Best estimates are that work comp accounts for 1-2% of overall healthcare costs in the US. We are close to a rounding error when compared to private health insurance (28-31%), Medicare (20-23%), Medicaid (18-20%), private pay (10%), and other government programs (5%) like the Veterans Administration, Tricare, and Indian Health Service.

Although we’re small in the big picture, broader healthcare trends almost always find their way into work comp eventually.

Something important is happening in healthcare right now that deserves our attention.

I’ve had a history of identifying and talking about medical issues in work comp before most of the industry recognized them. That includes the over-prescribing of opioids (and crazy cocktail of ancillary medications) in 2003, cognitive behavioral therapy and a biopsychosocial treatment model in 2010, medical use of cannabis in 2014, virtual reality in 2019, psychedelics for PTSD in 2023. My “Spidey senses” are that this macro change might be headed our way.

What is it? A kerfuffle on prior authorizations of medical care.

Aetna, Blue Cross Blue Shield Association, Centene, Cigna, Elevance, Humana, Kaiser Permanente, and UnitedHealth announced efforts to simplify and reduce prior authorization requirements. Actually, in June 2025 a total of 60 major health insurers “Pledge(d) to Improve Prior Authorization.” Their stated goals are to reduce the number of services requiring preauthorization, accelerate approvals, standardize electronic prior authorization, and improve transparency around denials and appeals. None of them, to my knowledge, say that preauthorization is bad practice. Instead, it’s about reducing administrative burdens and modernizing outdated workflows. They’ve already made a couple of mistakes, like leaning too much into AI for auto-denials. For example, ProPublica uncovered in 2023 that 300,000 claims were inappropriately denied by an algorithmic system called PxDx.

However, these changes are not happening without a reason. In my opinion, it is because pressure has been building for years from patients and providers who increasingly see prior authorization as an obstacle to care rather than a safeguard against inappropriate utilization. The December 2024 killing of UnitedHealthcare CEO Brian Thompson brought that frustration into sharp public focus.

According to an AMA survey published on May 13:

• More than one in four physicians (26%) report that prior authorization has led to a serious adverse event, including hospitalization, permanent impairment, or death.
• More than nine in 10 physicians (95%) say prior authorization delays access to necessary care.
• Nearly four in five physicians (79%) report that patients abandon treatment due to authorization challenges.
• More than nine in 10 physicians (92%) say prior authorization negatively affects clinical outcomes.

Whether you agree with that perception or not almost doesn’t matter anymore. Perception drives politics, and politics eventually drives policy.

To be clear, prior authorization did not appear out of nowhere. There were legitimate reasons it was introduced. In workers’ compensation, preauthorization became a necessity to better manage utilization, control costs, encourage evidence-based treatment, and reduce unnecessary or excessive care.

Most states have some combination of treatment guidelines, utilization review requirements, drug formularies, or procedural approval thresholds. In many jurisdictions, entire administrative infrastructures have been built around determining whether a treatment request is “reasonable and necessary.” That created a multitude of vendors who facilitate the process.

From a payer perspective, that structure exists for a reason.

Workers’ compensation is vulnerable to overtreatment, prolonged disability, excessive pharmaceutical utilization, provider shopping, and procedural inflation. We’ve all seen examples where oversight was necessary. Some level of utilization management is probably unavoidable in any system where financial responsibility and treatment decisions are disconnected (i.e. the patient does not pay for their medical care).

However, the public conversation around prior authorization is no longer being framed around “appropriate oversight.” It is increasingly being framed as “denial of care.”

For a quick overview of the vibe around preauthorization, read “Denied by a Bot? Doctors Warn AI Is Blocking Your Medicare Advantage Coverage” by Zack Sigel. Stories like this break trust and create a public backlash.

An injured worker does not differentiate between group health prior authorization and workers’ compensation utilization review. They simply hear stories about delayed MRIs, denied surgeries, postponed medications, or administrative barriers while someone is suffering. Those stories create emotional reactions. Emotional reactions create political momentum. Political momentum creates reform efforts. I was involved in the early 2010s in lobbying for drug formularies and saw firsthand how the political process is driven by facts and emotion, not necessarily in that order.

As large national insurers begin publicly repositioning themselves as reducing preauthorization requirements, that changes expectations across the broader healthcare ecosystem. That could eventually include work comp.

