve already decided what will happen. Nobody will listen to them or believe them. They know for certain (because of their past experience) that everyone is looking for a way to take advantage of them.

That isn’t necessarily an unreasonable reaction. Their distrust may have been earned. Psychologist Michael Sullivan’s research calls it perceived injustice, and it’s linked to longer work disability.

Their distrust may have been earned through painful experience that has created perceived injustice which research links to longer work disability. As I wrote recently, distrust doesn’t begin with the denial.

But what happened previously can become an obstacle to what might be possible today.

We cannot expect someone to trust us because we tell them this time will be different. We must demonstrate it.

That means returning phone calls, explaining decisions, listening without immediately becoming defensive, and treating the injured worker as a person rather than a claim number. Consistency builds credibility, which creates opportunities for trust, which can influence someone’s willingness to participate in recovery.

We increasingly recognize that social determinants of health – things like financial stability, housing, access to healthcare, medical literacy, and social support – can influence recovery.

The same is true of adverse childhood experiences, commonly called ACEs. The term came from a groundbreaking 1998 research paper, “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” Childhood abuse, neglect, household instability, and other traumatic experiences can have lasting effects on how people respond to stress, perceive threats, develop relationships, and manage adversity.

An injured worker doesn’t shed that history before entering the workplace. Someone who has experienced repeated betrayal may struggle to trust authority figures. Someone who grew up with instability may perceive uncertainty about benefits or employment as especially threatening. Those are responses shaped by experience, not character flaws.

Regardless of their source, risk factors are not destiny.

People demonstrate extraordinary resilience, especially when they have meaningful support, appropriate resources, and relationships that help restore a sense of safety and control.

Our responsibility isn’t to diagnose someone’s childhood or investigate their personal history. Instead, we need to recognize that every injured worker arrives with experiences we may know nothing about, but that will affect their resilience, recovery, and (for those who care about the bottom line) the total cost of a claim.

Federer’s point isn’t that yesterday doesn’t matter. It matters enormously.

His failures helped him improve. His victories demonstrated what was possible. But neither could win the next point for him.

I think there’s an important lesson here for everyone involved in work comp.

A difficult previous claim doesn’t guarantee another difficult experience for an injured worker. Recovery may still be possible, even when the path forward looks different from what they expected.

For claims professionals and clinicians, an injured worker who has been distrustful, angry, or disengaged isn’t necessarily destined to remain that way. Our next interaction may be an opportunity to change the relationship by proving that we are worthy of their trust.

None of this means ignoring legitimate trauma or pretending failure didn’t hurt. Positive thinking doesn’t overcome every obstacle. It simply means refusing to confuse a prediction with a certainty.

We can’t change what happened yesterday. However, we can learn from it, acknowledge its influence, and make better choices because of it.

Somewhere in your caseload today is an injured worker who already expects to be ignored. The next call you return is the next point.

Their past is a lesson. It doesn’t have to be a life sentence.

Your AI tool just turned a two-hour task into 20 minutes. Congratulations. Now, what happened to the other hour and 40 minutes?

New research from Wharton suggests many organizations aren’t asking. They’re counting the hours saved instead of what those hours produce.

Every technological transformation has promised to make us faster, more productive, and more efficient. Many have delivered (sometimes in ways that nobody originally envisioned).

Over four decades in technology, I’ve learned that just because technology makes a task easier doesn’t mean it makes the outcome better. That’s why every business leader, risk manager, and workers’ compensation professional should pay attention to Wharton’s latest study.

Wharton recently released its fourth annual study of enterprise AI adoption, The Adaptive Advantage: Who’s Winning with AI and How, conducted with GBK Collective. Researchers surveyed 1,416 people at large U.S. companies, from C-suite executives to entry-level employees. I’ll share my takeaways below, but I’d encourage every leadership team to read the full report.

The adoption numbers are impressive.

• 62% of managers report using AI daily
• 91% use AI more than weekly
• 73% say AI has significantly changed their workflows

We’re well beyond the days when AI was something interesting to experiment with during lunch. It’s becoming part of how organizations operate.

While 80% report positive returns from AI investments, only 28% report strongly positive returns. And just 7% of organizations demonstrate success across all three measures Wharton identified: proving value, transforming workflows, and aligning the organization.

Organizations are adopting AI at extraordinary speed. They’re spending money, changing processes, and introducing new tools. But relatively few are putting all the pieces together. Using AI and succeeding with AI are two very different things.

One statistic particularly deserves attention.

Forty percent of departments measure AI’s return on investment by hours saved, yet only 27% use net-new revenue as a measure.

Saving time is certainly valuable. I use AI daily for both professional and personal needs. From developing content to crafting meeting takeaways to simplifying research, I can attest to its power. And more than once, I’ve caught it being confidently wrong.

So, back to that hour and 40 minutes. Did the quality improve? Did the customer receive better service? Did the employee use that additional time to solve a more important problem? Or did we simply get the same result faster?

Wharton found that 35% of departments measuring at least one growth-related outcome reported strongly positive returns, compared with just 13% of those measuring efficiency alone.

Whether correlation or causation, that difference is hard to ignore.

There’s a difference between improving productivity and creating value. I suspect many organizations haven’t fully considered it.

Imagine a claims adjuster using AI to summarize medical records. Instead of spending an hour reviewing documents, the adjuster receives a summary in minutes. That’s a tangible efficiency improvement.

But did the summary accurately identify the important medical issues? Did it recognize conflicting information? Did the adjuster verify the output? Did that saved time translate into better communication with the injured worker, a more thoughtful claim strategy, or a faster return to work?

Now consider a risk manager using AI to identify emerging workplace safety trends. If technology helps recognize a pattern of injuries before another employee gets hurt, that’s not efficiency. That’s an employee who didn’t get hurt.

The same applies to identifying claims that are beginning to deteriorate, improving employee training, or helping smaller organizations access capabilities they previously couldn’t afford. The real opportunity isn’t simply automation, but using technology to improve decisions, prevent problems, and produce better human outcomes.

Then there’s the finding on agents.

