At this year’s Southern Association of Workers’ Compensation Administrators (SAWCA) Annual Convention, one theme surfaced repeatedly across multiple sessions: access to care. It wasn’t discussed simply as a healthcare issue or a reimbursement issue. It was presented as one of the defining challenges facing the future of workers’ compensation itself, and its implications were discussed from multiple perspectives throughout the week.

The theme was top of mind at the event’s inception in the Medical Forum, a 90-minute discussion with a full house of interested attendees. The session was moderated by Rosalie Faris (OMCA) and featuring Dr. Paul Nanda (TGH Urgent Care), Dan Sung (Colorado Department of Labor and Employment), and Greg Gilbert (Concentra). Rather than formal presentations with polished slides, the session felt more like sitting around a table with experienced professionals who spend every day wrestling with the realities of our healthcare system.

The issues they described aren’t coming. They’re already here. And unless we begin thinking differently about healthcare delivery, provider engagement, and system design, access to care may become the single greatest barrier to successful workers’ compensation outcomes.

The problem isn’t paying for care. It’s finding it.

When most people hear “access to care,” they immediately think about reimbursement.

Certainly, reimbursement matters.

But the panel made an important distinction. Before we can worry about paying physicians, we first have to make sure physicians actually exist and are willing to treat injured workers.

Greg shared sobering workforce trends. Medical school enrollment has improved somewhat, but it still isn’t keeping pace with population growth. Younger physicians are choosing different lifestyles than previous generations, often preferring fewer working hours. At the same time, a significant percentage of today’s physician workforce is approaching retirement. The result is simple: demand is growing faster than supply.

Workers’ compensation feels this shortage even more acutely.

Occupational medicine represents only a small slice of healthcare. From estimates I’ve heard, there are currently only 1,400 occupational medicine physicians in the entire US. Specialists who understand workers’ compensation, impairment, return-to-work, causation, and disability are even harder to find. Behavioral health providers, neurologists, pain specialists, ENTs, and other specialties are becoming increasingly difficult to recruit into a system that sees many long-tenured professionals leaving.

This isn’t just an inconvenience. Fewer physicians and clinicians, generalists and specialists alike, means real consequences for injured workers. Delayed appointments become delayed diagnoses. Delayed diagnoses become delayed treatment. Delayed treatment becomes delayed recovery. Each level of delay that occurs has a compounding negative effect on the clinical and financial outcomes.

Relationships matter more than networks

One of my favorite observations came from Dr. Nanda. Rather than talking about provider networks, he talked about provider relationships.

Urgent care centers now see approximately 200 million patient visits annually across the United States. For many workplace injuries, they represent an ideal alternative to overcrowded emergency departments. But simply having an urgent care center nearby isn’t enough. Employers should proactively build relationships with local occupational health providers, educate them about available modified-duty positions, and ensure clinicians understand the physical demands of specific jobs before injuries occur.

That last point really resonated with me. You can’t effectively return someone to work if you don’t understand the work. A broad concern I’ve heard for many years is that the job descriptions supplied by an employer to the injured worker’s clinical team are either inaccurate or incomplete. Dr. Nanda described working closely with employers so physicians know exactly what modified duty looked like, what essential job functions required, and when someone could safely return without unnecessary restrictions. In other words, if you don’t know what the target is, you can’t aim at it. The kind of collaboration Dr. Nanda described benefits everyone, but it starts with the employer. An accurate, detailed job description is on them to provide so all the stakeholders involved can agree upon what victory looks like.

Education may be our greatest recruitment tool

Another recurring theme was education.

Dan described Colorado’s long-standing philosophy that workers’ compensation providers aren’t born but developed. Medical school teaches physicians how to practice medicine. It does not teach impairment ratings, causation analysis, treatment guidelines, maximum medical improvement, return-to-work principles, or the many administrative nuances unique to workers’ compensation.

Colorado responded by investing heavily in provider education. They have expanded accreditation programs. They have also created a dedicated provider relations unit whose sole mission is recruiting physicians into workers’ compensation, actively mentoring new providers, and even exposing residents to occupational medicine early in their training. Early results have been encouraging, particularly in rural areas where provider shortages are often most severe.

They’re not just asking, “Why won’t physicians treat workers’ compensation patients?” They’re asking a deeper question, “How can we help physicians become comfortable treating workers’ compensation patients?”

We may need to rethink who delivers care

One of the liveliest discussions centered around nurse practitioners (NP) and physician assistants (PA). Almost everyone in the room admitted that when they go to a doctor’s office, they’re almost exclusively working with a PA or NP, not an MD or DO.

Historically, workers’ compensation has relied heavily on physicians serving as the gatekeepers of care. But as physician shortages continue, many jurisdictions are reconsidering whether advanced practice providers should assume larger roles.

The conversation was refreshingly balanced. Nobody suggested abandoning physician oversight overnight. In fact, it was underscored that oversight is required. Instead, the panel emphasized thoughtful, evidence-based evolution.

Greg referenced recent research showing increasing use of advanced practice providers with outcomes comparable to physicians for many types of workers’ compensation care, particularly in rural communities where physician shortages are most pronounced.

Dan echoed that perspective while cautioning against dramatic change. Healthcare systems don’t transform simply because regulations change. Professional roles, expectations, supervision models, and stakeholder confidence all evolve gradually. Meaningful reform often happens one carefully considered step at a time.

The biggest barriers aren’t always clinical

Perhaps the most revealing part of the discussion focused on why physicians sometimes choose not to participate in workers’ compensation. The reasons weren’t surprising:

• Administrative complexity
• Documentation requests
• Repeated status reports
• Utilization review
• Preauthorization
• Questions about causation
• Questions about relatedness
• Requests for information that simply don’t exist in traditional healthcare

Rosalie summarized it well when she noted that physicians often feel they’re being asked to do far more than simply care for patients. They’re expected to communicate with employers, adjusters, attorneys, nurse case managers, utilization review organizations, and regulators. That is on top of navigating a system that operates very differently from group health. I’ve argued before that we should make it easier, not harder, for providers who consistently get injured workers back to work quickly and keep them there.