Workers’ compensation already faces a perception problem in some circles. There are people who believe the system is too slow, too adversarial, too administrative, and too focused on cost containment. There are periodic stories that feed the stigma that some cast it as an indictment of the entire industry. I do not agree as I think the system works well a vast majority of the time. But one really bad experience can paint a broad-brush over all stakeholders. In legislative or regulatory environments, perception can sometimes beat reality.

The issue is not if preauthorization is “good” or “bad.” The issue is whether there is proper balance.

Nobody wants medically necessary treatment delayed unnecessarily. But nobody should want a system without guardrails either. Workers’ compensation is unique because treatment decisions directly impact disability duration, return-to-work outcomes, indemnity exposure, reserve adequacy, litigation risk, and long-term claim trajectory.

Ignoring this macro trend, however, would be a mistake.

Healthcare is clearly moving toward simplification and faster decisions facilitated by AI. The expectation of immediate access and reduced administrative burden is becoming culturally normalized.

Workers’ compensation will not be immune to that pressure forever.

It would be a good idea … now … to start evaluating where preauthorization truly adds value versus where it simply adds delay. Finding ways to drive innovation and efficiency to deliver evidence-based medicine will reduce friction.

I’ve heard of networks that treat the highest performing physicians and clinicians – those with quick and full functional recovery – differently than those who don’t have similarly good outcomes. It makes logical sense to reduce or even eliminate preauthorization requirements for medical providers who consistently deliver quality care that focuses on a return to function and work.

We should also better communicate the process to all the system stakeholders. The industry often explains utilization management in technical language while the public experiences it emotionally. That communication gap matters. Transparency as to purpose will help resolve that gap.

If this is news to you, this is your 2-minute warning.

The term “new normal” has been used – some might say overused – since it became popular after the 2008 financial crisis. It was used then to reset expectations of growth from before the crisis to after the crisis. Since that time, it has become the pop-culture way to describe a permanent shift after a major event.

The work comp industry has often used this phrase to describe what happens to an injured worker after an occupational injury or disease that is going to have a lasting effect. MMI, or maximum medical improvement, is a statutory way to determine if someone will not likely improve with any additional treatment. However, MMI is often misunderstood as indicating the injured employee will be back to the same level of function they had prior to the incident. In reality, people are judged to be at MMI whose capabilities have not been fully restored.

This creates a “new normal” that requires an adjustment to how they work and live their life.

The purgatory I mentioned is about the journey TO the “new normal.” It is the recovery process that can often be one step forward and two steps backward. This process can seem overwhelming at the beginning, and so incrementally slow from day to day, that it might seem unattainable. Both of those – overwhelming and unattainable – can be a deterrent to motivation. This creates anxiety, doubt, and a loss of self-efficacy and locus of control (a fascinating concept that I’ve talked about since 2011; read this Psychology Today article for more information).

This was reinforced to me over a recent dinner with a great friend. He had been in the hospital for four out of five weeks at the beginning of this year. I visited him in the hospital on the third day when the prognosis was unknown but serious. I visited him again a few days later when he was better but still not out of the woods. I visited him twice during his second stay in the hospital when recovery was in sight.

Those weeks of lying in a hospital bed sapped his stamina and strength. He also had some new health conditions and medications that will be lasting. He was starting a new job that involves quite a bit of walking and so he was motivated to get back to his robust physical capabilities.

But when he was back home, he didn’t move because he lacked his usual physicality. We texted and he was extremely frustrated, and to some extent, depressed. He knew in his head that the prior five weeks of being sedentary and having new medical conditions had an impact, but when it translated to being out of breath after just a few steps, it still gobsmacked him. And demotivated him. He was in the “purgatory” of recovery – out of the clinical crosshairs but not yet back to his old self.

There was a disconnect. He knew intellectually that he had a “new normal” but he still wasn’t prepared for it. He knew he had to put in the work to rebuild his stamina, but the hill seemed too steep (literally and metaphorically).

So, I texted him … just walk to the kitchen and back to the living room. Every hour. He set a reminder on his phone. I set a reminder on my phone and texted him each hour. In those texts, I let him know that he wouldn’t get better if he didn’t try. He is an extremely competitive person, so I knew that if I gave him a goal and provided accountability that he would rise to the occasion. He did.

