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 current laws and regulations that require employers and claims administrators to accept or deny claims within strict timelines and to base those determinations on objective evidence. When an injury is reported late, the ability to collect that evidence—such as witness statements, job descriptions, and initial medical findings—diminishes rapidly. Delays in reporting make investigations less reliable, more prone to procedural errors, and more likely to result in compliance violations, penalties, and increased litigation exposure.

Just as importantly, prompt reporting enables a thorough investigation into the root causes of the accident, which is the foundation of injury prevention—understanding why an incident occurred—whether due to unsafe behaviors, inadequate procedures, equipment failure, or environmental hazards—enables corrective actions to prevent recurrence. Without prompt reporting, those opportunities for prevention are lost, and the same type of incident is likely to happen again.

Equally important, prompt, high-quality medical care results in improved medical outcomes and significantly reduces overall claim costs. Early access to appropriate treatment promotes faster recovery, prevents complications, and strengthens the injured worker’s trust in the system. The earlier the proper care is provided, the more likely it is that temporary disabilities are shortened, permanent disabilities are minimized, and litigation is avoided.

Prompt reporting enables the timely delivery of medical care and benefits, ensuring that injured workers receive the support they need without unnecessary delay. This early intervention promotes faster recovery, improves employee morale, and reinforces trust between the employer and the workforce.

Perhaps most critically, prompt claim reporting significantly reduces litigation, which remains one of the most significant cost drivers in workers’ compensation. Early engagement, timely benefit delivery, and transparent communication reduce misunderstandings and prevent the adversarial attitudes that often lead to attorney involvement.

In short, for any workers’ compensation program, prompt reporting isn’t just a procedural requirement—it’s a strategic and compliance imperative.

The Fourteen-Day Goal

The goal of extraordinary claims administration is to accept or deny all claims within fourteen days of the date of injury. For the vast majority of claims, this target is realistic and achievable—but it depends entirely on immediate reporting.

When claims are reported promptly, the claims team can quickly and accurately determine compensability, verify details, and make a fair, well-supported decision. This timely determination protects the employer, the injured worker, and the integrity of the system itself.

However, it is essential to recognize that not all claims can reasonably meet the fourteen-day goal. Certain types of claims—such as alleged exposures to chemicals or asbestos, cumulative trauma, and “application first notice” claims (where the employer’s first notice of injury is through the filing of an application for adjudication)—often require additional time to investigate and obtain medical or factual evidence before a compensability decision can be made.

These exceptions should remain rare. The fourteen-day standard serves as both an operational benchmark and a management accountability tool. Even for complex cases, the expectation of timely documentation, early communication, and transparent explanation of delays should remain.

In California, the claims administrator is responsible for up to $10,000 in medical treatment costs until the claim is formally accepted or denied. This provision ensures that injured workers receive prompt care, but it also exposes employers to significant financial risk if the denial process is delayed. Late reporting and sluggish investigations can therefore result in thousands of dollars in unnecessary medical payments for claims that may later be deemed non-compensable. Timely investigation and decision-making are not only regulatory obligations—they are essential cost-control measures.

The California Division of Workers’ Compensation Audit Unit also places significant emphasis on “unsubstantiated denials.” If a claim is denied without adequate documentation or a complete investigation, it can result in penalties, fines, and audit citations. These findings can carry financial and reputational consequences for both the claims administrator and the employer. Prompt reporting gives examiners the time they need to develop proper documentation, conduct interviews, and accurately determine compensability based on objective evidence, ensuring compliance with audit standards.

There are also strict requirements when a claim is denied. Denials must be based on a thorough, well-documented investigation that satisfies statutory and regulatory standards. Early reporting is essential to meet these compliance requirements—it allows sufficient time for investigators to gather statements, review medical records, and ensure that the denial is accurate, defensible, and timely. A late report compresses the investigation window, leading to procedural errors, missed evidence, or improper denials that expose the employer to penalties and audit findings.

Using Analytics to Identify Systemic Delays

Analytics play a crucial role in identifying systemic barriers to prompt reporting. Every organization should regularly review claim data to determine whether there are consistent delays in reporting—and, if so, where and why those delays occur.

Patterns often emerge when data is analyzed by facility, department, division, or geographic location. By examining when and where reporting lags, risk managers can pinpoint the root cause—whether it’s a specific supervisor, a misunderstanding of policy, or a local incentive structure that discourages timely reporting.

The first step in improving prompt reporting is to determine whether delays exist within the organization. Once the data identifies the source of the delay, targeted interventions—such as retraining, clarifying processes, or adjusting incentives—can be implemented to address the problem.

Analytics can also uncover systemic delays within the claims operation itself. For example, data can reveal if there are bottlenecks in triaging claims to the appropriate examiners, or if examiners are delaying initial contact or the assignment of investigations once a claim has been received. These internal lags can have the same negative impact as late employer reporting—slowing the start of medical care, compressing the investigation window, and undermining compliance with the fourteen-day decision requirement.

In addition to identifying issues, regularly reporting analytic findings back to the front-line employer or the person responsible for paying for the insurance often results in substantial improvement. When employers receive timely feedback about reporting delays—broken down by department, location, or supervisor—it creates visibility, accountability, and engagement. This feedback loop promotes ownership of the process and reinforces the importance of compliance.

Just as importantly, this reporting allows management to see the actual financial impact of delays. When analytics show, for example, that each day of delay adds up to $1,200 in additional claim costs, leaders begin to understand that timeliness isn’t merely procedural—it’s a direct cost-control strategy—making that connection between delay and dollars spent drives lasting behavioral change and sustained improvement.

Equally important is setting specific goals for prompt benefit provision and ensuring that every claims examiner is accountable for meeting them. Analytics should track each examiner’s compliance with the organization’s prompt determination and benefit delivery standards. This creates transparency, reinforces expectations, and builds a culture where timeliness is not just encouraged—it’s measured and managed.

When claims teams know that their performance is being evaluated based on how quickly and accurately benefits are provided, behavior changes. Examiners prioritize early investigation, communication, and decision-making, which in turn reduces disputes, improves trust with injured workers, and lowers overall claim costs.

Barriers to Prompt Reporting

Despite the clear benefits of prompt reporting, several persistent barriers continue to delay the process—and these delays have measurable financial consequences. Research organizations have reported that each day a claim is delayed in being reported can add up to $1,200 in additional claim expenses. These added costs are typically due to delayed medical treatment, increased likelihood of litigation, and missed opportunities for early return-to-work planning.

One of the most common obstacles is the lack of training for front-line managers and supervisors. These individuals are often the first to learn of an injury, yet many do not fully understand the importance of immediate reporting or the long-term financial impact of delay. Without explicit instruction and accountability, production demands or administrative burdens often take priority over timely compliance.