The irony, of course, is that every additional administrative hurdle becomes another reason for providers to say, “I’d rather not treat workers’ compensation.”

That’s not a reimbursement problem. That’s a system design problem.

Healthcare is changing. Workers’ compensation must change with it.

As I reflected on the discussion afterward, I realized the Medical Forum wasn’t really about physician shortages. It was about adaptation.

Healthcare continues to evolve at a remarkable pace. Technology changes. Workforce demographics change. Provider expectations change. Care delivery models change. Workers’ compensation cannot remain frozen while the rest of healthcare moves forward.

That doesn’t mean abandoning the principles that have made workers’ compensation successful for more than a century. But it does mean asking uncomfortable questions, like:

• Are we making it easy, or unnecessarily difficult, for clinicians to participate?
• Are we educating providers instead of assuming they already understand our system?
• Are we building relationships with healthcare partners before we need them?
• Are we removing administrative friction whenever possible?
• Are we designing a system that makes clinicians want to care for injured workers?

For employers and adjusters, the process can start small. For example, poll three local occupational health providers and ask what modified duty positions you have on file with them. Check whether your corresponding job descriptions reflect the actual physical demands or are just boilerplate. That exercise might confirm you are letting your clinical partners (which also include case managers) know precisely what level of function is required so they can work towards that goal. Or, it might uncover an unknown gap in information that is handicapping the process.

The future of workers’ compensation will not be determined solely by legislation, reimbursement schedules, or emerging technologies. Instead, it will be determined by whether injured workers can access the right clinician, at the right time, with the right expertise.

Because without access to care, every other conversation we have about workers’ compensation becomes considerably more difficult.

Imagine walking into a clothing store and being told there is only one size available. It doesn’t matter whether you’re tall or short, narrow or wide. Athletic or not. Male or female. Everyone gets the same shirt.

Most of us would immediately recognize the flaw in that approach.

Yet when it comes to professional education, we do it all the time.

Organizations spend significant amounts of money on training programs that were designed for everyone, then wonder why the results often feel generic. Employees complete the courses. Continuing education requirements are satisfied. Certificates are issued and HR is notified. Learning management systems show completion rates approaching 100%.

Then Monday arrives and the same performance gaps remain.

That doesn’t mean the training was bad. It simply means it may not have been designed for the people taking it.

As a long-time educator and now Provost, I’ve become increasingly convinced that one of the biggest mistakes organizations make is confusing educational activity with organizational improvement. Training is often treated as the solution when it is only a tool. The real objective is performance. Better decisions. Better communication. Better outcomes. Better consistency. Better leadership.

The question should never be, “What training should we buy?” The question should be, “What problem are we trying to solve?”

That distinction matters because every organization is different.

Even within workers’ compensation, two claims organizations can have nearly identical business models while facing completely different challenges. One may struggle with internal communication while the other struggles with communicating to injured workers and employers. One may struggle with medical management while the other may need better understanding of psychosocial risk factors. One may be experiencing rapid growth as a startup while the other has maintained steady growth for decades. One may be in a single jurisdiction while the other is spread out all over the country. One may only manage work comp claims while the other covers all P&C claims with work comp only being a small piece.

Regardless of their differences, both organizations may purchase the exact same training and then wonder why the results are underwhelming.

The issue is not the quality of the content. The issue is relevance.

Adult learning science tells us that people learn best when they can immediately connect information to their daily responsibilities. The closer the learning experience is to the learner’s actual environment, the greater the likelihood that new knowledge will be applied. That is one reason why generic, not tailored, education frequently struggles to produce meaningful behavior changes.

People learn better when they can see themselves in the examples. It clicks more quickly and concretely when they recognize the challenges being discussed and understand exactly how the content connects to the decisions they make every day.

That is where customized education becomes so powerful.

It’s also the exact conversation we have with every organization before we design anything. We start with “What are you actually trying to fix.” Instead of starting with content, customized education starts with context:

• What are employees struggling with?
• What outcomes are not being achieved?
• What behaviors need to change?
• What skills need to improve?

Unfortunately, many organizations reverse that sequence. They start by selecting content and hope it addresses the problem. Hope is not a strategy.

Imagine a physician diagnosing a patient before conducting an assessment. Most of us would consider that irresponsible.

Yet organizations frequently prescribe training before diagnosing the performance issue they are trying to address. The training may be interesting, accurate, and filled with best practices. But if it doesn’t address the questions and issues the organization, department, or individual has, it doesn’t necessarily change outcomes.

Performance gaps are often symptoms rather than root causes. A claims organization may believe it has a communication problem when the real issue is confidence. A supervisor may believe employees need more technical training when they just need stronger critical thinking skills. A leadership team may focus on compliance when the underlying challenge is culture.

The most effective educational programs begin with discovery. Organizations that want to advance the capabilities of their team seek to understand not only what people need to know, but what people need to do differently. That shift moves the conversation away from content delivery and toward performance improvement, which is the point where education creates an ROI.

This becomes increasingly important as organizations navigate rapid change. Artificial intelligence, workforce shortages, multiple generations in the workforce, regulatory complexity, behavioral health concerns and advancement of presumptions, and increasing medical sophistication and options are reshaping workers’ compensation. The challenges facing organizations today are rarely solved through information alone and are not static (what you need today may not be what you need tomorrow).

That is why educational customization is no longer a luxury but a necessity.

The organizations that thrive over the next decade will not necessarily be those with the largest training budgets. They will be the organizations that most effectively align learning with organizational objectives. They will understand that education is not an event. It is a strategic investment in performance that is customized for each learner.