He was excited when he was able to go a little farther on the next iteration. The hourly schedule got so baked into his mindset that he provided an update before my reminder text. He was ecstatic when he first went outside to walk around his neighborhood. Slowly but surely, he gained confidence in the simple act of motion because he saw the small but measurable improvements.

When we met for dinner last week, we had a long recap discussion of his journey in three-plus months (it has been a whirlwind). We talked about how he has regained most of his mobility, has adjusted his diet, and embraced his “new normal.” Interestingly, it was so normal now that it was hard for him to remember the “old normal” (before his health concerns) or the purgatory of the recovery process. He has fully acknowledged and accepted his new limitations and it’s just, as a matter of fact, how it is. While he may miss some aspects of his “old normal,” he is living his “new normal” by asserting an internal locus of control. He is in charge of his attitude and actions.

Change is hard. It is manageable. But a person might need some extra TLC to get thru the slog of recovery into their “new normal.”

In work comp, that purgatory is where claims can go off the rails. It is reasonable for individuals to worry about their future. It should be expected they will be anxious working through a system for which they have no experience or education. We should anticipate that when the recovery gets hard or progress is imperceptible, motivation can dwindle. This is the human experience.

Don’t judge them. Help them.

Occasionally, you look up and realize something didn’t just progress. It shifted.

That’s what happened over the past week.

Two separate federal actions – one focused on psychedelics and the other on cannabis – may seem unrelated at first glance. Different substances. Different histories. Different levels of acceptance. But when you step back and look at them together, they tell a much bigger story.

The landscape around “alternative” treatments for mental health isn’t just evolving anymore. It’s accelerating. Today is what I’ve been discussing as a possibility since 2014.

My RxProfessor journey started by addressing work comp’s over-prescribing of opioids in 2003. As use declined, the next logical question was what would replace them for patients with real issues. NSAID’s were the conservative answer, but I didn’t stop there. The emergence of CBT and a biopsychosocial treatment model became a focus of mine in 2010. The 2014 Vialpando decision in New Mexico affirming medical use of cannabis for an injured worker piqued my interest. In 2019, I took on an advisory role with a company that offered virtual reality and through that became a fan of neuroplasticity. A conversation with a medical director in 2022 opened my eyes to the increasing use of psychedelics (specifically psilocybin) for PTSD.

My initial question of “what will replace opioids” became a quest to stay on top of the various options.

I did not address any of them from a perspective of advocacy, but from a place of awareness. Whether you agree with these therapies or not is almost beside the point. What matters is that they are moving – scientifically, culturally, federally – toward broader acceptance. When that happens, workers’ compensation doesn’t get to sit on the sidelines.

We must be ready. As you may know, the first step in risk management is identification.

President Trump issued an Executive Order on April 18 regarding psychedelics. It was interesting to see Joe Rogan and military veterans at the press conference who have advocated for ibogaine to treat mental illness and PTSD. This EO is a clear signal that the federal government is prioritizing the development and accessibility of new treatments for serious mental illness. This includes the potential of rescheduling after expanded clinical trials. That’s not fringe anymore. That’s policy.

While psychedelics may still feel like a future conversation for many in our industry, the reality is that the groundwork is being laid right now. Dollars are being budgeted. Clinical research is expanding. Regulatory pathways are being explored. And most importantly, the narrative is changing from skepticism to structured exploration. If you think about it clearly, the use of psychedelics in the Veterans Administration is workers’ compensation.

Today (April 23), President Trump made official what has been pondered for many years … moving cannabis from Schedule I to Schedule III. This was the next logical step after a December 2025 EO that expanded research. The DEA has already announced a June 29 hearing to define the pathway. The FDA, DEA, and NIDA decided in 2016 to not make that adjustment, which I wrote about in “Marijuana science still half-baked (?).” While this isn’t officially a legalization of cannabis, these changes make it more normalized, accessible, and embedded in conversations about care.

And that’s where this becomes very real for workers’ compensation. I’ve argued for 20+ years that we do not operate in a vacuum. We operate in a system where injured workers are influenced by what their doctors recommend, what their communities accept, and what the broader healthcare system begins to adopt. As alternative treatments, whether psychedelics or cannabis, continue to gain legitimacy, they will eventually show up in our claims. Spoiler alert … cannabis has intersected with work comp since 2014, at times very publicly but also (and I know from private conversations) more broadly outside the spotlight.