Sixty-seven percent of departments report using AI agents in some form. These are systems that can go beyond answering questions to perform tasks or take actions, such as sending a denial letter or setting a reserve. Only 17% report allowing agents to operate without someone approving every step.

We’re moving from AI that recommends to AI that acts.

What happens when an AI system influences a medical treatment recommendation, a claim reserve, or a decision about an employee’s benefits? Who …

• verifies the information?
• recognizes an error?
• is accountable when something goes wrong?

Oh, and who keeps track of your vendors’ use of AI?

I’m not convinced most organizations are developing the knowledge, policies, oversight, and accountability necessary to use AI responsibly.

Wharton’s research reinforces that concern. The report found that organizational alignment requires at least four of five factors: adequate AI training, a clear long-term vision from leadership, meaningful employee choice over how and when to use AI, people and processes that don’t hold the department back, and little resistance among colleagues. Notice that none of them is about the software.

And there’s a telling gap on the first one: 78% of leaders believe employees receive adequate AI training. Only 56% of employees agree.

Successful implementation involves more than purchasing software. It requires changing workflows, educating employees, establishing expectations, and aligning leadership around a common purpose. That’s a management challenge, not simply an IT project.

Next week, I’ll be in Sacramento delivering the keynote at the California Alliance of Self-Insured Groups’ annual conference. My presentation is titled “AI Is Already in Your Organization. The Only Question Is Who’s Controlling It.”

I chose that title deliberately.

Whether you’re running a self-insured group, managing claims, operating a business, or providing services to employers, AI is probably influencing your operations already.

Every leader should be able to answer four questions: Where is AI being used? What is it allowed to do? How are we measuring its value? Who’s responsible for the results? In reality, every employee should be asking them too.

I’m an optimistic realist. There are certainly challenges and unknowns as AI becomes more powerful at an ever-increasing pace. However, I believe AI presents extraordinary opportunities.

But enthusiasm without discipline isn’t a strategy. Neither is measuring success exclusively by how many hours we’ve saved.

Here’s where I’ve landed: our goal for AI shouldn’t be to make people unnecessary. It should be to make people more capable.

So the next time someone tells you how much time AI is saving your organization, ask a follow-up question: What are we doing with that time, and how do we know the results are better?

Hours saved is a number. An injured worker who returns to work sooner is an outcome. Start measuring the second one.

Gerald-Mark (Jerry) Breen had an IQ of 146. He earned a PhD in Health and Public Affairs. He published 30 articles and three books by age 29, one of which was cited by Supreme Court Justice Samuel Alito. He was a co-author of Improving the Quality of Care in Nursing Homes (Johns Hopkins University Press). He was a teacher. He was an accomplished classical pianist.

By almost any measure society uses to define success, Jerry was extraordinary.

But there was something his intelligence couldn’t overcome: addiction.

I recently had a deeply personal conversation with Bonni Breen, a registered nurse with more than 30 years in workers’ compensation. Because I’ve spent more than two decades speaking out against inappropriate opioid prescribing, she asked me to help share her son’s story, in the hope that someone else might recognize the warning signs before it’s too late.

Jerry’s challenges began early. He struggled with ADHD as a child. At age 10, he lost his father, leaving Bonni to raise him and his two brothers. He also received treatment for obsessive-compulsive disorder. What the CDC calls ACEs (adverse childhood experiences) were part of his foundation.

But a résumé and a diagnosis don’t tell you who Jerry was. A close friend from his years in Hawaii remembers an energy that was “infectious.” At a local brewery, Jerry would walk over to a tarp-covered piano that was clearly off-limits, pull the tarp off, and start to play. He wrote so quickly and fluently that his friend teased him about a ghost whispering in his ear. His students loved how freely he gave his help. And he talked about home. “‘My mom’ figured often in his conversations,” his friend wrote, “and Skyler, his dog.”

His exposure to opioids began with something seemingly ordinary: an ingrown toenail. What followed was anything but ordinary.

Despite his remarkable intellectual abilities, Jerry developed an addiction that increasingly controlled his decisions. He sought prescriptions from multiple physicians and pharmacies with no objective underlying pain that would require opioids. He underwent medical procedures to obtain medications. He completed two rehabilitation programs and spent years in counseling.

His mother watched it unfold. Bonni understood medications. She understood healthcare. She understood the dangers. And she repeatedly warned her son. So did a physician in Wisconsin.

Jerry knew the dangers, too. One of his favorite quotes, Bonni recalls, now feels painfully ironic: “To neglect your health is to accept illness as a friend.”

But Jerry believed he was smarter than the drugs. No one is.

On March 28, 2010, Bonni lost her son.

Jerry’s story shows what happens when physicians and pharmacies operate in separate information silos. Multiple doctors and pharmacies. Multiple opportunities to recognize what was happening. And a mother who knew exactly what she was witnessing but couldn’t make it stop.

In 2010, nothing required Jerry’s doctors to check what the others were prescribing. Gaps like these are why I spent years advocating for drug formularies and prescription drug monitoring programs, including California’s SB 482, signed into law in 2016, which requires prescribers to check a patient’s controlled-substance history before prescribing opioids and other controlled substances. Laws like that exist because of stories like Jerry’s.

Jerry sometimes called Bonni 20 times a day. Imagine being that mother. Knowing your son is struggling, recognizing the danger, loving him desperately, warning him repeatedly that his addiction could kill him. And yet, despite all of that, unable to change the trajectory.

We sometimes underestimate how helpless families can feel when someone they love is trapped in addiction. We assume that if the person were smarter, stronger, more disciplined, or more aware of the consequences, they would simply stop.

Jerry’s life challenges every one of those assumptions:

• Intelligence wasn’t enough
• Education wasn’t enough
• Accomplishment wasn’t enough
• Even repeated warnings and rehabilitation weren’t enough

Addiction is not a contest of intellect. Recovery requires more than willpower. Addiction doesn’t care about your occupation, education, income, IQ, or who pays for it. It certainly doesn’t care how much your mother loves you.

Bonni cannot change what happened to Jerry. For years, she couldn’t tell Jerry’s story without breaking down. Today she can, and she’s telling it in the hope that another family can have a different ending.