A claims adjuster experiences different challenges than a claims supervisor or the call-center customer service person. A nurse case manager requires different skills than an attorney. A physician needs different information than an employer. A newcomer has more basic needs than a long-tenured professional, but both need ongoing development. While certain foundational concepts may apply broadly, meaningful improvement often requires greater precision.

People do not learn in a vacuum. They learn within the context of their responsibilities.

Here’s a simple question to ask before deciding on a professional development strategy: “What would success look like six months after this training?”

I’m guessing that the correct answer is not “people completed the course.”

Instead, leaders would describe the desired outcomes (that are identified during the discovery phase):

• Better communication
• Stronger decision-making
• Improved consistency
• Higher engagement
• Reduced turnover
• Faster recovery
• Better claim outcomes

Some of those are subjective while others are tangibly measured and objectively assessed. However, none of them are limited to the acquisition of knowledge. They are all focused on the application of knowledge. And not just generic knowledge, but the kind of knowledge that makes the learner more effective.

That perspective changes how training should be designed, delivered, and evaluated. Instead of measuring attendance, we measure application. Instead of focusing solely on knowledge transfer, we focus on behavior change. Instead of asking whether people enjoyed the training, we ask whether they are performing differently because of it.

That is a much higher, more meaningful standard.

Off-the-shelf education will always have an important place. Foundational knowledge matters. Shared terminology matters. Common frameworks matter. To be clear, not every learning experience needs to be customized.

However, every organization has its own culture, challenges, strengths, blind spots, and opportunities. Those differences matter.

The most effective educational experiences are not the ones that provide the most information. They are the ones that create the most meaningful and lasting change that positively influences the effectiveness of an individual, department, product, workflow, or entire organization. They help people think differently, communicate differently, and ultimately perform differently.

If the goal is better outcomes, shouldn’t the learning experience be designed around how your team actually works rather than how someone assumes they work?

If you’re not sure how to answer that for your own organization, that’s a conversation worth having. Here’s where to start.

If you had told me fifteen years ago that opioid prescribing would eventually become one of the defining healthcare issues of a generation, I would have believed you.

If you had told me that we would spend more than a decade collecting mountains of data, implementing formularies, changing prescribing guidelines, introducing prescription monitoring programs, restricting access, educating physicians, and dramatically reducing opioid utilization, I would have believed that too.

I would have believed you because, starting in 2003, I built services, spoke and wrote, and lobbied regulators and legislators against the over-prescribing of opioids and the medication cocktails used alongside them to manage symptoms and risk. That is the origin story of my RxProfessor moniker.

What I would not have predicted is that many people would still misunderstand the lesson.

The opioid story was never really about opioids. It was about what the overuse of opioids revealed.

I have stated on many occasions that workers’ compensation was one of the earliest warning systems for what would later become a national crisis. Long before opioid overdoses became front-page news, claims professionals, nurse case managers, pharmacists, and physicians were seeing the consequences play out in real time. Injured workers who should have recovered within weeks were remaining disabled for months. Functional improvement was being replaced by medication dependence. Side effects were creating new problems. Families were struggling. Claims were deteriorating. Monthly and reserve costs were escalating.

Our industry recognized the issue early because we had the most at risk. Workers’ comp often carries the cost of medical care for years, sometimes decades, beyond the end of a policy year.

At the time, much of the industry’s attention focused on the medication itself. Its brand or generic name became an active part of our lexicon.

Over the past decade, however, the data has been telling a very different story. Opioid prescribing has declined dramatically across healthcare and within workers’ compensation. According to 2024 research by NIOSH, work comp claims involving opioid prescriptions declined from approximately 55% of prescription claims in 2012 to roughly 32% in 2022. That is a remarkable shift in a relatively short period of time.

More broadly, national opioid prescribing rates have fallen substantially from their peak years, and opioid dispensing rates continue to decline across the country. You can read more about it at the CDC’s “Opioid Dispensing Rate Map” published in February 2026.

By many measures, those statistical trends are a success story. But success stories can be dangerous when they create the illusion that the underlying problem has been solved.

The lesson was never simply “prescribe fewer opioids.” The lesson was “understand pain differently.”

One of the most important things the opioid crisis exposed was how often healthcare, and work comp specifically, confused symptom management with recovery. When an injured worker reported pain, the system frequently responded with a prescription, using the highly subjective Visual Analog Scale of 1 to 10 as an objective measurement. The goal was understandable. We wanted to relieve suffering, improve comfort, and help people regain function.

The problem was that pain is rarely that simple. Pain is physical, psychological, and social. Pain is influenced by expectations, fear, catastrophizing, stress, relationships, financial pressures, sleep quality, activity levels, the dynamics of the claims process itself, uncertainty about return-to-work, and countless other factors. Yet for years, many systems behaved as though pain could be solved primarily through pharmacology. Almost everyone chose the easiest path … a prescription.

In fact, treatment required a more holistic – biopsychosocial – approach. While that model was initially developed in 1977, it was a completely new concept to most of our industry when I first started advocating for it in 2011. Unfortunately, most people looked at me as though I was Medusa and wanted nothing to do with “opening pandora’s box of psych” as part of a work comp claim.

Eventually, we learned that reducing pain does not necessarily improve function and improving function does not always eliminate pain. Neither one automatically leads to recovery. That realization fundamentally changed how many of us think about claims management. That shift, from treating symptoms to treating the whole person, is the foundation of how we think about recovery today.

The most effective claims professionals no longer ask, “How do we reduce pain?” Instead, they ask, “How do we improve recovery?”

Those are very different questions.