The question is not if. It is when, and how prepared we are when they do.

One of the consistent challenges in our industry is that we tend to react to change rather than anticipate it. We wait until something becomes an issue before we build a strategy around it. This is one of those moments when the signals are strong enough – and early enough – that we don’t have to be caught off guard.

So, what does that look like in practice?

It starts with education. Understanding what these treatments are, what the research says (not just headlines), and where they may or may not be appropriate. It continues with policy awareness which includes tracking how federal direction influences state statutes, regulatory frameworks, and payer / employer obligations. It also requires open dialogue with providers, employers, and other stakeholders about how these therapies might intersect with return-to-work, safety, and overall claim management. And it requires creating policies around how their “reasonable and necessary” use for injured workers will be addressed.

It also requires something that may be even more important: perspective.

At the center of all of this is the injured worker. Many of them are dealing with chronic pain, trauma, sleep deprivation, depression, anxiety … often all at once. If new treatment options emerge that have the potential to improve outcomes, we must at least be willing to understand them, even if we’re not ready to fully embrace them.

That doesn’t mean abandoning evidence-based care. It doesn’t mean ignoring risk. And it certainly doesn’t mean opening the floodgates without structure or oversight. For example, the FDA Commissioner Dr. Marty Makary specifically mentioned that clinical oversight of psychedelics is a requirement. This is not a return to Timothy Leary or Cheech & Chong.

But it does mean acknowledging that the definition of “acceptable treatment” is changing. It’s changing faster than it has in a long time. And you may have no control over the pace of change.

One week didn’t decide the future.

But it made the direction unmistakably clear.

The evolution of alternatives is no longer a slow burn.

It’s here. And it’s picking up speed.

If you’re in the work comp industry and haven’t been paying attention, today is your wake-up call.

On February 26, WorkCompCollege.com and Workplace Health hosted the first ever “WCMICS Live.” WCMICS is the “Workers’ Comp Mental Injury Claims Specialist” certification that WorkCompCollege.com launched in Fall 2025. I served as moderator for the all-day event and specifically designed it to be a hybrid learning experience. We watched short video excerpts from the WCMICS faculty together then paused to discuss, challenge assumptions, and apply what we heard to real-world scenarios. I even created a 42-page study guide for the students to give them an opportunity to take notes.

After spending eight plus hours together with lively discussion throughout, I asked a simple question to end the day: What did you learn that you can actually apply when you get back to work?

That’s the real test. Not what sounds good in the room, but what behavior changes afterward. If you’ve ever heard me speak, you know I always strive to turn academics into action.

The answers were telling.

One of the most consistent themes as we went around the room was a shift toward seeing the injured worker more holistically. As one attendee put it, “We need to think of them in totality, both from a bio and a psychosocial evaluation.” That may sound obvious, but in practice, workers’ compensation has historically emphasized the physical injury while underestimating – or outright ignoring – the psychological and social factors that often drive the duration and complexity of a claim. Another participant reinforced that reality by noting that if we ignore what’s happening in someone’s personal life – divorce, financial stress, prior mental health history, etc. – we risk missing the very things that are prolonging recovery. That’s not a philosophical issue; it’s an outcomes issue.

Another shift came in how attendees viewed the “subjectivity” of mental injury claims. There is a long-standing belief in the workers’ compensation ecosystem that psychological conditions cannot be measured or validated in the same way as physical injuries. That belief started to break down during the session. As one attendee shared, “I always thought psych was just subjective … but now I see there are validation tools that make it more objective.” Whether it was understanding screening tools, recognizing the role of structured assessments, or applying frameworks like FIDOC, the takeaway was clear: this isn’t guesswork. There are ways to evaluate, validate, and challenge information in a disciplined, transparent, evidence-based manner. Several attendees mentioned that they now know what to look for in a report. Just as importantly, they now know what questions to ask when something doesn’t add up.

Communication and documentation – concepts that everyone in work comp is familiar with – took on a different level of importance in this context. One attendee said it best: “You don’t build a house on a bad foundation … communication and documentation are key.” In mental injury (or “psych”) claims, that foundation becomes even more critical because so much of the claim is shaped by conversations, perceptions, and recorded observations. Another participant made a comment that stuck with me: “There’s really no such thing as a casual conversation when psych is involved … everything matters.” That’s a powerful reminder that what may feel like routine dialogue can ultimately influence claim direction, credibility assessments, and even litigation outcomes.