A related challenge is the lack of understanding among workers themselves. Many employees do not realize that workers’ compensation is a no-fault system that protects them from retaliation and financial loss. Fear of being blamed, disciplined, or terminated discourages honest and timely reporting. This misunderstanding delays care, complicates investigations, and increases overall claim costs.

Language barriers can also significantly impact timely reporting. In workplaces where English is not the first language of many employees, injured workers may not understand reporting procedures, benefit availability, or even their right to file a claim without penalty. When workers cannot effectively communicate their injury or do not fully understand their options, injuries go unreported or are reported long after the fact. Providing multilingual materials, translators, and culturally sensitive communication channels is essential to overcoming this barrier.

Another serious and often hidden barrier involves the worker’s employment or immigration status. Undocumented or unregistered workers—who may already feel vulnerable—usually fear that reporting an injury or seeking medical treatment could lead to job loss, retaliation, or even deportation. As a result, they may avoid clinics, hospitals, or any contact with the employer’s claims system altogether. This fear-driven underreporting not only delays care and increases claim costs but also undermines workplace safety by discouraging transparency.

Another systemic barrier is misaligned financial incentives. In some organizations, charge-back or bonus programs penalize facilities, departments, or supervisors when claims occur. When an injury report results in the loss of a bonus or an increase in departmental expenses, the incentive structure unintentionally encourages underreporting or delayed reporting—creating a culture of concealment that ultimately drives up long-term costs and erodes employee trust.

An additional and often overlooked barrier involves post-injury drug testing policies. While drug testing can play an essential role in maintaining workplace safety, if not implemented with care and transparency, it can create fear among employees—particularly those who worry about job loss or disciplinary action. This fear can lead to underreporting of legitimate injuries or delayed disclosure, especially in workplaces where employees believe that any positive test, regardless of circumstances, automatically results in termination.

Finally, delays in reporting can hinder recovery from subrogation when another party is responsible for the accident or injury. In cases involving defective equipment, negligent third parties, or unsafe premises, the ability to recover costs through subrogation depends on prompt investigation and preservation of evidence. Late reporting can result in lost witness statements, unpreserved equipment, or expired notice requirements—all of which can eliminate the opportunity for financial recovery. Prompt reporting not only protects compliance and care delivery but also safeguards the organization’s right to pursue reimbursement from responsible third parties.

Conclusion

Prompt reporting of workplace injuries is one of the most straightforward yet most powerful tools for controlling workers’ compensation costs and improving outcomes. Every day of delay adds unnecessary expense, risk, and complexity. Meeting the fourteen-day goal for claim acceptance or denial depends entirely on early reporting, proper investigation, consistent analytics, and engaged leadership.

By combining data-driven insights, clear expectations, and aligned accountability, organizations can eliminate systemic barriers and foster a culture where timely reporting, accurate investigation, quality medical care, and prompt benefits are universal expectations—grounded in trust, integrity, and care.

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 a company is attempting to determine a return on investment in safety, or, for that matter, adequate staffing in claims, or calculating the cost to fight fraud. Indirect costs such as lost productivity, brand harm, collateral requirements, and the erosion of institutional knowledge are unmeasured and unaddressed. Catastrophic claims further complicate these calculations, as their ripple effects across morale, media scrutiny, and financial reserves tend to magnify indirect costs well beyond standard multipliers disproportionately. These claims can severely damage a company’s reputation, erode customer and employee trust, and trigger regulatory scrutiny and reserve spikes that persist for years.

This paper reframes injury prevention (and a few other risk activities) not as a cost center but as a high-return investment strategy.

Employers who take a holistic view of their Total Cost of Risk (TCOR) and proactively invest in prevention, early intervention, and employee trust-building programs see measurable gains in workforce stability, reduced claims costs, and enhanced organizational resilience. Through examples, financial models, and real-world observations, this document highlights how board-level awareness, audit oversight, and cross-departmental collaboration are critical to fully capturing and managing the long-tail risks of injury-related losses.

Bottom line: Accurately measuring indirect costs will find that they are usually at least ten times the direct costs. Most companies should invest in prevention and claims administration to reflect that exposure.

I. Safeway Case Study: A Real-World Transformation

Even though some organizations pay millions of dollars annually in direct losses within their workers’ compensation programs, very few corporate boards treat this expense as a strategic opportunity for competitive advantage. Most senior management and boards view workers’ compensation too often as a state-mandated administrative burden—an area with little room for innovation or meaningful financial improvement. This passive approach overlooks what could be one of the highest-return investments available to any large employer: proactive prevention.

At Safeway, we demonstrated that investing in injury prevention and claims administration yields measurable results. By strategically focusing on safety, early intervention, and care coordination—and successfully advocating for key changes in California’s workers’ compensation laws and regulations—we reduced our annual direct workers’ compensation costs from over $218 million to under $105 million. These results were not the product of regulatory luck or one-time negotiations, but the result of treating workplace injury risk as a strategic business issue. We approached workers’ compensation with the same rigor and accountability as any other core operating expense. Our philosophy was simple: treat our injured workers as valuable and trusted assets whose timely recovery directly supports our company. With this mindset, we built a program that could be influenced, managed, and optimized over time.

This level of savings didn’t just happen. It resulted from five years of focused, disciplined investments in safety, claims administration, and data-driven decision-making. We developed internal champions, aligned operational goals with risk reduction targets, and built cross-departmental trust in the return on these investments. Safeway’s success demonstrates that workers’ compensation isn’t just a compliance function—it’s a strategic lever. With the right leadership and commitment, employers can dramatically improve outcomes for injured workers and the bottom line.

As a new risk manager at Safeway, one of the first lessons I received from my casualty and property brokers was the importance of TCOR and how to use it in my efforts to secure adequate resources to reduce the frequency and severity of our claims.

My first challenge with accurately measuring our TCOR was capturing all the data needed to assess our total cost of risk. It took the corporate risk management department months to wrestle the data from the various departments and divisions because I had only indirect oversight of many of the costs, which were hidden in each division. We had to identify and connect disparate data sources—claims files, HR records, legal fees, training expenditures, productivity loss estimates, turnover rates, replacement costs, and collateral charges—to get a clear picture of the actual financial impact of workplace injuries.

One of the additional barriers was not just that the data lived in silos—it was that the different departments and divisons defined the costs differently, often not in alignment with risk management principles. For example, a legal fee, severance payment, or supervisor backfill cost might not be tagged as injury-related by the department incurring it. Reconciling these inconsistencies was foundational in our journey to accurately quantify TCOR. Some organizations had never been asked to calculate certain types of loss-related data before, especially costs like employee replacement, turnover, or lost institutional knowledge. These areas were simply not part of standard financial reporting in most departments. As a result, risk management had to lead a discovery process across the company, introducing new definitions and educating internal stakeholders on how these hidden costs affect the total cost of risk. Without this internal shift in understanding, it would have been impossible to capture TCOR meaningfully.