Perhaps a parent will recognize the warning signs sooner. Perhaps someone struggling with addiction will acknowledge that they need help. Perhaps a physician will look more carefully at prescription history. Perhaps a claims professional will question whether continued opioid therapy is helping someone recover or creating another problem.

Every time Bonni hears Beethoven’s “Für Elise,” she believes Jerry is sending her a message from heaven.

Jerry was brilliant. He was accomplished. He was loved. He was somebody’s son.

Addiction didn’t care.

If someone you love is struggling, you don’t have to figure it out alone. SAMHSA’s National Helpline (1-800-662-4357) is free, confidential, and available 24/7.

Four words have quietly ended more careers than any layoff: “I already know enough.”

I started my professional career as a mainframe computer operator. Today, I’m the Provost of WorkCompCollege.com.

There is no logical career path connecting those two jobs, at least not one I could have predicted when I was sitting at the console of a mainframe computer four decades ago.

The common thread throughout was curiosity. I have spent my entire adult life wanting to know more than I knew yesterday. Not simply about the job I was doing, but about subjects, technologies, people, and perspectives that might have little obvious connection to my immediate responsibilities.

I believe the moment you stop learning is the moment you start becoming irrelevant. With the pace of change we’re experiencing today, being a lifelong learner is even more important.

My first professional reinvention was from mainframe computer operator to software developer. I taught myself multiple programming languages and platforms, which eventually led to business analysis, project management, and department management. Then I entered the workers’ compensation industry and began to engage in an entirely different world: insurance, healthcare, legal, regulations, claims management, human behavior. As I leveraged my software development skills to create new products, I added more skills like marketing and sales. That led to an opportunity to write and speak at conferences, ultimately creating the RxProfessor brand. I even evolved my subjects over time, from opioids to AI.

Then, in 2021, I got laid off. After decades of building a reputation, I had to answer a question I hadn’t asked myself in years: What now? The answer had been built, piece by piece, from everything I’d learned when nobody required me to. My employer’s decision led to my next reinvention: business owner and Provost of WorkCompCollege.com.

I sometimes joke that I’m on version 476 of Mark Pew.

I didn’t learn all those things because I knew I would need them someday. I learned because I was interested. When new opportunities appeared, or circumstances forced me to change direction, my accumulated knowledge and experiences made those transitions possible. Everything I learned yesterday was quietly building toward today.

I’ve lived through the transitions from no computers to mainframes, personal computers, the internet, mobile, cloud computing, and remote work. Each transformation changed how people worked and what they needed to know. AI feels different, though, because of the speed and breadth of its potential impact. Skills that were valuable yesterday may become automated tomorrow. Tasks that once required specialized expertise can increasingly be accomplished by someone who knows how to ask the right questions and evaluate the answers. The World Economic Forum’s 2025 Future of Jobs Report estimates that 39% of workers’ core skills will change by 2030. The status quo isn’t coming back.

I’ve discovered that knowledge from seemingly unrelated subjects frequently becomes useful in unexpected ways. My technology background influences how I think about education and business development. My experience in project management helps me organize complex initiatives. Marketing taught me to communicate ideas provocatively. Speaking and writing have forced me to clarify what I believe in a concise and understandable manner. Studying human behavior has fundamentally changed how I interact with the world, both professionally and personally.

Experience is a wonderful teacher, but it can also become a trap. Nobody says “I already know enough” out loud. We say it with our calendars, by what we never make time to learn.

Author David Epstein explains why in Range: Why Generalists Triumph in a Specialized World. He describes “kind” learning environments, like golf or chess, where the rules are clear and practice makes perfect. Then there are “wicked” environments, where the rules shift, feedback is delayed, and today’s situation rarely matches yesterday’s. In wicked environments, people who draw on a wide range of experience consistently adapt better than those who know only one thing. If you’ve ever handled a work comp claim, you already know which kind of environment we work in. Learn one thing every quarter that your job doesn’t require.

A claims adjuster needs to understand statutes, case law, compensability, medical terminology, financial reserving, claims procedures, and return-to-work best practices (among many others). But to be effective, they also need to understand:

• Psychology: recognizing fear avoidance and catastrophizing before they stall recovery
• Effective communication: the first call that sets the tone for the whole claim
• Artificial intelligence: knowing what to automate, and what to double-check
• Leadership: influencing outcomes you don’t control
• The economics of healthcare: why the cheapest provider is rarely the least expensive claim

The same principle applies to clinicians, attorneys, salespeople, executives, and just about everyone else.

Sometimes the most valuable thing you learn has nothing to do with what you thought you needed to learn. That’s why I encourage people to seek information from multiple sources and perspectives, including those that challenge their assumptions. For example, I don’t limit my daily reading to work comp content, because macro trends eventually find their way into our industry.

Ask yourself these three questions:

1. What have I learned in the past 90 days that genuinely changed my thinking?
2. What subject outside my immediate expertise could make me more effective, personally or professionally?
3. What am I doing today to prepare for opportunities or disruptions that I cannot yet anticipate?

Those questions apply whether you’re just entering the workforce or approaching retirement. Give question two your attention for 30 minutes per week for the next 90 days. When the 90 days are up, answer question one again. After all, the value of education isn’t what you know when the course ends. It’s what you do differently afterward.

If question two left you stuck, that’s exactly why we built the Advanced Training & Education Center (ATEC) at WorkCompCollege.com. ATEC reflects what I think continuing education should look like: broad, ongoing, and intentionally diverse. Rather than focusing exclusively on a single certification or discipline, ATEC provides an expanding library of learning opportunities across the workers’ compensation ecosystem. There are resources covering claims management, medical management, legal issues, risk management, return to work, humanities, and technology. Specialized offerings explore subjects such as mental injury claims, independent medical examinations, medical settlements, and practical AI applications. Jurisdiction-specific content now covers 38 states, each explained by a human expert in that state’s nuances. Pick the course farthest from your job description, as that could be your answer to question two.

So who owns your professional development? TIP: You do.

An employer can provide opportunities. A manager can encourage you. An organization can pay for training. But nobody can make you curious. Nobody can force you to ask better questions, explore unfamiliar subjects, or reconsider long-held assumptions. Face it … nobody has a greater stake in your future than you do.