There was also an honest admission from several attendees who had been hesitant to engage in deeper conversations with injured workers. As one person shared, “I’ve shied away from asking those kinds of questions … I didn’t want to open Pandora’s box.” That concern is real and it’s common. By the end of the session, that hesitation had shifted into something more productive: a recognition that understanding context is not about creating problems but about uncovering what’s already there. When handled correctly, those conversations don’t complicate the claim. They clarify it.

That ultimately led to the most important takeaway of the day: everyone was committed to doing something different. This wasn’t a theoretical discussion, but something that inspired change. I have advocated for a biopsychosocial approach since 2011 and am now the Provost of the change agent that is WorkCompCollege.com. The aspiration for change was music to my ears.

Attendees talked about asking better, open-ended questions and actually listening to (then documenting) the answers. They talked about setting clearer expectations with providers and holding them accountable for more thorough documentation. They talked about reviewing reports more critically instead of accepting them at face value and paying closer attention to medication interactions. They reinforced the need to be more intentional about building trust, starting with the very first interaction with all of the stakeholders, especially the injured worker and their family or support structure.

The takeaways weren’t about replacing what works. Instead, it was about expanding it to reflect the reality of today’s claims environment.

The full WCMICS online curriculum is designed to be practical and immediately applicable, reinforcing concepts like early identification, structured investigation, and coordinated communication across stakeholders. But what matters more than the structure is the shift in mindset that comes from the education. Moving from a purely physical focus to a whole-person approach. From assuming subjectivity to applying structure. From reacting to being intentional.

Because at the end of the day, these aren’t just claims. They’re people trying to get back to their jobs, their families, and their lives.

If that’s the lens we use to approach our work, better outcomes will follow.

I had the privilege last week of being part of a panel, for the fifth year, at the California DWC educational conference in Oakland. This time it was two panels, both of which were focused on the use and implications of AI in workers’ compensation.

While I have been a work comp “educator and agitator” (yes, the real tagline associated with my The RxProfessor brand) for over twenty years, much of my own professional growth has come from personally interacting with experts from many perspectives.  I don’t learn in a silo. Thus, I was thrilled to be invited by Dr. Chris Brigham to be on these panels.

To prepare, I not only reviewed the intended content but also my co-panelists (of whom I only foreknew Chris). As a daily user of AI for just about two years, I was a tad intimidated. Look at their LinkedIn pages and you will see why:

• Alex Almazan Esq., Almazan Law (FL)
• Ben Wen, RevTops and others (CA)
• Chris Brigham MD, Brigham and Associates and others (SC)
• Harvey Castro MD MBA, Medical Intelligence Ops and others (TX)
• Mark Tainton, Wisedocs (IL)

I always strive to not be the smartest person in the room. I was ridiculously compliant this time.

However, our first meal together on the night before the conference made me feel at home.

Not only were each of them highly intelligent and accomplished, but they were also warm and kind. Eye contact, inquisitive conversation, and easy smiles and laughs were their hallmark of engagement. As we had other meals together, we learned about one another beyond the resume. I soaked up new insights from their vast experience, pushing to broaden my horizon. We even had a group text chat that we continued using during our respective plane rides home. We connected, and our chemistry showed when it came time to be on stage.

During that time of building rapport, I recognized that I belonged in the room.

Why am I sharing this?

Being in the room is important for professional and personal growth. Whether you feel like you “belong” or not (aka imposter syndrome), you need to be in the room. Whether you are invited into the room or invite yourself, you need to be around people that at first glance may be out of your league. You need to be in rooms of your subject matter expertise and in rooms where you are a novice at best. Rooms need to be both comfortable and uncomfortable. You can be a mentor in one room and a mentee in another room. Importantly, you can be a sponsor for someone who does not have access to a room but belongs there.

Since beginning my professional career in 1980, I have had dozens of mentors and mentees and thousands of important conversations. I have “snuck” inside some rooms, been invited to others, invited others to a room where I already was, and in some cases even created my own “room.” What is in my brain (and comes out on stage or in writing) is a synthesis of every conversation in every room. The importance of casting your net wide for opportunities to learn cannot be overstated.

The ability to maximize your God given talents, refine your skills, and achieve your true purpose in life is completely related to your commitment to being a lifelong learner, wherever that takes you.