Fortunately, my boss understood the importance of investing in safety to reduce claims frequency and ongoing costs. He gave me the confidence to spend money on prevention and invest in the proper care for our injured workers.

When measuring the indirect costs at Safeway, we began with our known costs. Then we added figures calculated through collaborative analysis with our most experienced team members in both the risk and accounting departments. Together, we developed what we believed to be the most accurate methodology for estimating indirect costs. From this exercise, I firmly believe that the OSHA and other formal models—which suggest that indirect costs range from four to ten times the direct losses—substantially undervalue the actual financial impact of these hidden costs.

We found that for every dollar of direct cost, there were at least five dollars in indirect costs. When presenting this analysis to executives, we translated this into business language. For example, in the grocery industry, where the profit margin is relatively small—about 5 to 8.5%—we calculated how much product sales were needed to offset the cost of workplace injuries. When our claims costs were $218 million, translating into over $2 billion in required milk sales just to break even, this comparison powerfully reframed injury prevention from a compliance obligation into a vital business strategy.

II. Indirect Costs Defined and Categorized

Indirect costs include a broad range of hidden financial impacts not included in traditional claims accounting. These often untracked costs include:

• Lost productivity from the injured worker
• Time spent by supervisors and HR managing the incident
• Overtime and temporary replacement worker costs
• Decline in team morale and engagement
• Legal and administrative costs
• Brand and reputational harm
• Training and onboarding new hires
• Lost institutional knowledge and continuity
• Collateral costs for self-insured retentions
• Fraud prevention through claims reduction

These categories can be quantified through estimates or modeling. Below is an illustrative breakdown:

Estimated Breakdown of Indirect Costs

Note: Catastrophic claims (e.g., amputations, fatalities) skew these numbers significantly higher due to greater media exposure, litigation, and loss of trust.

III. The Illusion of Savings

One of the most significant barriers to prevention investment is the illusion of savings. Cost-cutting measures like reducing safety staffing or delaying treatment approvals may lower short-term expenses but increase long-term losses. Safety success is invisible in many companies—”nothing happened”—and therefore not celebrated.

Without measuring indirect costs, businesses think they’re saving money when, in fact, they are increasing their total cost of risk.  This illusion arises because financial systems easily capture direct costs but overlook what the injury truly costs across the organization.

IV. Real Barriers to Accurate TCOR

Calculating TCOR entirely is often challenging because many expenses are not in the same budget bucket. The whole picture requires HR, production, payroll, operations, safety, legal, and finance data. Fragmented systems, privacy concerns, and inconsistent definitions often prevent complete TCOR measurement, making a culture of interdepartmental collaboration even more essential.

V. Overcoming Barriers to Prevention Investment

Several factors still hold companies back:

• Budget silos: HR, Operations, and Risk don’t always share safety goals or expenses.
• Short-term focus: Leadership changes and quarterly KPIs work against long-term investments.
• Misunderstood ROI: Prevention success often looks like “nothing happened,” which is hard to celebrate in a reactive business culture.

To overcome these, safety professionals must serve as internal consultants, translating safety wins into business impacts, aligning metrics, and advocating for prevention as a revenue protection strategy.

VI. Conclusion: Prevention Is the Highest-Return Investment

The return on investment in injury prevention becomes clear once an employer fully understands their total cost of risk. Ignoring indirect costs creates a false economy, where cost-cutting in safety leads to larger financial and human losses later.

Every injury avoided protects your bottom line, people, and reputation.

When safety is seen as an investment rather than an expense, leadership prioritizes it. And when leadership prioritizes safety, everyone benefits—from the frontline worker to the shareholders.

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 I also witnessed how easily our workers’ compensation system could fail them, often in ways that seemed inexplicable at the time.

I remember one of my risk directors telling me about her son, who worked as a courtesy clerk in one of our stores. He was on the autism spectrum, and one day, he came home genuinely upset—almost indignant—that a coworker wasn’t sweeping the floors with the same focus and precision he prided himself on. He couldn’t understand why someone wouldn’t approach the task with the same level of commitment and attention to detail.

His mother paused, then gently offered, “Maybe she’s also a bit challenged in her own way.”

He stood there stunned for a moment. “I never thought of that,” he said quietly. From that moment on, his attitude shifted completely. He became more understanding—not just of that coworker but of others who worked differently, communicated differently, or saw the world through a different lens.

That conversation stayed with me because it represents precisely the kind of shift we need in workers’ compensation. Sometimes, all it takes is a moment of awareness—the recognition that what looks like defiance or indifference might actually be someone trying their best to navigate a system that wasn’t designed with them in mind.

The numbers tell us this isn’t a rare situation. 1 in 36 children is now diagnosed with autism, according to the CDC, and many adults remain undiagnosed, particularly women and minorities. This means every claims professional will encounter injured workers on the autism spectrum, whether they realize it or not. When we fail to recognize and accommodate autism-related needs, claims can cost 40-60% more due to misunderstandings, delays, and unnecessary complications.

More importantly, we miss the opportunity to do what we’re really here to do: help injured workers heal and return to productive, meaningful work. 

Understanding What We’re Working With

Autism Spectrum Disorder affects how people communicate, process sensory information, and navigate change and uncertainty. It’s called a spectrum because it presents so differently from person to person. Some individuals might be highly verbal professionals with subtle social challenges, while others might be non-verbal with significant support needs. What unites them is a different way of processing the world around them.

In the workplace, autistic employees often demonstrate exceptional attention to detail, strong adherence to procedures, remarkable reliability, and honest, direct communication. They frequently excel at pattern recognition and can develop deep expertise in their areas of interest. These are exactly the qualities most employers value.

But when injury strikes, the very traits that make these employees valuable can become challenges in our traditional claims process. Someone who thrives on routine and predictability suddenly faces a chaotic world of medical appointments, changing schedules, complex forms, and ambiguous instructions. Someone who processes information literally might misunderstand casual language or implied expectations. Someone who is sensitive to sensory input might be overwhelmed by the bright lights and noise of medical facilities.

The result can look like non-compliance when it’s actually confusion. It can appear to be indifference when it’s actually overwhelm. It can seem like obstinacy when it’s actually a desperate attempt to make sense of a system that feels incomprehensible.

