During my early career as a claims adjuster, the industry was focused almost exclusively on providing prompt, accurate benefits to injured workers. Success was measured by speed and accuracy in benefits provision, with little emphasis on the worker’s long-term recovery journey. Over time, however, the industry evolved toward a model of “advocacy,” prioritizing quality medical care to improve outcomes and reduce claim costs. This shift toward advocacy has had a…
At the start of each year, I like to revisit what the ideal workers’ compensation system should look like. Reviewing an ideal system helps all participants understand where they fit into it, and encourages them to look inward to determine whether they are helping achieve the optimum system. This view is not perfect, but it is a start. It is a very high-level view of the system. The challenges and…
Introduction Throughout my career in risk management and workers’ compensation, I witnessed a puzzling phenomenon: some workers with seemingly “minor” injuries never returned to work. In contrast, others with severe injuries returned remarkably quickly. My medical team and our medical director explained that a significant factor behind many of the high-cost cases was Adverse Childhood Experiences (ACEs). These early traumas contributed to disproportionate claim costs because the affected workers often…
Executive Summary Addressing sleep problems in injured workers is essential for ensuring a successful and timely recovery, as sleep quality significantly impacts physical healing, mental well-being, and overall outcomes. Key Findings: Sleep disturbances are common among injured workers and can hinder recovery. Factors affecting sleep quality include pain, medication side effects, environmental issues, and psychological distress. Addressing sleep problems requires a holistic approach involving healthcare providers, claims examiners, employers, and…
This paper provides insight into workers’ compensation insurance collateral requirements and collateral processes affecting employers that are self-insured or that retain risk associated with their workers’ compensation program. Collateral, which is an asset (cash, or securities) that is pledged by an employer as security to ensure payment of workers’ compensation benefits in the event of its default, is a significant part of the insurance expense for many employers. Understanding the…
Jack Immendorf is an authority, pioneer, luminary, and elder statesman of the subrosa industry in Northern California. These are his thoughts and commentary on how we can improve the outcomes from subrosa. Introduction Subrosa investigations are a valuable tool in the workers' compensation industry, providing documented evidence and information not available elsewhere. However, the process is often flawed, with inadequate assignments, poorly planned investigations, and no plans for how the…
As our economy becomes front-page news, the familiar refrain will soon be published in industry blogs, newsletters, and magazines that if there is a recession there will also be an increase in workers' compensation claims frequency The relationship between economic downturns and workers' compensation claims frequency has long been debated. Conventional wisdom suggests that claims frequency increases during economic slowdowns as workers file claims to avoid layoffs or maintain medical…
The ProblemThis paper covers many issues surrounding misdiagnosis in workers' compensation. It was written to start an industry-wide discussion on the issue. The ideal goal in workers’ compensation is to “provide the right care at the right time” to maximize recovery and return to work. Workers' compensation often deals with a range of injuries and conditions that can be difficult to diagnose accurately, especially early in the claim. The increasing use of…
This article was cowritten by Bill Zachry and Timothy Hui, PT, DPT. I. Restoring Function Quality physical therapy restores function and mobility, enabling a faster return to work and daily activities. Early intervention using physical therapy prevents long-term disability and chronic pain. Quality-focused physical therapy with patient engagement results in shorter disability durations, better mobility, and lower claims costs. Patients who do not adhere to their physical therapy regimen are more…
There are many different life situations facing parents. One of the most rewarding and challenging is the balancing act of raising children while meeting work responsibilities. The fundamental obligation of a parent is to make sure that their children obtain the necessary education to be successful in life. Children who are engaged and supported at school usually become successful adults. Many times employers ignorantly create work situations that do not…
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