The key to success is … Be in the room.

That has been my description of the past several holidays. It always elicits an eyeroll from my wife with a corresponding “that doesn’t make sense” comment. Which, I agree, the phrase is somewhat nonsensical.

The words “new” and “tradition” don’t usually fit within the same sentence. A tradition, in the traditional definition, is something that happens without much change more than once, whether it was intended to be recycled or not. New is obviously the antithesis of that.

This is my sixty-fifth holiday season. I recall very little of the first few. However, once I got married and built a family, I was in a lead role for creating our holiday traditions. Back then, what we did one year was highly predictive of what we would do the next year.

When I was newly married with young children and all our parents (their grandparents) were alive, Thanksgiving and Christmas mostly had the same agenda year after year. Thanksgiving was when multiple generations gathered (20-30 people) together for pot-luck meals and football in the front yard and on TV. A smaller group attended Christmas Eve service then came to our house to watch “It’s a Wonderful Life” and wake up to stockings and gifts under the tree. Even my tradition of shopping on Christmas Eve was baked into the expected process.

As my father, father-in-law, and other relatives passed away and our children became adults with their own families, each year was different. Gatherings were smaller and in various locations at different times. We generally knew what we were doing and with whom, but the timing and sequence was often a puzzle we pieced together real-time. Honestly, I wasn’t a fan at first. I missed my traditions from the past, but having a “blank slate” each year also brought a new sense of adventure.

This year followed the same newness pattern over the past decade or so. For the second straight year we drove up to Raleigh to visit my brother-in-law’s family at Thanksgiving, but with only one functioning car it required a rental to fit passengers and luggage. I spent Christmas Eve overnight in the hospital with my best friend who just had back surgery after a truncated dinner that was not at our usual Japanese steakhouse location. Christmas morning was a direct drive to pick up my Mom to go to – not our house, as usual – my daughter’s house. On the day after Christmas, we bought a car.

Regarding a new annual tradition, 2025 told all the previous years to “hold my beer.”

Fortunately, one tradition has remained for several years – watching “A Christmas Story” on endless loop on TNT / TBS and waiting for the most predictable but memorable scripted line ever in a movie … “Oh my God, I shot my eye out.”

Does any of this sound familiar to you? You have a vision in your head of what should happen, an expectation that how it’s been is how it will always be. Then, suddenly or gradually, it changes. To be clear, I am not trying to equate being able to go to Helen GA every Thanksgiving to life-altering events like death or catastrophic injury. But I have found that how you respond to “little” things is a predictor of how you will respond to “big” things.

Being able to adjust to change is called resilience (“the capacity to withstand or to recover quickly from difficulties; toughness”). It is what we ask injured workers to have as they progress towards recovery. It is what we all learned we had – or didn’t have – during COVID. It is the difference between dwelling on the past and cherishing their memories as you create a new future.

This is being published on January 2, 2026. Yes, a new year. It is impossible to know what will happen over the next 363 days, what will remain the same / as expected and what will change – for the better or worse. One thing you can count on IS change.

Are you prepared for the new annual tradition that is coming your way?

As I mentioned in Part 1, I was on a medical malpractice jury in June 2024. There were several things that I learned through that process that I think work comp stakeholders should consider on each individual claim.

People put into unfamiliar circumstances are reliant on experts. Many of the medical terms used throughout the trial were foreign to everyone on the jury. Since we could not do any research outside of the courtroom, we were reliant on expert witnesses, the attorneys and the presiding judge to ensure we knew enough for it to be useful. Most injured workers are not work comp experts. While they are not prohibited from doing their own research, they are still very reliant on experts to educate them on terms, benefit and treatment options, and the general process. This is not a role that any stakeholder should take lightly because the possibility of positive outcomes diminishes in the absence of trustworthy and understandable information.

Differing opinions from experts complicate choices. The details of the case were very important to understand, from macro to micro, so there were many medically oriented expert witnesses. Often, though, the expert for the defense had a different opinion than that of the plaintiff’s expert. Who to trust came down to their education and experience, but as importantly how their information fit into the big picture. Injured workers may receive a variety of opinions that can seem contradictory. When providing that expert advice, it will come down to whether you have credibility from your background AND your communication style. The goal is to educate, not convince, so the injured worker can make the best choice for their circumstances.