What This Means for Claims Professionals

I’ve learned that recognizing autism-related needs doesn’t require becoming a psychologist or memorizing diagnostic criteria. It requires paying attention to patterns and being willing to adjust our approach when our usual methods aren’t working.

Consider the injured worker who consistently misses appointments but seems genuinely distressed about it. Before labeling them as non-compliant, ask whether there might be transportation challenges. Ask if the worker experienced any difficulties at the facility that made the appointment problematic. Bright fluorescent lights, unexpected sounds, and crowded waiting rooms can trigger sensory overload that makes it physically difficult for some people to remain in those spaces.

Think about the worker who gives flat, seemingly emotionless responses during interviews, leading you to question their credibility. Many autistic individuals express emotions differently than we might expect. A lack of facial expression doesn’t indicate a lack of pain or concern—it might simply reflect different neurological wiring for emotional expression.

Or consider the worker who seems to ignore your instructions, then calls repeatedly with the same questions. Rather than assuming defiance, consider whether your instructions were clear and literal enough. Phrases like “follow up as needed” or “take it easy” can be meaningless to someone who processes language literally. They need to know exactly what to do, when to do it, and how to measure success.

The key insight is this: when our standard approaches aren’t working, the solution isn’t to push harder with the same methods. It’s to step back and ask what might work better for this particular person.

Practical Changes That Make a Difference

The most powerful tool in supporting injured workers on the autism spectrum is clear, structured communication. Instead of saying “We need to touch base about your claim,” try “I need to discuss three specific items about your workers’ compensation claim with you. This call will take about fifteen minutes.” The difference is specificity and predictability.

After every significant conversation, send a written summary. Include what was discussed, what decisions were made, what the next steps are, and when they’ll happen. This isn’t just good practice for autistic individuals—it’s good practice for everyone, and it dramatically reduces misunderstandings and missed deadlines.

When scheduling medical appointments, ask about communication and environmental preferences. Some people need written instructions about what to expect. Others benefit from scheduling during quieter times of day. Some need advance notice about any changes, while others might need help navigating transportation or parking.

If you have the injured worker’s consent, share relevant information with medical providers. A simple note explaining that someone prefers written instructions, needs extra time to process questions, or is sensitive to bright lights can transform a medical encounter from stressful to successful.

For complex cases or when standard approaches aren’t working, consider requesting a medical management nurse with autism experience. These specialized nurses understand how autism affects medical treatment compliance, pain expression, and recovery processes. They can bridge communication gaps between the injured worker, medical providers, and your claims team. Their expertise in autism-informed care coordination often prevents the misunderstandings and treatment delays that drive up claim costs and prolong recovery.

When planning return to work, think beyond medical clearance. Consider whether the work environment has changed, whether new accommodations might be needed, and whether supervisors understand how to communicate effectively with this employee. Often, simple adjustments like providing written job expectations, giving advance notice of schedule changes, or allowing the use of noise-canceling headphones can make the difference between success and failure.

Reframing Our Claims “Red Flags”

One of the most important shifts in working with autistic injured workers is learning to interpret behaviors differently. What we traditionally view as red flags often have completely different meanings when autism is involved.

When someone repeatedly misses appointments, our instinct might be to question their motivation or commitment to recovery. But for an autistic individual, missed appointments might reflect sensory overwhelm, confusion about transportation, or anxiety about unfamiliar environments. The solution isn’t enforcement—it’s problem-solving. Ask what would make appointments more manageable and work together to address those barriers.

When someone seems to ignore instructions, our tendency might be to assume non-compliance or poor cooperation. But unclear or overly complex instructions can be genuinely impossible for some people to follow. Instead of repeating the same instructions more forcefully, try breaking them into smaller steps, providing written formats, or asking what part of the process is unclear or difficult.

When someone appears emotionally flat or disengaged, we might question their honesty or investment in their recovery. But emotional expression varies enormously among autistic individuals. Some feel emotions deeply but struggle to express them in ways others recognize. Rather than interpreting body language or tone, focus on what people actually say and ask direct questions to understand their experience.

The pattern here is consistent: when we encounter behaviors that don’t match our expectations, our first response should be curiosity rather than judgment. What might be driving this behavior? What accommodation or adjustment might help? How can we work together to achieve the goal we both want—successful recovery and return to work?

The Business Case for Getting This Right

When we handle autism-related needs appropriately, claims resolve faster and more successfully. Medical treatment becomes more effective when providers understand how to communicate with their patients. Return-to-work success rates improve when accommodations are thoughtfully planned and implemented. Worker satisfaction increases when people feel heard and supported. Litigation risk decreases when trust is maintained throughout the process.

Conversely, when we miss autism-related needs, costs escalate quickly. Medical care becomes ineffective when patients can’t communicate their symptoms clearly or can’t tolerate treatment environments. Claims drag on when instructions aren’t understood or followed. Workers may never return to productive employment when return-to-work planning ignores their communication and environmental needs. Legal exposure increases when workers feel discriminated against or inadequately supported.

The accommodations that support autistic workers are typically simple and low-cost. Written communication, structured processes, environmental modifications, and clear expectations benefit everyone involved. We’re not talking about expensive technology or major system overhauls. We’re talking about thoughtful adjustments to how we do work we’re already doing.

Resources for Immediate Support

When you need consultation on workplace accommodations, the Job Accommodation Network at askjan.org provides free guidance. For healthcare providers working with autistic patients, the Autism Healthcare Accommodations Tool at autismandhealth.org offers practical strategies. The CDC’s autism information page provides current statistics and basic educational material, while Autism Speaks offers toolkits specifically designed for healthcare providers and first responders.

For legal questions about confidentiality and disclosure requirements, consult your organization’s legal counsel and your state workers’ compensation commission for jurisdiction-specific guidance. Local disability advocacy organizations can provide community-specific resources and support.

The Autistic Self Advocacy Network offers perspective from autistic adults themselves, which can be invaluable in understanding how autism affects real people in real workplaces. Project ECHO Autism provides professional development opportunities for healthcare providers who want to improve their skills in working with autistic patients.

Your Path Forward

The changes I’m asking you to make don’t require extensive training or major system overhauls. They require awareness, curiosity, and a willingness to adjust your approach when your usual methods aren’t working.

Start this week by paying closer attention to communication patterns in your current cases. Are there workers who seem to struggle with verbal instructions but respond well to written communication? Are there people who appear anxious or overwhelmed by changes in schedule or procedure? Begin asking about communication preferences and providing written summaries of important conversations.

Over the next month, develop some simple templates for common situations. Create standard language for explaining benefits, scheduling appointments, and summarizing treatment plans. Build relationships with local resources that can provide consultation and support when you encounter situations that require additional expertise.