Replace “I already know enough” with three better words: “Tell me more.” I’m working on version 477. What version are you on?

The workers’ compensation industry is focused on responding to injuries. What if the most important work comp claim is the one we prevent from ever happening?

That question was in my head while moderating the National Comp session “Before the Breaking Point: An Integrated Framework for Workplace Violence Prevention and Response” on September 29. Of all the great content included in the agenda, our session was the only one devoted specifically to workplace violence.

At first glance, that subject might seem a little out of place at a work comp conference. It is reasonable to assume that workplace violence is a safety, security, HR, or law enforcement issue. And it certainly is all of those.

Except when someone gets hurt and becomes a workers’ compensation issue. Maybe workers’ compensation needs to start thinking a little further upstream.

That premise launched an excellent discussion with Ari Stowell (Corporate Director of Workforce Health & Safety at HCA Healthcare), and Dan Hanlon (Director of Training & National Account Development at The Noble Group). Dr. Ann Hawkins (Chief Innovation & Marketing Officer at Health Karma Inc.), who helped plan the session, had a schedule conflict and couldn’t join us.

Dan spent 30 years in law enforcement before bringing that experience into workplace violence prevention. Based on his experience, serious incidents usually have a history. As Dr. Hawkins put it on one of our slides, “Workplace violence doesn’t begin with violence. It begins with warning signs.” Dan described those signs as increasing hostility, intimidation, threatening language, and talk of retaliation or harm, along with changes in behavior or attendance and substance abuse.

Dan’s concern wasn’t whether somebody noticed those warning signs. It was what happened next, which he distilled into four questions:

• What did we know?
• When did we know it?
• What did we do?
• What did we document?

Those are certainly important questions after something terrible happens. But they are much more valuable before they do. Dan mentioned the increasingly high cost of negligence and the evolving regulations around prevention and response that involve all four of those questions.

Unfortunately, the numbers are moving in the wrong direction. We discussed how COVID was an inflection point for mental health and wellness. According to NCCI, nonfatal workplace assaults rose at an annualized rate of 5.3% from 2011 through 2022. The Bureau of Labor Statistics counted 470 workplace homicides in 2024, up from 458 in 2023.

Dan said violence creates consequences beyond the person who is physically attacked. Coworkers witness it. Teams experience it. People may become afraid to return to the same environment. Psychological injuries can emerge alongside physical ones. Turnover, absenteeism, and morale can all be affected.

To underscore his point, Dan described the November 2022 incident in Chesapeake, Virginia, where a supervisor opened fire in the employee break room and killed six coworkers. The subsequent lawsuits allege the employer knew about the shooter’s prior threatening behavior, that employees had reported him, and that nothing was done. Dan described a survivor who was seated next to a coworker who was shot in the head. He did not sugarcoat what that means for a claim. That’s not a typical recovery timeline. It’s a claim that may last a lifetime.

Run that case through the four questions, and the answers are hard to read.

Healthcare makes this particularly visible.

Ari told us that HCA Healthcare has seen a dramatic increase in workplace violence since the pandemic. HCA employs approximately 320,000 people across a system of roughly 190 hospitals and thousands of other care locations. Most people do not manage workplace safety at anything remotely approaching that scale. But what HCA learned while trying to solve the problem at that scale can apply to every employer.

Ari pointed out that, by her count, only 22 states currently have laws addressing workplace violence in healthcare. A review by Epstein Becker Green counted at least 20 as of March, so the list is growing fast. Dan pointed out that the mandates aren’t just for healthcare. California’s law reaches most employers, and New York has extended similar requirements to retail. In Dan’s opinion, California currently has the most stringent mandates and can be a good starting point for others. Whether or not your state requires a prevention program, the negligence lawsuits Dan described don’t wait for a mandate.

Ari identified five challenges: standardization, visibility, accountability, culture, and ownership. When she asked which mattered most, the room guessed it: culture.

Healthcare has historically tolerated a certain amount of violence as part of the job. When a patient is sick, confused, medicated, frightened, or elderly, it can be part of the culture that a behavioral health crisis is “understandable.” While those circumstances may explain behavior, they do not make an employee’s injury acceptable.

That distinction matters far beyond healthcare. Every organization has things they simply learn to tolerate:

• “That’s just how he is”
• “She was angry”
• “Nothing actually happened”
• “We don’t want to overreact”

Until something bad happens and “nobody saw it coming.”

Interestingly, Ari said that when HCA made reporting easier and more consistent, its reported numbers initially went up. That wasn’t failure. It was visibility. You cannot manage what people are afraid, unwilling, or unable to tell you about.

HCA eventually organized its approach around three pillars: people, process and technology:

• People means leadership involvement, accountability, and culture
• Process means standardized reporting, training, follow-up, and clear expectations
• Technology means giving people practical ways to report problems, communicate quickly, and get help when something happens

At HCA, that includes executive oversight and workplace violence committees at individual facilities. It includes centralized incident reporting that allows employees to self-report and automatically alerts the appropriate team. It’s even piloting wearable duress buttons that employees can activate when they feel unsafe or threatened. HCA chose a top-down approach in which leadership is financially incentivized to plan, document, and enact both proactive safety steps and quick response. Each year, facilities earn credits or are charged debits based on how their program is graded. Regardless of an organization’s size or industry, a whole-of-enterprise system will uncover and address blind spots while reducing resistance to engaging with red flags early. In the famous words of Barney Fife, “nip it in the bud.”