None of the key stakeholders chose their role. Neither the family nor doctors chose the circumstances that led to the reason for the trial. None of us on the jury chose to be there – we were selected for jury duty and then for the jury itself. The attorneys, judge, and bailiffs chose to be there as part of their profession, but the ones with the most at stake did not. Unless there is fraud involved, neither the injured worker and their family nor their employer and coworkers wanted an occupational injury or illness to occur. They were in the wrong place at the right time. The lack of choice meant they were not prepared for what happened nor what that meant for their future. Keep that in mind when they are confused, angry, or anxious.

Collaboration through relationship will ensure the right decision. After the initial vote showed an even split of Guilty v. Not Guilty, it was obvious that reaching a unanimous decision was going to take an open mind, critical thinking, and transparent dialogue. Nobody on the jury knew each other before the voir dire, and because we were not allowed to discuss the case during the trial, we talked very superficially before deliberation. The initial trip around the table to discuss the first vote (and counterclockwise later to give everyone a chance at stating the discussion) was designed to build a relationship. It was a complicated case that we needed to hash out together, and that could not be done by strangers. The entire team of stakeholders responsible for returning an injured worker back to health and work must be just that … a collaborative team. While the claims adjuster is the “foreperson” leader, everyone should work together for the common goal of helping that injured worker back to normality.

Don’t underestimate the importance of communication. Whether it was the attorneys explaining the nuances of medical treatment or the judge outlining how the law applied, clear communication was key to the jury so we knew in that closed room how to proceed. None of us had any expertise on the subject matter and all we could consider was the evidence and our handwritten notes, so it was incumbent on the other stakeholders to be as clear as possible. When helping an injured worker who is not an expert on the complexity of work comp, it is the expert’s responsibility – not theirs – to communicate in a manner that is understandable, concise, and actionable. Using industry-specific acronyms and polysyllabic words might serve to complicate and confuse rather than simplify and enlighten. Make it a habit to ask open-ended questions to gather information, end each soliloquy with “did you understand what I just shared” question, and take on an attitude and tone of empathy.

Facts and law trump emotions. Both sets of attorneys had emotional stories to tell, especially in their opening and closing statements. However, the judge constantly reinforced that the only thing that mattered was the facts of the case as presented during the trial and the applicable law. As empathy increasingly is a term used in communication with the injured worker, what rules the day are the facts of the case and the applicable statutes, regulations and case law. While those can be considered a “floor” (meaning there are often opportunities to exceed what is required), they must guide the actions taken by all stakeholders. The key to success is for the injured worker to fully understand their implications, which (again) is the responsibility of the work comp experts.

Every stakeholder at the trial took their role very seriously and did their best to state their case / come to a well-reasoned decision. Every work comp stakeholder should likewise recognize the stakes of each claim and be part of a team focused on fairness to the parties and compliance with the law.

I had the privilege of being the foreperson on a medical malpractice trial in June 2024. Based on the expressions of most of the people during voir dire, “privilege” wasn’t the first word that was on their mind. Once selected, however, the countenance of the chosen changed dramatically. From the case summary we heard, the stakes were high. If the two defendants were found guilty, they would be financially burdened, and their reputations tarnished. If they weren’t, the decedent’s family would feel they had not received the accountability they sought for seven years.

Just a few weeks prior, I had watched the 1957 movie “12 Angry Men” (if you haven’t seen it, I highly recommend it). This was the third jury trial I’ve been selected for and second time I was elected foreperson, but the movie turned out to be a very helpful refresher course for what was to come. The movie reminded me of the dangers of cognitive bias and herd mentality and the powers of observation, critical thinking, and being independent. All of those factored into my leadership role on the jury.

The trial lasted a total of eight days, four and a half of which was the trial itself. During testimony and cross-examination and exhibits, I developed a new appreciation for attorneys and their staff. I know quite a few attorneys, and some have shared their trial experience. The level of preparation required and mastery of terms – the lead attorneys could teach a course on epidural steroid injection – demonstrated an amazing commitment to their craft. The presiding judge was masterful in his management of the courtroom. The bailiffs were extremely supportive of our needs. The overall excellence included the charging statement, collectively created by the judge and all attorneys, which was clear but carefully restrictive. In this case, the law mattered greatly.