Looking ahead, advocate within your organization for autism awareness and accommodation training. Share what you learn with your colleagues. Track the outcomes when you use autism-informed approaches and document the improvements you see in claim resolution and worker satisfaction.

The Call to Action

The injured workers on the autism spectrum in your caseload are counting on you to recognize their needs and respond appropriately. They’re not asking for special treatment—they’re asking for the opportunity to recover and return to work successfully, just like any other injured worker.

This isn’t about political correctness or compliance checkboxes. It’s about effectiveness. It’s about doing our jobs well. It’s about recognizing that our systems weren’t designed for everyone, and that adapting them isn’t just the right thing to do—it’s the smart thing to do.

When we lead with empathy and curiosity instead of assumptions, when we provide structure and clarity instead of ambiguity, when we treat communication barriers as problems to solve rather than character flaws to judge, we don’t just improve individual claims. We build a better system for everyone.

The son of my risk director learned something profound that day: sometimes people who seem difficult or different are simply doing their best in a world that wasn’t designed for them. The same insight that helped a young man become more understanding of his coworker can help all of us become more effective at serving injured workers who see and experience the world differently than we do.

The question isn’t whether you’ll encounter injured workers on the autism spectrum. The question is whether you’ll recognize their needs and respond appropriately when you do.

Start today. The workers, depending on you, deserve nothing less than your best effort to understand and support their path to recovery.

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” of them.

I viewed this as deception. During depositions, many injured workers seemed to have no recollection of underlying medical conditions, pre-existing injuries, surgeries, or prior industrial accidents. My attorneys often treated these moments like “gotcha” opportunities, and our Special Investigation Unit was always pleased to report that the worker was not being truthful.

What I did not understand was this: forgetting pain is part of being human. We are biologically wired to suppress painful memories.

Dr. Steve Feinberg once told me that if women truly remembered the intense pain of childbirth, the human species would not have survived. He called it “putting the pain in a box and then putting the box aside.”

I realized he was right when I reflected on my own experiences. I cannot recall the exact dates or physicians from my two shoulder surgeries. And when I injured myself diving to tackle a camera thief in Barcelona, yes, I got my camera back and I vividly remember the adrenaline and anger. But I cannot clearly recall the pain, even though I tore a muscle completely off the bone.

Every time I think about that event, I can feel the rush of adrenaline and the anger but not the pain. That is pain memory biology in action.

This realization changed how I saw workers’ compensation claims. What I had once assumed was dishonesty was often a biological phenomenon. Most injured workers weren’t lying, they truly couldn’t remember.

Why Pain Memory Fades

Medical science confirms this. Pain memories are not stored like other memories. The brain suppresses much of the sensory detail to protect us.

Neuroimaging studies show that when we recall pain, the brain’s pain-processing centers especially the contralateral posterior insular cortex are far less active than when pain is actually experienced. We remember that something hurt, but not how much it hurt.

Behavioral economist Daniel Kahneman’s “peak-end rule” adds more context:
We remember the worst moment and how the pain ended, not the full duration.

This means an injured worker may vividly recall the moment of injury or relief after treatment yet forget weeks of lingering pain in between.

This forgetfulness has evolutionary purpose. If every painful detail stayed sharp, we would become fearful, avoid activity, and struggle to recover. Forgetting pain allows us to move forward.

Other Factors That Cloud Memory

In addition to biology, several factors can impair recall:

• Trauma & stress hormones: Can disrupt memory formation.
• Medication: Opioids and other drugs interfere with memory consolidation.
• Attention limits: During acute pain, the brain prioritizes survival, not record-keeping.
• Head trauma: Can damage brain regions crucial for memory, leading to fragmented or inaccurate recall.
• Kinesiophobia: Fear of movement due to anticipated pain can persist even when the pain memory fades.

These are not excuses, they are explanations grounded in neuroscience.

What Looks Suspicious — But Isn’t

Adjusters often see the following as red flags, but they are common and predictable responses to injury:

• Forgetting which hospital or doctor performed a past surgery
• Failing to mention a prior workers’ compensation claim
• Inconsistent descriptions of pain levels over time
• Incomplete or changing accident recollections
• Demonstrating fear of movement without recalling pain severity

These are not necessarily signs of fraud.  They are signs of being human.

The Technology Solution

Human memory is a poor database. Instead of relying on recall, we should rely on data.

Modern AI can:

• Search across medical records and pharmacy networks
• Identify prior treatments and surgeries
• Build accurate timelines
• Recognize patterns far better than human memory

This shifts the process from interrogation to documentation. It reduces bias, minimizes conflict, and supports fact-based investigations.

A Paradigm Shift for Claims Professionals

To better serve injured workers and employers, we need to update our mindset:

• Memory gaps are not immediate fraud indicators
• Human biology not dishonesty explains many inconsistencies
• Interviews should focus on objective records, not perfect recall
• Training teams in pain memory science improves fairness and efficiency

When we understand pain memory and the psychological responses to injury, we improve accuracy and compassion in the claims process.

Biology, Not Deception

Injured workers who forget prior medical history or details of their injury are not necessarily lying. The brain is designed to let pain fade so we can survive, recover, and move on.

Memory lapses are not evidence of fraud. They are evidence of biology working as intended. By accepting this and using technology to fill the gaps, we create a workers’ compensation system that is both fair and effective.  One built on science, not suspicion.

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 starts it.

I learned this truth early in my career. On my second day as a claims examiner, my supervisor dropped four files on my desk and told me to call the doctors and either approve or deny surgeries. I had no medical training—only a semester of high school physiology—yet I was being asked to make decisions that could change lives. At the time, I trusted the doctors and approved every surgery. Years later, when I was overseeing claims operations, I made sure those decisions were left only to medical professionals. It was the right change, and it underscored something larger: people without medical training cannot be expected to make complex medical choices. And yet that is exactly the position most injured workers find themselves in when they are hurt.

The World Health Organization defines health literacy as the ability to find, understand, and use health information to make informed decisions. That definition has two sides. Personal health literacy is the worker’s ability to understand their condition, their treatment options, and their role in recovery. Organizational health literacy is the responsibility of employers, claims administrators, and medical providers to communicate in a way that makes understanding possible. When either side fails, engagement falters.

Workers’ compensation adds another layer. Injured workers don’t just need to know about their medical care; they must also develop “workers’ compensation literacy.” They need to understand their rights and responsibilities, how claims are reported and processed, what benefits are available, and how disputes are resolved. Without this system knowledge, the process feels arbitrary and intimidating, which discourages participation.