Based on the insights from Dan and Ari, I noted five intentional things that every employer can do:

1. Decide who owns workplace violence and make sure the answer is “all of us.” Security cannot solve this alone. Neither can HR, risk management, workers’ compensation, or safety. Someone needs responsibility for coordinating the program, but information must move across all organizational silos. At HCA, workplace violence prevention deliberately brings together leadership, legal, HR, employee health, behavioral health, security, patient safety, and other disciplines. While smaller organizations may have fewer people and departments, silos still exist. On this subject, those communication and coordination barriers must be removed.
2. Give employees one obvious way to report concerns. If an employee sees troubling behavior, do they know where and when to report it? As importantly, do they have confidence that something will happen when they do? Reporting needs to be easy, understood, and trusted. Don’t measure success simply by fewer reports because, as Ari pointed out, sometimes more reporting means your reformed culture is working. As Dan recommended, offer a confidential or anonymous option for people who fear retaliation.
3. Train people to recognize what happens before violence. Don’t limit training to what employees should do once an attack begins. Teach supervisors and employees to recognize increasing hostility, intimidation, fixation on grievances, behavioral changes, and threatening language. Then teach them what to do with the red flags that are identified. You don’t want to be the one who “never saw it coming.”
4. Create a repeatable process for acting on information. A report without follow-up is just documentation, and the people who report it ultimately know if it’s a useful or useless exercise. Establish who reviews concerns, how risk is escalated, what corrective action is available, and how the response is documented. Periodically test whether the process works. This is very similar to an organization’s disaster recovery plan that looks good on paper but doesn’t work when a disaster happens.
5. Learn from every incident, including the ones that almost happened. Don’t close the file when the immediate danger ends. Ask what was known beforehand. What worked? What did not work? What communication succeeded or failed? What should change? The goal isn’t simply to recover from an event. It is to make the organization stronger because of what it learned.

To quote one of the most provocative slides: “Workers’ compensation isn’t only about paying claims after harm occurs. It’s about reducing frequency, severity, duration, and exposure.”

We talk constantly about injury prevention, ergonomics, slips and falls, fleet safety, safe lifting, and return to work programs. After preparing for and delivering this session, I’d argue that workplace violence belongs in that same conversation. Perhaps the artificial line between prevention and workers’ compensation deserves to disappear.

So, ask yourself: If someone at your company started showing these warning signs tomorrow, would anyone notice? Would anyone report it? Would anything happen if they did?

If your honest answer to any of those is “I don’t know,” that’s your first finding. Someone will eventually ask Dan’s four questions. The only choice is whether it happens before the incident or after.

Here is a statistic that seems to contradict itself.

The U.S. Bureau of Labor Statistics projects employment for claims adjusters, appraisers, examiners, and investigators will decline 6% over the next decade. Yet BLS also projects approximately 21,600 job openings every year. Neither one cancels out the other.

Note that the BLS numbers include all insurance claims professionals, not just workers’ compensation. But the broader workforce dynamics should sound very familiar.

BLS estimates there were approximately 389,700 people working in these occupations in 2025. By 2035, that number is projected to decline by about 21,800 positions.

So where do 21,600 openings every year come from?

BLS provides the answer. All those projected openings are expected to result from people transferring to other occupations or leaving the workforce, including retirement.

That means we are facing a future where we need to continually replace an enormous amount of experience walking out or through another door.

The numbers become more interesting when you put them beside workers’ compensation-specific research.

The 2024 Workers’ Comp Industry Insights Survey from Healthesystems and Risk & Insurance surveyed 500 industry stakeholders. Half of the respondents identified workforce recruiting, retention, and succession as a major industry challenge. The report included a comment that should sound familiar: “… adjuster turnover, caseloads are too high. So many things fall through the cracks.” When experienced people leave, the remaining people inherit more work. That higher workload creates stress. That stress contributes to burnout. Burnout contributes to turnover, which further reduces the workforce and starts the cycle over again.

There is some encouraging news, though.

The Jacobson Group and Aon’s Q3 2026 U.S. Insurance Labor Market Study found that 89% of insurance organizations surveyed plan to either increase or maintain their staff size during the next 12 months. About half expect to increase staff. Jeffrey Blair of The Jacobson Group said many organizations appear to be hiring to backfill key positions and bring in new talent rather than simply hiring for growth.

AI is increasingly changing the claims process. AI already summarizes voluminous medical records, assists with documentation, and identifies risks faster and more consistently than humans.  It doesn’t take much creativity to identify other uses of AI. Just a look at the mundane or overly complicated tasks still waiting to be automated. If you aren’t careful, you might assume that technology can fill the gap of missing adjusters.

However, Milliman’s 2024 examination of claims department challenges made an important distinction. Its authors described AI as a way to complement the expertise of claims professionals, not replace it. AI processes large amounts of information so people can focus on the issues that most need their attention. It frees humans to do uniquely human things, like show empathy and take context into account. Today’s adjuster is managing information completely differently than their predecessors. They’re also managing more information than ever before. Technology can assist.

But at the end of the day, somebody still needs to talk with the injured worker who is unsure whether they will work again. Somebody must recognize that a straightforward claim isn’t progressing the way it should. Somebody must communicate with the employer, clinician, attorney, nurse case manager, and a multitude of specialized service providers. Somebody must make decisions when the answer isn’t obvious.

Technology can give that person better information, but it doesn’t automatically give them wisdom.

So where do the next great adjusters come from?

Workers’ compensation is an unusual profession because very few kids grow up saying, “I want to be a workers’ compensation claims adjuster.” This industry is filled mostly with people who happened into their role, choosing it without necessarily choosing it. That’s great for the ones who found us, but hope is not a strategy when trying to staff properly.

The good news is that, once you’re here, you’re hooked. There are many disciplines involved in the role of a claims adjuster. Insurance, medicine, law, communication, negotiation, data, finance, return to work, risk management, human behavior, safety, technology, the list is endless. A claims adjuster combines all those unique vantage points into a single purpose: helping someone navigate what may be one of the most difficult periods of their life while fulfilling an obligation to the employer and the workers’ compensation system.

Recruitment to a non-destination is the first part of the challenge. The other part, when they arrive, is how to prepare them. Experience doesn’t transfer through osmosis.

Rising Medical Solutions’ 2023 Workers’ Compensation Benchmarking Study surveyed more than 1,300 frontline claims professionals. It found 72% of organizations provided formal training for new claims hires with little or no experience. The same study found that 87% of frontline claims professionals received ongoing skills training and development. Yet fewer than half strongly agreed that they received enough applicable ongoing training and development to effectively do their jobs. Rising’s research points to communication, active listening, critical thinking, and empathy as soft skills needed to excel in this role. Interestingly, only 38% reported receiving empathy training.