The opioid data also taught us something equally important about unintended consequences. In healthcare, every intervention has the potential to create a cascade. A medication prescribed to address one problem creates side effects that require another medication. Activity levels decrease. Sleep becomes disrupted. Anxiety increases. Functional capacity declines. At some point, we are treating the consequences of treatment rather than the condition that initiated the process (also known as iatrogenesis). As an example, the 2016 Super Bowl advertisement that introduced OIC (opioid induced constipation) as a new medical acronym was a wakeup call for many. Especially when they realized the commercial was on behalf of a medication that would address OIC and not the reduction of the opioids that were inducing constipation.

I’ve written previously about the concept of a medical cascade. The opioid crisis provided one of the clearest examples our industry has ever witnessed of that concept.

The good news is that many stakeholders responded. Formularies were implemented. Guidelines evolved. Prescription monitoring improved. Educational efforts to both prescribers and patients expanded. Clinical oversight increased. As a result, prescribing patterns changed dramatically.

The other good news is that our thinking changed as well. We … eventually … embraced the bigger opportunity. We learned that:

• Injured workers are more than diagnoses
• Communication influences outcomes
• Expectations matter
• Function is often a better measure of progress than pain scores
• Behavioral health cannot be separated from physical health
• Early intervention matters

And perhaps most importantly, we learned that recovery requires a whole-person perspective.

Those lessons remain just as relevant today as they were during the height of the opioid crisis. In fact, they may be even more important.

Today, our industry faces new challenges. Behavioral health claims, presumptive or not, are increasing. Medical complexity continues to grow. An aging workplace brings more physical and psychological comorbidities. New treatment options continue to emerge like cannabis, psychedelics, and virtual reality. Meanwhile, acupuncture, once considered alternative, is gaining acceptance among a growing number of payers, including work comp.

Different issues. Same underlying lesson.

The answer is rarely found in a single treatment, a single medication, a single technology, or a single intervention. Recovery is much more complicated than that.

When you review a claim today, are you more interested in the pill count or what the pill count represents? What is driving the prescription? What barriers to recovery exist? What conversations are occurring? What expectations have been established? Is the worker becoming more functional? Are they empowered and engaged?

Those questions tell us far more than a pharmacy report ever could.

The opioid crisis taught our industry many valuable lessons, but perhaps the most important one is this: data is only useful if it changes how we think as we uncover the root cause(s). We can celebrate declining prescribing rates, reduced opioid utilization, and improvements in clinical oversight. Those achievements matter and should be recognized.

But the real value of the past decade lies in what it revealed about recovery itself.

The goal was never to win a war against opioids. The goal was always to help injured workers reclaim their lives.

If the last decade taught us anything, it is that recovery cannot be measured by the number of pills prescribed, denied, or discontinued. Instead, it is measured by whether the person behind the prescription is moving forward.

And that is a lesson worth carrying into whatever challenge comes next.

There was a time when earning a professional credential meant something very specific.

It meant you had invested time, demonstrated competence, and met established standards. It meant you had proven a level of mastery that distinguished you from others in your field. The credential itself wasn’t valuable because of the paper it was printed on. It was valuable because people trusted what it represented, the combination of its credibility and your effort.

Today, that trust is being tested.

Over the past decade, the number of professional certifications, certificates, badges, micro-credentials, and digital designations has exploded. In almost every industry, there are more opportunities than ever to earn a credential. On the surface, that sounds like a positive development: more education, specialization, and opportunities for professional growth.

But in work comp, the stakes are different. Daily decisions made by claims professionals, case managers, attorneys, medical providers, employers, and risk managers directly influence outcomes for injured workers. In an environment where expertise carries real-world consequences, credentials must mean more than participation. They must represent competence.

A common misconception about professional certification is that the value comes from issuing the credential. The real value comes from the standards behind it. The rigor of the curriculum. The quality of the assessment. The integrity of the process. The consistency of expectations. That its value is recognized both by those who earn it and the employers who seek it.

There is a significant difference between completing something and demonstrating mastery.

For example, if someone told you they had earned a pilot’s license, you would probably feel comfortable boarding a plane with them. Not because you personally reviewed their training records, but because you trust the standards behind the credential. You assume they were required to demonstrate knowledge, skill, and judgment many times before receiving that designation. You also assume that if they did not demonstrate mastery, their license would not have been issued. In other words, that license gives you confidence that they know what they’re doing.

The same principle applies to professional certifications. The credential itself is simply a symbol. The standards behind it create trust.

And that trust matters for …

• The professional who earns the credential
• The employer evaluating qualifications
• The clients seeking expertise
• The people impacted by the decisions being made

One of the things I have learned throughout my career is that professionals rarely object to high standards. Most individuals who want to be real professionals (not just a clock watcher) seek them out. They understand that rigor is not a barrier to success; it is what makes success meaningful. They want to be excellent in all they do, and recognize that being challenged in pursuit of their goals will sharpen not only their skills but their instincts.

Those same people object when everyone receives the same recognition regardless of effort. They object when mastery and participation become indistinguishable. They object when a credential that required months of preparation carries the same perceived value as one that required little more than showing up. Most people want to feel as though they earned whatever they achieved.

Lowering standards does not create more excellence. It simply creates more certificates.

This is particularly important in workers’ compensation because our industry often struggles with professional identity. Unlike physicians, attorneys, accountants, or engineers, many work comp professionals enter the field accidentally rather than intentionally. There are risk management degrees but very few workers’ compensation degrees. Most work comp professionals learn through experience, mentorship, continuing education, and professional development. OJT, or on-the-job training, is how most newcomers build expertise.

That reality makes credible certification programs even more important.

They provide a framework for professional growth. They establish common expectations. They create a shared body of knowledge. Perhaps most importantly, they help elevate the profession itself.

But that only happens when the standards remain meaningful.

As Provost of WorkCompCollege.com, I often find myself thinking about the balance between accessibility and rigor. We had those exact discussions in 2022 as we launched the WRP (Workers’ Recovery Professional) certification. The hardest part wasn’t deciding what to teach. It was deciding what to leave out, and how much to ask of someone to ensure the credential meant something.