The effects are not only administrative—they are deeply human. Workers who understand what is happening experience less anxiety and fear. They are more confident in their recovery, more likely to follow through with therapy and medication, and better able to explain their situation to their families. This support network then strengthens their recovery. When workers grasp the return-to-work process, they are more willing to reengage with their employer, even if modified duties are required. Clarity breeds confidence, and confidence drives engagement.

Improving literacy does not require grand programs. It requires clear, plain communication without jargon. It requires checking for understanding—asking workers to repeat instructions back in their own words. It requires reinforcing information in multiple ways: verbal explanations, written materials, visual aids, and even short videos or apps. Technology can help by reminding, demonstrating, and tracking progress. But technology must never replace the human touch. A coach, supervisor, or case manager who listens, encourages, and answers questions is often the single most important factor in keeping an injured worker engaged.

Organizations also have a role. Employers can prepare workers ahead of time by providing education on rights and processes before injuries occur. Claims administrators can adopt standardized communication protocols so that messages from doctors, adjusters, and HR do not contradict each other. Medical providers can prioritize patient education, making sure that “informed consent” truly means the worker understands. Case managers can serve as translators of medical complexity, advocates for comprehension, and steady points of contact when the system feels fragmented.

The case for improving health literacy is not only moral but financial. Research shows that workers with higher health literacy adhere better to treatment, return to work faster, and require fewer disputes and interventions. Health literacy programs have demonstrated reductions in medical costs, disability durations, and litigation, while improving satisfaction and trust. In other words, investing in literacy pays for itself many times over.

If I, after a lifetime in workers’ compensation, sometimes feel lost in the maze of medical terminology and protocols, imagine how a warehouse worker, a nurse’s aide, or a farmworker feels when they are suddenly injured. For them, health literacy is not a slogan—it is the difference between passive confusion and active engagement in their recovery.

Engagement begins with understanding. When we make the system clear and communicate with respect, we give injured workers the confidence to participate in their healing, the strength to return to work, and the dignity of being partners in their recovery. That is the true promise of health literacy.

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
As 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 “no memory” of these events. I saw this as deception. I also saw many depositions where the injured worker had no information on underlying medical conditions, pre-existing injuries, surgeries, or prior industrial accidents. My attorneys were always playing the “Gotcha” game with these claims. Our Special Investigation team was always pleased to say that the worker was not telling the truth.

What I did not understand was that forgetting pain is part of being human. We are biologically wired to suppress painful memories. Dr. Steve Feinberg once told me that if women truly remembered the intense pain of childbirth, the human species would not have survived. He called it “putting the pain in a box, and then putting the box aside.”

I realized he was right when I reflected on my own experiences. I can’t recall the exact dates or doctors of my two shoulder surgeries. This selective memory process became even clearer to me when I injured myself while diving to tackle a camera thief in Barcelona. As I now tell my friends, I earned style points for the dive, but I didn’t stick the landing—I tore the muscle off the bone in my shoulder. By the way, I did get my camera back. The pain was rather intense as soon as the adrenaline wore off. However, it was the intense anger at the thief that I could reproduce. Every time I thought of the event, I could feel the adrenaline and anger at the thief, but not the memory of the pain. This experience demonstrated exactly what Dr. Feinberg meant about putting pain in a box and setting it aside.

The insight from Dr. Feinberg altered my perspective on workers’ compensation claims. What I once thought was dishonesty was, in fact, a biological phenomenon. Injured workers weren’t lying to me. They simply could not remember.

Why Pain Memory Fades
Medical science explains this. Pain memories are not stored the same way as other memories. The brain suppresses much of the sensory detail to protect us. MRI studies show that when we recall pain, the brain’s pain-processing regions are far less active than when pain is actually experienced. The contralateral posterior insular cortex, which is crucial for experiencing pain intensity, is notably absent during the recall of pain. We can recall that something hurt, but we don’t remember how much it hurt.

Daniel Kahneman’s research on the “peak-end rule” adds insight: we remember the worst moment and how the pain ended, but not the whole duration of the experience. As a result, patients in his studies rated longer but less painful endings as more tolerable than shorter, sharper experiences. In workers’ compensation, this means an injured worker may vividly recall the moment of injury or the relief from the treatment, but forget the weeks of lingering discomfort in between.

This forgetfulness has evolutionary value. If every painful detail stayed sharp, we would be too fearful to take risks, unable to recover, and consumed by anxiety. Forgetting pain allows us to move forward.

Other Factors That Cloud Memory
Beyond biology, several circumstances further impair recall:

• Trauma: The stress hormones released during an accident can disrupt memory formation, leaving gaps or fragmented recollections.
• Medication: Opioids and other drugs interfere with memory consolidation. Workers may genuinely forget conversations, prior treatments, or even earlier injuries.
• Attention Limits: In the case of acute pain, the brain allocates resources to coping rather than recording details. Information like dates, doctors, and timelines often never makes it into memory.
• Head Trauma: Head injuries often disrupt the hippocampus and frontal lobes, which are critical for forming and recalling memories. This can lead to fragmented or inaccurate recollections of the severity of pain felt at the time of injury.

These are not excuses — they are explanations of how and why injured workers forget.

What Looks Suspicious But Isn’t
Adjusters often interpret these scenarios as fraud indicators, but they’re actually normal biology:

• A worker can’t remember which hospital performed their back surgery two years ago.
• A worker fails to mention a previous workers’ compensation claim when asked about prior injuries.
• A worker gives different descriptions of their pain level when interviewed at different times.
• A worker can’t recall specific accident circumstances.
• A worker shows apparent fear of certain movements but can’t explain the original pain severity.

None of these automatically indicate fraud. They’re predictable results of pain-offset relief, the peak-end rule, and protective fear mechanisms.

The Technology Solution
Human memory is a poor database. Instead of expecting workers to recall complex medical histories, we should lean on technology.

Modern AI systems can rapidly search across medical records, pharmacy data, and treatment histories from multiple healthcare systems. They recognize patterns across years of data, build accurate timelines, and highlight relevant pre-existing conditions far better than human recall ever could. AI can provide comprehensive coverage that no individual could reasonably be expected to remember, cross-referencing dates and treatments more accurately than human memory.

This shift from interrogation to documentation removes bias, reduces conflict, and allows investigations to be based on evidence rather than faulty memory.

A Paradigm Shift for Claims Professionals
This understanding requires a cultural change. Memory gaps should not automatically be treated as red flags for fraud. They are expected outcomes of human biology.

As adjusters and attorneys, our role is not to “catch” workers in memory inconsistencies but to recognize the limits of memory and focus on objective evidence. Interviews should explore whether there are objective records of prior accidents and medical treatment. We should ask about current function, documented treatment, and objective limitations—not rely on pain recall as a credibility test.