The study also found that only 54% of organizations offered a formal career path with growth opportunities for claims staff. That is consistent with what I wrote about Gen Z (“Gen Z Isn’t Looking for the Exit. They’re Looking for the Ladder.”)

If we need thousands of new people over the coming decade, recruiting them into an entry-level job isn’t enough. We need to show them a career.

For years, I’ve heard variations of the same concern: We’re going to have an adjuster shortage.

Based on everything I’ve shared thus far, I think that description may be incomplete.

What is more important is the experience shortage. You can hire a person, but you cannot instantly hire 25 years of judgment. When a veteran claims professional retires, we don’t simply lose one person from the organizational chart. We potentially lose thousands of accumulated decisions, conversations, mistakes, lessons, and pattern recognitions:

• The claim that looked ordinary but wasn’t
• The physician who needed a phone call instead of another form
• The injured worker whose anger was really fear
• The employer who needed coaching on return to work
• The little warning sign that an experienced adjuster noticed because she had seen it 100 times before

AI can preserve some institutional knowledge, but organizations still must intentionally transfer human knowledge. That means mentoring, structured onboarding, and professional development. That is the exact gap we built WorkCompCollege.com to close. It means giving newer adjusters progressively more complicated situations while experienced professionals are still around to help them understand why a decision was made, not merely what decision was made. It means creating a learning culture before necessity creates a staffing crisis.

Retirements, burnout, and automation are here. But that creates an opportunity – actually … 21,600 opportunities – to find talented people willing to learn and to help others.

This isn’t a dying profession, just one that is going through a unique period of metamorphosis. The organizations and people who seize the opportunity will be the ones still here in a decade. The future of claims may require fewer people doing yesterday’s work, but it also requires a lot of well-trained people capable of doing tomorrow’s work.

A new healthcare workforce study reports that 70% of Gen Z healthcare workers expect to look for a new role (inside or outside their current organization) within the next year. Only 44% of Gen Z feel “very loyal” to their current employer. Those numbers seem to confirm Gen Z stereotypes:

• They aren’t loyal
• They’ll leave a job at the first opportunity
• They expect promotions too quickly
• They don’t want to “pay their dues”

If you’re an employer, that’s enough to make you question investing heavily in developing someone who may already have one foot out the door.

But keep reading.

The same research showed that 95% of Gen Z respondents said long-term job security is important. In addition, 65% said they expect to remain with one employer for at least five years.

Huh?

They expect to look for a new role. But they also want stability and expect to stay with one employer for years. The two findings actually don’t contradict each other. Together, they suggest how the next generation sees work, learning and loyalty.

Maybe they don’t want to leave. Maybe they want to grow.

The study, 2026 Healthcare Workforce Barometer, was conducted by The Harris Poll on behalf of Strategic Education, Inc. and Workforce Edge. It surveyed 1,514 full-time, patient-facing healthcare workers and 304 healthcare employers.

Important disclaimer: This is research within the healthcare industry, not workers’ compensation. Nobody should assume their findings automatically transfer to every industry or every Gen Z employee. But I would be equally cautious about ignoring what the data is telling us. Consider it a hypothesis worth testing in our own industry and across all generations.

Among Gen Z respondents, a strong majority felt professional development mattered: 89% said clear opportunities for advancement matter, 71% valued the speed of career progression, and 86% believed education or learning new skills would help them advance. They’re not afraid of work, but they do have clear expectations for progress in their careers.

To paraphrase, they’re asking: If I give you the next five years of my career, who can I become while I’m here?

That’s a fair question. Employers need an answer.

The following important statistics come from the same report but are not specific to Gen Z employees:

• 26% “have a great deal of trust that their employer will support their long-term career growth”
• 23% “trust their employer a great deal to be a partner in helping them advance their career”

Meanwhile, for employers:

• 47% point to “a lack of opportunities for career advancement, professional development, or education opportunities as the main reasons why employees leave”

These are the report’s exact words, and they should make every employer uncomfortable. Employers have a credibility problem with their own teams: they know development matters, but their employees aren’t convinced they’ll provide it. Eighty percent of healthcare employees say advancement matters, but only 26% trust their employer to support it. That 54-point gap is worth paying attention to.

Jill Anelli, Tanner Health’s senior vice president and chief human resources officer, told HealthLeaders, “People stay when they know they have a future in that organization.”

Retention isn’t simply about convincing someone not to quit. It is giving them a reason to stay.

A 24-year-old entering our industry today doesn’t just want to learn how to do the job. They want to know where it can lead and how far they can go.

For instance, someone may enter workers’ compensation as a trainee claims adjuster, but what’s next?

• Senior adjuster?
• Catastrophic claims specialist?
• Supervisor?
• Risk manager?
• Nurse case manager with the right credentials?
• Operations leader?
• Compliance specialist?
• Executive?

One of my favorite cartoons that I’ve used often in presentations on this subject asks two questions:

What if I train them and they leave? Developing someone who leaves can feel like an investment made for somebody else’s benefit.

What if you don’t train them and they stay? You now have an under-equipped employee on the team, and you’re the reason.

The survey found that 75% of healthcare employees are interested in continuing their education, and 81% would be interested in an employer-sponsored program. Yet only 48% of healthcare employers have a comprehensive workforce education strategy.

Talk about a disconnect.

Taking all of this into account, imagine interviewing a talented 25-year-old and being able to explain not merely the job you’re offering, but the education, certifications, mentoring and career pathways that can follow it. Now you’re not just offering employment, but a future. As one of the report’s section headers clearly states, “Purpose gets people into healthcare. Growth keeps them invested.”

A certificate sitting on someone’s wall is nice. Being better equipped to have a difficult conversation with an injured worker matters more. Understanding medical issues well enough to ask better questions matters more. Learning leadership skills that prepare someone to mentor the next generation matters more.

Education becomes professional development when employees can connect what they’re learning to what they can do, and what they can do to who they can become. Not education for education’s sake, but education that changes behavior, develops people, and creates possibilities.

Here’s the takeaway for two potential readers of this blog:

Employers: Resist interpreting Gen Z’s appetite for advancement as impatience. Instead, ask yourself whether you have shown them a future worth staying for.