We wanted a program with real breadth and depth and so we settled on eight schools of discipline, 64 courses, and 50+ hours of instruction. However, lots of content was not the goal. We were just as focused on the balance between hard and soft skills, anchored around a workers’ recovery mindset. In our opinion, technical knowledge without that mindset is only half the job. The real test wasn’t whether we could build something comprehensive. It was whether we could build something that challenged people without overwhelming them. That it was rigorous enough to mean something but also accessible enough that the right people would finish it.

When we launched WRP (and shortly thereafter, the WRPA certification, a similarly broad but less deep dive into work comp), it had no value. Its only credibility was the people who created it, the subject matter, and our aspirations to improve the work comp ecosystem. Now, with more than 215 WRP graduates and more than 130 WRPA graduates, credibility is in its adoption. Its value comes from seeing graduates with a variety of job duties who have changed how they view that job and those they serve. Its merit is shown by individuals who have received job offers or promotions because of the investment they made in themselves.

A certification gains value precisely because it cannot be earned casually. The effort required to achieve it is part of what makes it meaningful. When professionals invest significant time and energy into mastering a subject, they deserve a credential that reflects that accomplishment. Protecting the standards protects them.

High expectations communicate respect. They signal that the profession matters. They reinforce that expertise has value. They create confidence that those who earn the credential have truly demonstrated competence.

True professionals at the top of their game don’t just want letters after their name. They want exposure to best practices that will influence their decisions and outcomes. Those letters after their name show they’re ready to make a difference.

A certificate is not a piece of paper. It is a promise. A promise to employers that the individual has demonstrated competence. A promise to clients that expertise has been validated. A promise to the profession that standards have been upheld. And perhaps most importantly, a promise to the individual who earned it that their accomplishment means something.

If you’ve spent any time in workers’ compensation, you’ve probably attended a conference or training program that looked successful on paper. The room was full. The instructors were engaging. The PowerPoint slides had graphs and graphics. I’ve seen, from the stage, attendees nod in agreement and take notes. Everyone left feeling like they learned something, and the instructors felt like they made a difference.

Then Monday arrived, and very little changed.

That disconnect fascinates me, not just as an educator but as someone who believes education is a lever for improving outcomes in work comp. After all, if education doesn’t change behavior, then why are we doing it?

The answer, unfortunately, is that many training programs are designed around content delivery rather than learning. We assume that if information is presented clearly enough, people will absorb it, remember it, and apply it. Yet adult learning science has repeatedly demonstrated that learning doesn’t work that way, and that has significant implications for our industry.

Workers’ compensation is a profession built on decision-making. Claims professionals, case managers, attorneys, risk managers, medical providers, and service providers make hundreds of decisions every day that influence recovery, disability duration, medical costs, litigation risk, and ultimately the lives of injured workers. Those decisions are often made under pressure, with incomplete information, competing priorities, and deeply ingrained habits.

Under those circumstances, simply providing more information rarely creates meaningful change.

Think about how continuing education works. You attend a conference. You sit through six hours of presentations (with cookies in between), hopefully taking notes. You have an app where you can download presentations, contact the presenters, and network with other attendees. You get the necessary paperwork to validate your license’s CE requirements. A week later, you remember a few key points. A month later, most of the details are gone and you may not be able to decipher the notes written hurriedly. Six months after the fact, there may be no evidence you attended.

The problem is not that the attendees weren’t paying attention. The problem is that attention is not the same thing as learning, and learning is not the same thing as behavior change.

One of the most important concepts in adult learning science is that adults learn best when they understand why something matters, can immediately connect it to their existing experiences, and have opportunities to apply it in realistic situations. This is the core insight behind Malcolm Knowles’ theory of andragogy. In other words, learning is not simply about acquiring knowledge. Understanding the rationale for and application of change creates better outcomes.

For example, most claims professionals can probably define active listening. Many have attended sessions on communication skills. Yet when an injured worker becomes emotional or confrontational, do those listening techniques consistently show up in the interaction?

Sometimes yes. Often no.

That is because knowledge alone is insufficient. The skill must be practiced, reinforced, and applied repeatedly before it becomes a natural response.

The same principle applies across virtually every area of workers’ compensation. We know …

• The importance of early intervention
• The impact of psychosocial factors
• That communication influences outcomes
• That return-to-work programs matter
• That empathy improves cooperation

Yet knowing and doing are two very different things. The gap between knowledge and action is where learning design becomes important.

Consider how most people learn to drive a car. Nobody reads a manual, passes a test, and immediately becomes a skilled driver. It takes instruction, observation, practice, feedback, correction, repetition, and experience. That often includes a parent pressing on the invisible brake pedal in the passenger seat to get the point across. The learning process is designed around behavior, not information.

Yet in professional education, we often expect the opposite. We deliver content and hope behavior follows.

Adult learning science suggests we should reverse the equation.

Instead of asking, “What information do people need to know?” we should ask, “What behaviors do we want people to demonstrate?“

That single question changes everything.

If the goal is better communication, learners need opportunities to practice communication.

If the goal is more effective coordination of care, learners need opportunities to review and refine their collaboration process.

If the goal is better claim decision-making, learners need opportunities to evaluate claim scenarios and solicit constructive criticism.

Information still matters, but information alone is rarely enough.

This becomes particularly important in work comp because so much of what determines success involves real-time judgment. There is no checklist for building trust with an injured worker. There is no formula for navigating difficult conversations. These skills develop through experience, both negative and positive.

Our industry often treats education as an event rather than a process.