As we left the jury box for the deliberation room on the sixth day, we all felt the weight of the decision we were selected to make. We took with us multiple pads of handwritten notes from numerous experts with conflicting opinions. Nobody on the jury was a medical practitioner and many of the terms during the trial were foreign to us, so we were reliant on what we heard in the courtroom to be self-defining.

My first act as foreperson was to take a private paper vote so everybody could say Guilty or Not Guilty without regard to the opinions of others. My second act was to work around the room clockwise so everyone could explain their rationale while introducing themselves. We were split evenly. At that point, I reached back to the movie for inspiration on how to engage a civil dialogue with the goal of a unanimous decision. It took almost three days, but eventually we reached a verdict.

Why am I sharing this in a blogpost? Because there are lessons to be learned for everyone involved in workers’ compensation. I will lay those out for your consideration in my next post.

Everyone under the age of 80 probably recognizes the term FOMO – fear of missing out.

This is a primary strategy of marketing, to make the potential consumer want to buy the product for fear of missing out on (fill in the blank). That underlying fear is what makes social media so compelling as connections post their vacation pictures or their new car or their wonderful family. FOMO isn’t inherently negative because motivation comes in different forms. When FOMO turns into ENVY, however, it’s a never-ending thirst to keep up with the (fill in the blank) that can never be quenched.

A new term came to my attention recently that I think can be equally challenging to manage: FOMU, or fear of messing up.

FOMU often happens because past failures are felt to be inevitable for future attempts. FOMU can also come from seeing others try and fail, often in very public and spectacular ways. In either case, it’s not necessarily the activity that causes fear but the repercussions of failure. When FOMU strikes, rigor mortis sets in. It can also be called freeze, paralysis by analysis, or “deer stuck in a headlight.” Whatever phraseology is used, FOMU can be debilitating for positive forward progress.

My personal and professional story is littered with two steps forward and one step back – or even one step forward and two steps back. The scar tissue from those major / minor defeats can build up to the point where you don’t want to try again. A frozen shoulder because the patient is afraid of reinjury is a real medical complication. A frozen career is as well.

However, defeats can be opportunities to learn what NOT to do – or TO do – for the next attempt. All it takes is supplanting a past defeat with a present victory, however small, to give confidence for the next step, action, or mindset adjustment. There isn’t a single successful person (however they define that) who hasn’t suffered defeat and used the lesson(s) learned as inspiration for the next attempt.

Here’s the optimal process:

1. Try
2. Fail
3. Learn
4. Keep going until you succeed

Knute Rockne was quoted as saying, “It’s not how many times you get knocked down that counts, it’s how many times you get back up.”

Is there something in your life, personal or professional, where you have FOMU?

According to AI, the human brain remembers negative things more than positive things due to:

• Emotional processing
• Survival
• Negative bias
• Evolutionary defense mechanism
• Vividness
• Heightened awareness

This explains a very common comment as a new year arrives – “I’m sure glad that year is over with.”

A lot can happen in 365 days (or 366 days in the case of 2024). Unless you keep a journal that documents the daily rollercoaster, most of what we remember are the bad things that occurred. A primary driver of negative bias is the fact that bad things are memorable because of their impact. A cancer diagnosis, income loss, hurricane damage, the dissolution of a relationship, and any number of other negative events leave an indelible mark on our desire, confidence and even future.

In contrast, the simple fact that you woke up this morning is underappreciated.

I don’t usually craft a new year resolution. They typically are overly ambitious and lead to disappointment. January 1 is a convenient but arbitrary “new” because each day – even moment – brings its own opportunity to reinvent.

However, 2025 is going to be different. Given the things that happened in 2024 to me, my family and my friends, I sometimes lost sight of my blessings. As the year evolved, it became easier to focus on the compounding negatives instead of the overall positive because the negatives were big and the positives were voluminous but small. However, I do not believe in coincidences. What happened in 2024 has prepared me for whatever good and bad surprises 2025 has in store.

So, in 2025, I commit to a “glass half full” approach to life.

I will purposefully celebrate the positive and privately journal it for encouragement when the negative inevitably happens. I will be a beacon of positivity and a model of resilience in the midst of negativity. My new year resolution is not a specific task list, prone to abandonment, but a philosophical attitude towards life.

I’m taking the advice of the renowned philosopher Bobby McFerrin … “Don’t Worry, Be Happy.”