• Have you identified the skills they’ll need to reach their potential?
• Are you providing education, coaching and mentorship to help them develop those skills?
• Do your youngest employees know what opportunities could exist two, five or ten years from now?

This week: pick one entry-level role, map its next two steps, and share the map with the person who holds it.

Gen Z professionals: If your employer invests in your development, invest in it too. Be curious, find mentors, ask questions. That approach has defined my career since 1980. Professional development isn’t something an employer does to you. It’s something you do together.

Whichever reader you are, here’s the good news: 86% of Gen Z healthcare workers believe education and new skills will help them advance, and 80% of all healthcare workers say clear opportunities for advancement matter to them.

They believe they can advance. They want to learn. They want to develop. They want to see what’s next.

The data is clear about what Gen Z wants, and just as clear about what many employers haven’t built. Every year that we wait, the people we most need to keep are deciding whether we mean it.

Instead of hoping they’ll stay, show them what their next five years look like. If you want help building the education that connects one step to the next, start a conversation about custom training. Gen Z doesn’t need convincing that growth matters. We do.

I had a very difficult June, losing both my daughter-in-law and best friend to cancer. During that time (and since), my mind did something predictable.

I replayed the circumstances. The extended battle, the moment, the preparation of my BFF’s eulogy / watching my son eulogize his wife, the fond memories of the past that remind me there will be no future memories to make.

The replays only helped let something in the past occupy my present. The more I replayed them, the more power I gave it.

Then I remembered cognitive reappraisal, a concept that psychologists have shared with me over the years in one-on-one conversations and from conference stages.

Reframe.

Reframing doesn’t change what happened. It changes the frame (or prism) through which we look at what happened. The facts remain the facts. Instead of asking, Why did this happen to me?, the question becomes, What can I do with where I am now?

Instead of counting my problems, I started deliberately counting my blessings (yes, I sang that song to myself). Instead of continually looking backward, I tried to redirect myself toward the present and eventually toward the future.

I did not pretend the difficult things didn’t happen. I simply decided they did not deserve unlimited reruns.

How often do we make injured workers replay instead of helping them reframe?

Think about what happens after a workplace injury. The supervisor, then HR, asks what happened. The initial medical provider asks. The nurse asks. The claims adjuster asks. The nurse case manager asks. Maybe an investigator asks. If litigation occurs, attorneys, experts, and others may eventually ask.

Tell me what happened.

Again. And again. And again.

Obviously, that information is necessary. Clinicians need an understanding of the medical history. Claims professionals need to investigate the compensability of the claim. Employers need to understand how an accident occurred so they can mitigate future accidents. There are legitimate medical, legal, safety, and administrative reasons for asking questions.

I wonder whether we sufficiently appreciate what we may also be asking the person to do: Replay one of the worst moments of their life.

For us, it may be another claim intake.

For them, it may be the moment the machine caught their hand, the ladder moved, the truck crossed the center line, they heard the pop in their back, they looked down and realized something was terribly wrong.

We need the story. But perhaps we don’t need to keep making them live in it.

What if we changed the questions? This is where reframing becomes interesting to me from a work comp perspective. After we have the facts we legitimately need, what if more of our conversations shifted from:

     What happened to you?

     to

     How are you doing today?

Followed by:

• What’s better than it was last week?
• What can you do today that you couldn’t do a month ago?
• What are you looking forward to getting back to?
• What’s important to you outside of work?
• What would progress look like to you?
• What can we help you accomplish next?

Notice what those questions do. They don’t deny the injury, minimize pain, or promise an outcome. They certainly don’t eliminate legitimate claims investigation or medical history-taking. They simply move the center of gravity. The injury becomes part of the person’s story rather than the only part of the story.

That is a very different frame.

We tend to measure what is wrong. Workers’ compensation is remarkably good at documenting deficits …

• Pain is 7 out of 10 (FYI … I have not been a fan of the visual analog scale since 2003)
• Range of motion is limited
• MRI shows this, restrictions prohibit that
• Employee cannot lift 20 pounds
• Employee cannot stand longer than 30 minutes
• Employee has not reached maximum medical improvement

Those measurements matter.

But imagine experiencing your recovery primarily through a system that continually catalogs everything you cannot do.

What happens if we also start measuring what is returning?

• I walked to the mailbox today
• I drove for the first time
• I slept through the night
• I picked up my child
• I made dinner
• I worked four hours
• I laughed with my coworkers
• I went fishing
• I had an entire afternoon when I didn’t think about my injury

Those things may never appear in a claims system, but they are evidence of recovery. Some of our most important milestones don’t have billing codes.

This connects directly to empathy. On September 3 I wrote about empathy not being soft, but strategic. To me, reframing is a natural extension of that idea.

Empathy asks us to understand what an injured worker may be experiencing. Reframing asks us what we can do with that understanding.

We cannot change the accident. We cannot un-break the bone. We cannot erase the surgery. We cannot give someone back the Tuesday morning before everything changed.

But we can be intentional about where our interactions direct their attention next.

• Toward the injury or toward recovery?
• Toward everything they’ve lost or toward what they’re regaining?
• Toward what happened or toward what happens next?

That doesn’t require becoming someone’s therapist. It requires becoming more thoughtful about our words.

To be clear, reframing isn’t positive thinking. Telling someone who is hurting to “look on the bright side” isn’t reframing. It could actually be perceived as dismissive, condescending, or invalidating.

Reframing doesn’t replace reality with optimism. It expands reality.

• Yes, this happened … and this is where we are now.
• Yes, you still have pain … and look at the progress you’ve made.
• Yes, your life may be different … and let’s talk about what you want that life to look like.

Both things can be true.

That’s what I had to (re)learn this summer. Counting my blessings didn’t dry my tears. Being present didn’t rewrite the past. Looking toward the future didn’t mean pretending everything behind me was wonderful. I just stopped giving the replay button quite so much attention. Instead, I focused on supporting both surviving spouses and my two granddaughters.

Workers’ compensation professionals encounter people during seasons they didn’t choose.