• Attend the webinar, complete the course
• Earn the credit hours
• Move on

But meaningful learning doesn’t occur in a single sitting. It occurs over time as concepts are reinforced, challenged, applied, and refined. The best educational experiences do not simply provide answers. They change how people think. And when thinking changes, behavior becomes more likely to change as well. That is why I prefer the term “professional development” because that is the goal … refining the skills necessary to be a true professional.

While AI can help identify trends and potential solutions, the decision to act is still a human one. AI can offload mundane and repetitive tasks, but critical thinking, knowledge of the system, and interpersonal communication skills will remain the biggest differentiator between success and failure. Those competencies are refined through education and experience. Those capabilities are developed, not downloaded.

I believe the future of workers’ compensation education looks very different from its past. The organizations that thrive into the future will not be the ones that provide the most content. They will be the ones that create the most learning. They will focus less on checking educational boxes and more on changing workplace behaviors and workflow. They will measure success not by attendance, but by application. Donald Kirkpatrick’s Four Levels of Training Evaluation (Reaction, Learning, Behavior, Results) describes the gap between feeling like you learned something and changing behavior. Bridging that gap is our goal.

Shaping actions that benefit the primary stakeholders, an injured employee and their employer, is the real purpose of education.

The ultimate measure of learning isn’t what someone remembers when they leave the classroom. It’s what they do differently when they return to their desk.

Nobody who files a workers’ compensation claim expects it to become a catastrophe. Yet every day, a strained back becomes surgery, a minor sprain becomes disability, and a routine claim becomes a six-figure reserve.

Over the years, I’ve come to believe that many of these situations can be explained by a concept increasingly discussed in healthcare as the “medical cascade.” The idea is simple. One event triggers another. One decision leads to the next. A seemingly reasonable intervention creates an unintended consequence, which prompts another intervention, which creates another consequence. Eventually, everyone responds to the cascade rather than addressing the original problem.

Work comp and healthcare sometimes rewards activity more than outcomes. Yet the most effective intervention is not always another intervention. Sometimes it is reassurance. Sometimes it is education. Sometimes it is listening. Sometimes it is helping someone understand that their recovery is progressing exactly as expected.

The challenge is that cascades rarely look reckless when they begin. Each step usually appears reasonable when viewed independently. A physician orders another diagnostic test “just to be safe.” A medication is prescribed to address symptoms. A specialist referral is made because nobody wants to overlook an important finding. An employer seeks clarification. An adjuster asks additional questions. An attorney becomes involved to protect someone’s interests. None of those actions are inherently problematic. Collectively, however, they can create momentum that becomes increasingly difficult to stop.

The most obvious example is what I would call a medical cascade. An injured worker experiences pain after an injury and receives a prescription medication. The medication creates side effects. Additional medications are prescribed to address those side effects, which creates an increasingly complicated cocktail. Activity levels decline. Physical deconditioning begins. Sleep is disrupted. Recovery slows. The worker becomes frustrated. New symptoms emerge. Additional testing is ordered. Before long, the treatment plan is focused on managing the consequences of treatment rather than the injury that started the process.

The original condition may have improved months ago. The cascade has not.

But some of the most damaging cascades in workers’ compensation have little to do with medicine.

Consider the communication cascade. An injured worker reports an injury and enters a system they know very little about. They are worried about their health, income, job security, and future. If expectations are not established early, assumptions quickly fill the void. Questions go unanswered. Anxiety grows. Trust begins to erode.

What started as an information problem gradually becomes a relationship problem, which has a way of becoming a claim problem.

Communication is one of the most powerful interventions available in workers’ compensation. Not because communication solves medical conditions, but because it influences how people experience those conditions. A worker who understands what is happening is less likely to assume the worst. A worker who feels heard is less likely to become adversarial. A worker who trusts the process is more likely to participate in it.

Then there is the psychological cascade.

Consider what happens when a physician mentions “some degeneration” on an MRI without explaining that such findings are common in adults of any age. The worker goes home and searches the term. What they find frightens them. They begin protecting the injury, limiting movement, avoiding activity. Their function declines, not because the injury worsened but because their understanding of it did. The physician, seeing reduced progress, orders further evaluation. The cascade has begun, triggered not by pathology but by a single unexplained phrase.

Research has repeatedly demonstrated that expectations influence outcomes. People who believe they will recover often do better than those who believe they are broken. That does not mean positive thinking cures injuries. It means that beliefs influence behavior, and behavior influences recovery.

Words (verbal and non-verbal) matter, far more than many of us realize.

There is also a litigation cascade. An employee feels ignored. An attorney becomes involved. Communication channels narrow. Positions harden. Suspicion replaces collaboration. The focus gradually shifts away from recovery and toward conflict.

The injury itself has not changed. The environment surrounding the injury has.

What makes all these examples so challenging is that nobody wakes up intending to create a cascade. Physicians want to help. Employers want productive employees. Adjusters want accurate information. Attorneys want to protect their clients. Every stakeholder is generally trying to solve a problem.

The issue is not bad intentions. The issue is unintended consequences.

That is why one of the most important questions in workers’ compensation is also one of the simplest: “What are we trying to accomplish?”

Every test and specialty referral should have a purpose. Every medication should have a purpose. Every conversation should have a purpose. All those purposes should ultimately connect back to the same objective: helping the injured worker achieve the best and quickest possible recovery.

When we lose sight of that objective, the risk of a cascade increases dramatically.

At WorkCompCollege.com, we frequently discuss a workers’ recovery mindset because recovery is influenced by much more than medical treatment. It is influenced by trust, communication, expectations, relationships, purpose, and confidence. When those elements align, recovery often accelerates. When they are disrupted, the first domino begins to wobble.

The good news is that cascades can work in positive directions as well.

A thoughtful physician who explains a diagnosis clearly can change the trajectory of a claim. An employer who stays connected to an injured worker can reinforce purpose and belonging. An adjuster who takes the time to listen can build trust. A case manager who recognizes psychosocial barriers early can prevent them from becoming larger obstacles later. One positive interaction can create momentum just as surely as one negative interaction can.