Training teams to understand pain memory and kinesophobia transforms the process. It reduces unnecessary conflict, improves fairness, and saves time. Most importantly, it aligns workers’ compensation practices with human reality.

Biology, Not Deception
Injured workers who forget prior injuries, doctors, or dates are not always liars. They are human. The brain is designed to let pain fade so we can recover and move on. When they show fear-avoidance behaviors alongside poor recall, this demonstrates that normal biological processes are working exactly as designed.

By accepting this truth and embracing technology to fill the gaps, we can create a system that is both fairer and more effective. Claims investigations built on science, not suspicion, lead to better outcomes for workers and employers alike.

Memory lapses are not evidence of fraud. They are proof of biology working precisely as intended.

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 same retort. When our VP of managed care said to me that we were paying for TD twice as long as the industry for similar injuries, I realized that I was a victim of my bias and that we were not as perfect as I thought. That resulted in a reformatting of our light and modified duties program at Safeway. I could have saved a lot of money and time if I had listened the first time they told me.

Another bias I carried was egocentric bias—assuming that everyone in the office saw the system and the friction points the same way I did. I regularly fell into the trap of a false consensus effect, expecting people to act on things I believed were obvious. When they did not see it my way, I wondered why they weren’t doing exactly what I believed they should be doing to get better results.

Biases can keep claims examiners from doing the right thing to get the injured worker engaged, or they can also keep the injured worker from becoming engaged in their recovery. It is helpful for us to understand the biases that color our view of the world and appreciate how they can help or hurt us in our efforts to work for the injured workers. Like almost everything, biases can be used for good, or they can be used against you and what you want to accomplish. Understanding how biases work and how they sometimes keep you from seeing the whole picture is the first step to doing better.

1. Confirmation Bias: It’s too easy for an examiner to size up an injured worker early in the claim process and never shift that first impression. Let’s say a worker calls in late to a first appointment or seems unsure when describing the mechanism of injury. The examiner—already managing a heavy caseload and looking for patterns—files this away as a possible red flag. From then on, every piece of information is subconsciously filtered through that initial suspicion: missed call? Avoidance. Slow recovery? Malingering. Requests for second opinions? Manipulation. The examiner may not realize that they are only collecting evidence that confirms their gut feeling—and ignoring facts that challenge it.

Impact: This bias, known as the Confirmation Bias, can lead to reduced empathy and a delay in approving care that could be entirely appropriate. The examiner builds a wall of assumptions, and the injured worker—feeling mistrusted—may disengage or even litigate.

Engagement Tip: To counter the effects of the Confirmation Bias, train examiners to pause and deliberately seek out disconfirming evidence. Encourage them to document what fits their theory and what challenges it. This approach can help them maintain a more balanced perspective.

2. Fundamental Attribution Error: This bias shows up when we misread someone’s actions and assign them to character rather than circumstance. Say a worker snaps at a nurse or misses a follow-up appointment. The examiner may quickly label them as complex or irresponsible. But often, there’s something deeper going on—fear of losing their job, unmanaged pain, or confusion about the process. When we attribute these behaviors to a flaw in personality rather than a reaction to stress, trauma, or pain, we lose the opportunity to offer support that could improve outcomes.

Impact: The examiner’s attitude hardens. Support is replaced by blame. And the injured worker, feeling misunderstood, distances themselves even more.

Engagement Tip: Encourage examiners to pause and ask, “What might be happening behind this behavior?” That slight shift in mindset can change the trajectory of the claim.

3. Negativity Bias: It’s human nature to remember the one negative incident in a sea of neutral or even positive ones. For claims examiners, one difficult phone call, one missed deadline, or one frustrated voicemail can cast a long shadow over an injured worker’s file. We may start expecting the worst from that person, interpreting every action with suspicion, even when they do their best to recover.

Impact: This cynicism can lead to micromanagement and care delays. The examiner might hold back on approvals or double-check everything, not realizing they create more friction.

Engagement Tip: Encourage examiners to reflect on success stories and use case-based learning to reinforce a sense of perspective. Balance matters, especially when trust is on the line.

4. Halo Effect / Stereotyping: We often allow one trait—positive or negative—to define an entire person. That label can stick if an injured worker is seen as angry or uncooperative early in the process. From then on, every request, delay, or question may be interpreted through that lens. It becomes harder to see progress or effort because the stereotype has taken over.

Impact: This can lead to delayed care, strained communication, and increased litigation. The worker is no longer seen as a whole person but as a problem to manage.

Engagement Tip: Use objective engagement metrics like adherence to physical therapy, General Self-Efficacy scores, or PHQ-8 assessments. These tools give you a more balanced, data-informed view that helps strip away stereotypes and focus on actual progress.

5. Bias Blind Spot: One of the most persistent biases is the belief that bias is something other people have. Claims professionals are trained to be objective, and many pride themselves on fairness. But that pride can create a blind spot. If you don’t believe you have bias, you won’t look for it and certainly won’t challenge it.

Impact: This can lead to rigid thinking and resistance to feedback or improvement. It stalls growth and prevents learning from mistakes.

Engagement Tip: Normalize the idea that everyone has bias. Incorporate bias recognition and reflection into training. Make it safe for examiners to acknowledge where their thinking may need to evolve.

6. Empathy Gap: Claims are often managed under pressure—with limited time, high caseloads, and a strong focus on compliance. In that environment, it’s easy to forget that the person on the other end is in pain, possibly scared, and may not understand what’s happening. When we underestimate the emotional toll of injury, fear of job loss, or unfamiliar medical and legal jargon, we risk sounding cold or indifferent—even if we don’t mean to.

Impact: That emotional disconnect can shut down engagement. The injured worker feels like just a number, not a person.

Engagement Tip: Train and coach examiners to start every interaction with empathy. A simple “That sounds tough—let’s see what we can do to help” before diving into logistics or documentation can go a long way in building trust.

Enhancing engagement by teaching examiners about bias awareness can improve results.

Bias management skills:

• Understand how biases can impact engagement
• Listen more openly
• Ask better questions
• Build rapport
• Advocate for timely care
• Track progress fairly
• Recognize and Encourage engagement when it takes place

By doing so, examiners become more than just paperwork processors—they become advocates, allies, and trusted guides on the injured worker’s path to recovery. Shifting the dynamic from managing a claim to supporting a person is better for outcomes, it’s simply the right thing to do.

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 meet production targets. A few use claims as a workaround for denied vacation, like those who are mysteriously injured just before hunting season. And some treat the system as a means of leverage or litigation.

In my career, this problem has been constant.

