One Color Per Year When I was VP of Claims at CE Heath, we had a problem that was simple to state and harder to solve. Required notices had to be posted. That was the law. But failure to comply created consequences far beyond a regulatory citation. When a worker was injured and looked at the wall, what they found — or did not find — shaped everything that followed.…
Introduction The role of a claims manager is not just pivotal but indispensable in ensuring the smooth operation of any claims organization. These professionals oversee complex claims processes, manage teams, and make critical decisions impacting organizational performance and customer satisfaction. However, without the necessary training and development, claims managers can struggle to handle these challenges, leading to inefficiencies, increased costs, and reduced customer satisfaction. By investing in a comprehensive training…
Identity Loss, Role Transition, and the Path Back to Work I have gone through a difficult period. Over the last year, I lost a sister-in-law, two brothers-in-law, three of my closest friends, and several close friends. The losses came one after another, each arriving before I had finished grieving the last. The movie Coco resonates with me because it reflects how I choose to handle loss — by holding onto…
Introduction One of the most overlooked and underutilized tools in workers’ compensation is also one of the simplest: a clear, accurate physical job description of the work the worker was doing at the time of the injury. Early in my career, I encountered a case that perfectly illustrates why this matters. This true story has stayed with me because it demonstrates how easily a misunderstanding about a job can affect…
A year and a half ago, we published a fairytale about Doctor Google. Since then, a lot has happened in the Fairytale magical medical world of Workers’ Compensation. A common complaint from many treating physicians is that their patients had already visited "Doctor Google" and that "Doctor Confirmation Bias" had already confirmed the diagnosis. This has made it more difficult for the physician to make the correct diagnosis. The problem…
The Foundation of Effective Claims Management The first and most important responsibility of a risk manager overseeing a workers’ compensation program is to ensure that all claims are reported promptly. Timely reporting is the cornerstone of effective claims management. When claims are reported immediately, the organization can quickly and accurately determine compensability—while the facts are still fresh, witnesses are available, and documentation is accurate. Prompt reporting also improves compliance with…
Executive Briefing This paper focuses on the business case for strategic investment in injury prevention and quality claims administration. The central pillar of this process is calculating the Total Cost of Risk (TCOR), which helps the employer calculate indirect costs accurately. Many companies dramatically underestimate the actual financial impact of workplace injuries. While the direct costs of claims and premiums are visible, the actual indirect costs are rarely included when…
The Reality We Face When I was the Group Vice President of Risk Management for Safeway, we were the largest employer of individuals with disabilities in the United States. Among our hundreds of thousands of employees, those with disabilities—including many on the autism spectrum—were consistently among our hardest-working, most dependable, and lowest-risk workers. They showed up every day. They followed procedures meticulously. They cared deeply about doing things right. But…
Key Message: Memory gaps about painful experiences are not evidence of fraud — they are evidence of normal human biology functioning exactly as designed. A Claims Examiner’s Revelation When I first began taking statements from injured workers, I believed that when someone failed to disclose previous accidents or surgeries, they were intentionally withholding information. The ISO search would reveal prior accidents, yet the worker would claim to have “no memory”…
Health literacy—the ability to understand and use health information—is not an academic idea. In workers’ compensation, it is the foundation for recovery. When injured workers cannot make sense of their diagnosis, treatment, or benefits, they disengage. Recovery slows, disability periods lengthen, costs climb, and frustration grows. When they do understand, they become active participants in their healing. Engagement is the engine of recovery, and health literacy is the key that…