The challenge for all of us is learning to recognize the first domino before the entire chain begins to fall.

Recognition requires curiosity by stepping back occasionally and asking whether the current plan still addresses the original problem. It requires the courage to ask a question that our industry does not ask often enough: “Are we still helping?” For example, if a claim is in its third month with no clear recovery trajectory, it may be time to ask yourself what the original problem was and is our current plan still addressing it.

The opportunity is not simply to manage the consequences once they appear. The opportunity is to recognize the first domino, understand where it may lead, and intentionally set it in a direction that supports recovery rather than undermines it.

That is how better outcomes happen. One decision, one interaction, and one domino at a time.

For an industry that spends a lot of time talking about indemnity and medical benefits, RTW, litigation, and now artificial intelligence, it is remarkable how often the biggest factor influencing outcomes comes down to something much simpler.

Human connection.

That was the central theme of a session I attended at the Tennessee Bureau of Workers’ Compensation Annual Education Conference on June 11. The session, Working for a Brighter Day: Rewriting the Narrative for Success Using Empathy, featured three people I have come to know and respect tremendously over the years: Greg Hamlin, Mollie Kallen, and Dr. Josh Schuette. Each brought a different perspective – claims leadership, case management, and clinical recovery respectively – but they all arrived at the same conclusion.

Empathy is not a nice thing to do. It is a smart thing to do.

And perhaps most importantly for an industry that measures everything, it is a profitable thing to do.

Since our founding in 2022, WorkCompCollege.com has advocated for the adoption of a workers’ recovery mindset. For more than a decade before that, I advocated for a biopsychosocial treatment approach that takes the whole person into account. At its core, those philosophies recognize that injured workers are more than diagnoses, body parts, claim numbers, or reserve estimates. Recovery is influenced by physical health but also by emotional well-being, family dynamics, financial stress, social support, purpose, and hope. Greg, Mollie, and Josh reinforced just how important that broader perspective has become.

Mollie started things off by defining empathy as being able to look at the injured worker holistically rather than focusing solely on the injury itself. She spoke about social determinants of health, which are the economic, educational, social, and environmental factors that influence recovery. A shoulder injury is never just a shoulder injury if the injured worker is worried about paying rent, caring for children, navigating transportation challenges, or wondering whether they still have a future with their employer. Understanding that person requires curiosity, conversation, and … empathy.

Josh expanded on that idea by reminding everyone that two people with the exact same diagnosis can have dramatically different outcomes. One recovers quickly while another struggles. The difference often has less to do with medicine and more to do with the person behind the diagnosis. That is why Josh engages his patients (with a song, or as a DC Comics superhero, or just a smile) as people, not as billable time.

During the pandemic, Greg began challenging his organization to rethink how claims were handled. The goal wasn’t simply to administer benefits according to statute. The goal was to create cooperation, trust, and ultimately better outcomes. The result was what he described as an “empathetic resolution model.” Rather than asking, “What is the minimum we are required to do?” the question became, “What is the right thing to do?” Greg powerfully made the point that nothing precludes a claims professional from doing more than what the statutes or regulations require. They are the floor, not the ceiling.

In one example, Greg talked about an injured worker who suffered devastating injuries and experienced a delay in benefit payments due to an internal system issue. Rather than simply explaining the problem and asking for patience, Greg’s team dug deeper and learned the worker had no food in the house. In response, they provided groceries while working to resolve the payment issue. The cost was one percent of the $200,000 claim reserve. That minimal cost earned trust, prevented unnecessary conflict, and demonstrated that someone genuinely cared. Interestingly, not only did the injured worker recognize their compassion and creativity but his own claims team did as well. It confirmed their culture.

This story illustrates something our industry sometimes forgets. Empathy and financial performance are not opposing forces. They are often aligned.

Greg shared that his organization’s empathy-focused approach has produced a return on equity in the 26-28% range. That means doing the right thing is not just morally satisfying but operationally effective. Trust reduces friction. Cooperation reduces litigation. Communication reduces misunderstandings. Employee retention improves. Outcomes – physical and financial – improve. The total cost of the claim declines as a result.

That is a lesson far beyond workers’ compensation. While it applies to how we interact with colleagues, clients, and injured workers, it also applies to:

• Leadership
• Parenting
• Marriage
• Friendships

One topic that generated considerable discussion was artificial intelligence. Unsurprisingly, all three agreed that AI will continue changing how work gets done. But they also agreed on something equally important: AI cannot replace empathy. It can help draft emails (Greg did a real-time AI edit to add empathy to a benefits description). It can help summarize information (Mollie mentioned how it creates efficiencies for case managers). It can reduce documentation burden (Josh shared a hospital that reported a 38-minute reduction in documentation time).

However, it cannot notice a subtle facial expression that reveals anxiety. It cannot hear the hesitation in someone’s voice. It cannot build trust through authentic human connection. That distinction matters.

The future may belong to organizations that use AI effectively, but it will also belong to organizations that preserve humanity while doing so.

As the session concluded, the panel summarized their message using six simple words: Educate. Communicate. Celebrate. Consider. Support. Evolve.

Those aren’t just workers’ compensation strategies. They are life strategies.

• Educate people before problems occur
• Communicate consistently and clearly
• Celebrate progress and success
• Consider the circumstances others may be facing
• Support them when they need help
• And continually evolve based on what you learn

Those six principles could improve virtually every relationship we have. They certainly can improve recovery outcomes.

Empathy is not weakness. It is not softness. It is not lowering standards. It is not abandoning accountability.

Instead, empathy is listening and understanding. Empathy recognizes that every person we encounter is carrying burdens we may not see that can impact what we do see. Empathy is consciously choosing to humanly engage.