We cannot control how someone responds to an injury. We cannot manufacture resilience. And we should never trivialize the emotional consequences of having health, independence, income, identity, or purpose suddenly disrupted. But we can influence the environment surrounding their recovery.

Every conversation can reinforce the injury or create a little more room for the person beyond the injury. Every question can pull someone backward or help them look forward. Every interaction can focus exclusively on what’s wrong or remind someone of what’s becoming right again.

We will always need to ask: “What happened?”

Maybe we just need to become equally good at asking: “What’s possible now?”

The past deserves to be understood, but it doesn’t deserve to be lived forever. Just like my difficult June.

In last week’s blog, I wrote about the claims strategy of empathy as a recap from the WCI conference.

Just a few days later, I was sitting in a room at the Georgia State Board of Workers’ Compensation conference listening to two experts make that idea tangible.

The session was titled “When Life Is Not a Beach.” It featured Josh Schuette of Brooks Rehabilitation and Scott Hoskins of Shamrock Prosthetics. Josh is a physical therapist. Scott is a prosthetist. Both have spent their careers helping people rebuild lives after catastrophic injuries.

Scott said something early that I wrote down and stayed with me during the entire session: “Life is unfair to everyone, so it actually is fair.”

At first, it sounds almost flippant. It isn’t. It was said in the context of helping amputees adjust to a new normal.

One day the prosthesis fits perfectly, then the next day it hurts. One day, forward progress is tangible. The next day, everything falls backward. Bodies change. Limbs change. Strength changes. Confidence changes. Recovery is not linear, an important reminder for catastrophic injuries.

Josh framed the entire session around two concepts: resilience and empathy.

He gave the audience example after example of people who suffered injuries that most of us would find almost unimaginable, and yet they somehow found a path forward by being resilient. One example involved a woman who had lost all four limbs, became independent again, resumed caring for her family, drove herself, and later became a mentor to another quadruple amputee. She certainly had assistive devices to make that happen, but getting there was primarily due to her mental strength.

What separates the people who make extraordinary recoveries from those who struggle? There is no easy formula. As Josh put it, there is no gene for the human spirit. You can study injury severity, age, comorbidities, functional measures and every other variable we routinely put into our predictive models. But none of those fully measure the person. Until presented with a seemingly insurmountable challenge, nobody ever really knows how they’ll respond. With resilience by them and empathy from us, the path is easier (relatively speaking) to recovery.

One of Scott’s slides addressed something we don’t talk about nearly enough in workers’ compensation: identity. After an amputation, the challenge is not simply learning to use a prosthetic device. It may be grieving the person you were, anger that it happened to you, or a completely altered body image that stares at you in the mirror. The slide said it plainly … “I’m not the same person anymore.”

Scott estimated the journey as “20% physical, 80% mental.” His point was not that physical rehabilitation is easy. His point was that the body can often adapt faster than the mind accepts what has happened. We cannot separate physical rehabilitation from that psychological adjustment.

Think about the implications of that for workers’ compensation. One morning someone wakes up, goes to work and assumes the day will be ordinary. Hours later, they may wake up in a hospital without a limb. They are still a spouse, parent, an employee. They are the same person who fixed things around the house, coached Little League, went fishing, worked construction, picked up their grandchildren or lived independently. Except they’re not. In the blink of an eye, almost everything about how they performed those roles has changed.

The hardware matters, but the human matters more.

Scott talked about the sophistication of prosthetic technology, but he repeatedly returned to the idea that the device itself does not create success. He could put a crude device under a highly motivated, capable amputee and that person would find a way to use it. “The componentry doesn’t make you a good walker,” he explained. “The human makes a good walker.” Read that again, just to let it soak in.

That statement does not minimize the importance of excellent prosthetic care. It instead underscores that no amount of technology will empower an unmotivated patient to regain their life.

The question should never be: What is the most advanced device available?

It should be: What will help this person rebuild their life?

The goal is, in the work comp context, returning to work. But it also includes playing with their children, walking on the beach, fly fishing in Montana or simply moving through the house independently. In other words, whole-person recovery. Sorry (not sorry) to constantly bring that up in everything I write …

Josh did something clever during the session. Sometimes, we need to experience frustration to make progress. He asked several able-bodied audience members to temporarily experience what injured workers face.

One used a lower-extremity simulation device that forced the person to relearn balance. Another tried a body-powered upper-extremity device that required coordination, practice and concentration. Another used a wheelchair on carpet.

That theme continued with traumatic brain injury. I happened to be one of the people given glasses that simulated visual impairment. My assignment sounded ridiculous in its simplicity: Text someone. Except suddenly I was trying to decide which of the multiple phones I appeared to be seeing was the real one. It was disorienting, frustrating, and humbling.

None of those temporary experiences compared to someone living without a limb or with repercussions from a TBI. But it changed the question.

Instead of asking, “Why is this person having so much trouble doing something simple?”

You begin asking: “What does simple feel like from their side?”

In other words, empathy.

Recovering from these kinds of injuries is a marathon, not a sprint. Both Scott and Josh repeatedly emphasized patience.

For example, pushing harder is not always better for an amputation. Wearing a new prosthesis an extra hour may seem like determination, but if it creates a wound or infection, that “extra effort” can set recovery back weeks or months.

Scott also warned against comparison. An injured worker sees someone online running a marathon with a prosthetic leg and wonders why they can’t do that (yet or ever). It could be that person was born without a leg and has had a lifetime to adjust, while the injured worker is only two months past the traumatic event. Comparison, for anybody at any time, can be the thief of joy.

The biggest takeaway from this session is simple but profound. In the case of catastrophic injuries, sometimes the old life cannot be restored exactly as it was. The goal then becomes something more difficult.

Reinvention.

That is a good lesson for us all. When bad things happen, our response is the only thing we can control. If that response is pity, fear, and anger then the outcome is not likely to be positive. However, if the response is hope, resilience, and reinvention then the new you might even be better than the old you.

Shamrock’s three pillars are hope, inspiration, and reinvention. For those of us fortunate enough to work alongside someone whose life changed on the job, our responsibility is not simply to manage the impairment. It is to help create the conditions for their hope, resilience and reinvention.