Category: Simple Concepts by Bill Zachry

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 RevelationAs a claims examiner, when I was taking statements from injured workers, I used to believe that when they didn’t disclose previous accidents or surgeries, they were intentionally withholding information. The ISO search would often reveal prior accidents, yet the worker claimed to have…

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As the GVP of Risk at Safeway / Albertsons, I was the victim of my biases.  Once, when my VP of finance told me that we were overpaying for TD, I told him that our TD was higher due to our wages being higher due to our union contract. Soon after, Alex Swedlow told me we were overpaying the TD after he had analyzed our program. I responded with the…

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In every organization, a small group of employees seems to defy the odds, repeatedly “getting injured on the job.” They’re often called “frequent flyers.” While easy to spot in the data, their stories are anything but uniform. Some are just unlucky, accident-prone (usually at home as well as on the job) or always seem to be in the wrong place at the wrong time. Some cut corners on safety to…

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One of the most overlooked aspects of successful recovery from a work-related injury is the injured worker's mindset. Nick was a friend of mine who played racquetball. Famously, he hated to lose. One day, he told me that he was scheduled for a back fusion. As a claims adjuster, I had seen the usual time for recovery of a low back fusion to exceed two months. He turned to me…

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Executive Summary Informed consent and patient advocacy are crucial concepts in healthcare, but they serve different purposes and involve different responsibilities. This paper examines the concepts of informed consent and patient advocacy, highlighting their key differences and importance in modern healthcare. Informed consent is a legal and ethical requirement, ensuring patients understand the potential benefits, risks, and alternatives of proposed medical procedures. Patient advocacy involves supporting and representing patients' rights…

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As a claims adjuster, I used to think that if I got the injured worker to show up for their medical appointments and if they followed the doctor's orders (at least most of the time), they were doing what they were supposed to and that they would recover and return to work. I never thought of physical therapy and what happened there. That activity was below my radar as a…

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Eeyore, the gray and gloomy donkey from Winnie the Pooh, is famous for his pessimistic outlook: "I miss my tail," "It was a nice tail," and "Sure would be nice to have it back." He always sees what's missing, what could go wrong, or what already has. In a world filled with more energetic (and charismatic) characters, Eeyore remains part of the team—sometimes overlooked but always consistent. In the workplace,…

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The Fastest Horse in the World A horse owner was selling the fastest horse in the world. “How do you make him run fast?” the buyer asked.“Say ‘Giddyup,’” the seller said. “He takes off like a bat out of hell.” The buyer responded, “How do you make him stop?”“You hit him over the head with a two-by-four.” was the reply. “Does that stop him?”“Nah,” the seller said. “But it gets…

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Introduction: The Power of Faith in Recovery Whether rooted in spirituality, organized religion, or a personal belief system, faith offers profound comfort and resilience during life’s most challenging moments. Faith can be a transformative force for injured workers, fostering emotional strength and psychological well-being. Yet its role in recovery is often overlooked in the workers' compensation system, as claims administrators, physicians, and attorneys may hesitate to address spiritual concerns due…

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Permanent Disability (PD) is a defined workers' compensation benefit and a critical medical and legal concept. It represents indemnity payments for lasting physical or psychological restrictions resulting from work-related injuries or illnesses. PD is central to the workers' compensation system, compensating for  the loss of a body part (or its function) or the diminished ability to earn income after reaching Maximum Medical Improvement (MMI). Despite its importance, the definitions and…

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