Some individuals and organizations still view empathy as an added task that slows the process and increases the cost. The evidence increasingly suggests it may be one of the highest returns on investment they can make.

Perhaps that is the real lesson from my friends Greg, Mollie, and Josh.

Being human is not separate from achieving results. Being human is often how the best results are achieved.

In a world increasingly focused on technology, efficiency, and compliance, maybe the greatest competitive advantage available to any of us is remarkably simple: Treat people like people.

When people hear that someone has joined an organization, they often focus on the individual.

I tend to focus on what the addition says about the organization. Every hire is a signal, revealing where an organization believes the future is headed.

That is why I am particularly excited to announce that Dr. Waqas Buttar has joined WorkCompCollege.com as our Medical Director.

While this certainly is a story about Dr. Buttar, it is also a story about our continued evolution.

When we launched in 2022, our primary focus was education for workers’ compensation stakeholders with the Workers’ Recovery Professional (WRP) certification. Claims professionals, case managers, attorneys, employers, risk managers, clinicians, regulators, ombudsmen, and service providers were our primary audience. Our educational philosophy centered around a “whole person recovery mindset” where outcomes improve when we recognize that injured workers are more than diagnoses, body parts, claim numbers, and reserve amounts. They are human beings attempting to recover physically, psychologically, socially, and financially.

We still believe that.

But as our organization has grown, another reality has become increasingly apparent. If we want to improve outcomes, we must also improve the quality of medical decision-making that supports those outcomes.

The workers’ compensation industry is becoming more medically complex. Questions involving causation, impairment, presumption, treatment appropriateness, functional capacity, return-to-work readiness, and permanent disability remain important. Healthcare shortages increasingly stress the system. An aging workforce brings unique physical and psychological comorbidities. Medical records are becoming more voluminous and digital. AI creates opportunities while introducing new challenges. Physicians and clinicians are expected to do more, document more, and justify more with less time and fewer resources.

Since medical costs are approximately 60 percent of total work comp costs, this matters.

That realization led us to expand beyond our traditional educational offerings and dive deeper into the medical-legal environment by partnering with Workplace Health to develop WC DocWise. Then, on May 4, we announced the acquisition of AMAguides.com, Impairment.com, and CertifiedRater.com from Dr. Christopher Brigham, an internationally renowned expert on the AMA Guides and impairment rating process.

Four years ago, I could have never imagined that WorkCompCollege.com would be building platforms dedicated to impairment evaluation and supporting physicians in the US and as far away as Australia, Canada, and South Africa. Yet here we are.

And this is where Dr. Buttar enters the story.

We first met Dr. Buttar in September 2025 through our initial conversations with Dr. Brigham. What caught my attention were the same things that would catch anyone’s attention: his credentials, experience, and accomplishments.

But over time, what most impressed me had nothing to do with his résumé. It was how he approached his work.

Dr. Buttar possesses a combination of characteristics that are surprisingly difficult to find in a single individual.

He is exceptionally intelligent. He has an extraordinary work ethic. He is incredibly responsive. He embraces technology without becoming distracted by it. He communicates well. He learns quickly. And perhaps most importantly, he genuinely cares about helping people.

That last point is easy to say and difficult to prove. However, in the intervening months, I have seen it repeatedly.

I’ve sent him emails when I expected a response the next day but had a thoughtful answer 15 minutes later. I’ve watched him interact with clients and noticed that he never rushes to answer before understanding the question. Whether he is helping a client navigate a complex impairment question, supporting one of our physician-facing initiatives, or discussing an injured worker’s circumstances, there is a consistent sense of empathy behind the expertise.

Dr. Buttar has more than 19 years of experience spanning clinical medicine, healthcare administration, impairment evaluation, medicolegal consulting, and healthcare technology. He has the highest Certified Impairment Rater score to-date. He learned much from Dr. Brigham, but had significant foundational clinical experience before that. He is a medical consultant with the United Nations for a truly global perspective.

Physician. Hospital administrator. Medicolegal consultant. AMA Guides and impairment rating expert. Technologically fluent. Global reach. Most people possess one or two of those. Dr. Buttar possesses all of them.

At this point, you may be thinking, “That’s great, Mark. You found a smart physician with an impressive background. Why does that matter to me?”

Our clients partner with us because they need solutions. They need trusted guidance. They need education that is practical, current, and applicable. They need resources that help them navigate increasingly complex medical, legal, and administrative environments. Dr. Buttar helps us check all those boxes.

When a physician has a question about the AMA Guides, our clients now have access to one of the most knowledgeable impairment professionals in the world. When an organization needs support interpreting complex impairment issues, causation questions, or medicolegal concepts, they have a trusted resource available. As we develop new curriculum, students benefit from the insight of someone who has lived in both the clinical and medicolegal worlds.

One of the things I’ve learned over the years is that organizations rarely remain static. They either evolve intentionally or drift unintentionally.

I strongly prefer the former.

When I look at the future of workers’ compensation, I see a system that will require greater collaboration between disciplines than ever before. Claims professionals will need to better understand medicine. Physicians will need to better understand disability and return to work. Attorneys will need to navigate increasingly complex medical evidence. Technology will continue to influence every aspect of how information is gathered, analyzed, and communicated.

The future belongs to organizations that can bring people together across disciplines and create shared understanding. That is precisely where I believe WorkCompCollege.com can make a meaningful contribution.

Adding Dr. Buttar as Medical Director is not simply about impairment ratings. It is not simply about physician education. It is also about strengthening our ability to connect medicine, claims, law, technology, and education in ways that ultimately improve outcomes for injured workers and the professionals who serve them.

Adding Dr. Buttar as Medical Director isn’t about where we’ve been. It’s about where we’re going.

Because sometimes the right person doesn’t just fill a role. Sometimes the right person helps define the future.

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.