Whatever the cause, the pattern isn’t just a financial headache, it’s a strategic and cultural landmine. These repeated claims drain resources, frustrate supervisors, and exhaust coworkers who pick up the slack. They also consume an outsized share of claims examiners’ time, which could be better spent supporting recovery or resolving other complex cases. Frequent flyers are one of the reasons employers lose confidence in the workers’ compensation system and begin to believe that all injured workers are frauds or faking their injuries.

Historically, the most common solution was to remove the employee through a lump-sum settlement tied to a resignation or through progressive disciplinary action aimed at termination. In non-union environments, this was often the path of least resistance. The process was slower and more contested in union shops, but the goal was always to get the employee out of the organization. This persisted even though terminating someone for having had an industrial injury is illegal and is an uninsurable risk. Still, employer anger and frustration often pushed decision-makers toward risky, reactive strategies.

Can the cycle be broken? Absolutely. Here’s how.

A Constructive Alternative

Recently, a more strategic and constructive approach has emerged. Rather than viewing frequent flyers as liabilities, some organizations reframe them as safety assets. By involving these employees in prevention efforts—turning them into safety advocates, peer educators, and hazard spotters—organizations can break the cycle of individual injury and simultaneously strengthen their safety culture.

In one notable case, a large retail organization assigned employees with recurrent injury patterns to help lead safety initiatives. Some were given full-time assignments, while others retained their original duties and took on safety as an adjunct responsibility. The physical risks of their roles remained, but the shift in focus changed everything. Their experience gave them credibility. Their new role gave them purpose. And being trusted by leadership fundamentally changed how they approached their work. The results? A measurable drop in injury rates—not just for the individuals involved, but across the workforce—proves this new approach’s success.

Rethinking the Problem: Insights from Other Industries

This model of turning risk into value isn’t unique to workers’ compensation. Similar transformations have occurred in other sectors.

In hospitality, some hotels have hired former dissatisfied guests as service consultants. Their insight into customer frustration lets them pinpoint pain points that managers miss. In addiction recovery, peer coaches—people who’ve battled addiction themselves—guide others through recovery, not because of their credentials, but because of their lived experience. Their credibility helps rebuild trust, offer hope, and reduce relapse.

The same principle applies in the workplace. When workers with a history of injuries are empowered to prevent them, not only in themselves but also in others, they become a cultural bridge. Their past becomes a tool for progress, inspiring others to take control of their safety.

Strategic Goals of the Safety Assignment

1. Individual Risk Mitigation
The immediate goal is to stop the cycle of injury. By shifting the employee into a purpose-driven safety role, the organization reduces physical exposure and reframes the worker’s identity from risk to resource. The result is often a change in behavior, mindset, and long-term outcomes.

2. Systemwide Claims Reduction
Frequent flyers understand how injuries happen. They know where safety breaks down, what shortcuts people take, and how coworkers think. Their lived experience gives them authenticity, allowing them to influence behavior more effectively than policies or posters ever could.

3. OSHA Compliance as a Structural Benefit
Designating frontline safety advocates also helps ensure compliance with OSHA standards. While compliance alone won’t prevent every injury, it provides a framework for tracking, accountability, and continuous improvement.

4. Practical Experience in Safety Leadership
Engineers, EHS professionals, or managers often fill traditional safety roles. While technically skilled, these individuals may not always understand the day-to-day realities of physically demanding jobs. Employees with firsthand experience, especially those injured—bring a different, practical perspective. They know what it’s like to work through pain, to manage awkward equipment, and to deal with unclear instructions. When these employees lead safety initiatives, their recommendations often carry more weight and resonate more deeply with the broader workforce. They also reflect the diversity of the workforce’s experience—physical, cognitive, and linguistic—which helps build more inclusive and realistic safety solutions. Injured workers, especially those who are older, smaller, bilingual, or from historically marginalized groups—bring new insights that lead to better, more inclusive solutions, making everyone feel included and valued in the safety process.

The same is true in safety. A back-injured worker might identify a poor lift table design. A Spanish-speaking employee might flag that half the shift didn’t understand the safety video. A worker with carpal tunnel might spot the flaw in a commonly used hand tool.

Changing who leads safety can change how safety is designed and implemented on the front line.

Implementation Strategy: Making It Work

For this model to succeed, it must be implemented with intention, transparency, and structure. Key steps include:

• Careful Selection: Not every frequent flyer is ready for this role. Choose those with insight, influence, and the willingness to contribute positively.
• Mentorship & Training: Pair new safety leaders with experienced professionals to ensure guidance, credibility, and technical grounding.
• Pilot Assignments: Before expanding responsibilities, start small—toolbox talks, hazard walks, or peer check-ins.
• Workforce Communication: Be clear about the role’s purpose. This is not a reward or punishment, it’s a strategy rooted in accountability and prevention.
• Oversight & Metrics: Track individual performance and overall safety outcomes to ensure the program’s integrity and effectiveness.

Poor Implementation Can Backfire

When mishandled, this strategy can do more harm than good. Watch for these pitfalls:

• Poor Selection: Some workers just are not suited to lead others.
• Lack of Training: Unprepared employees can spread misinformation or overlook hazards.
• Lack of Management Support: If senior leaders don’t visibly back the effort or supervisors undercut it with sarcasm or exclusion, the employee is set up to fail.
• Damaged Credibility: If peers see the assignment as performative or punitive, the role will lack influence, and trust across the workforce could quickly erode.

In short, this approach builds trust and engagement when done well. When done poorly, it undermines safety culture.

Metrics and Equipment: Non-Negotiable Foundations

No safety strategy can succeed without proper equipment and data. Metrics help identify trends, validate success, and catch issues early. Near misses, leading indicators, and engagement levels should all be tracked.

Likewise, safety leaders must be equipped with what they need—functioning PPE, ergonomic tools, and proper lighting. A strong culture can’t compensate for broken gear or missing gloves.

Clarifying the Difference: Recurrent Injury vs. At-Risk Employees

It’s essential to distinguish between employees with recurrent injuries and those considered “at-risk.” The former group may benefit from structured leadership roles and accountability. The latter—often individuals with Adverse Childhood Experiences (ACEs), poor coping skills, or psychological distress—require early intervention, support, and care coordination.

Conflating the two leads to misaligned strategies. Addressing them separately allows for more precise, practical solutions.

Leadership Sets the Tone

No safety program will thrive without visible, consistent leadership from the top. When senior leaders prioritize safe production over fast production, they send a clear signal. The message is just as loud when they fail to act or reward corner cutting. Safe production has been proven to be faster, with fewer disruptions, less downtime, and lower total costs.

Assigning frequent flyers to safety roles works best when the company culture supports it. When workers see that the effort is real and their voices matter, they believe that safety is everyone’s job.

Parallels with Deming’s System of Management

This approach to engaging employees with recurrent injuries in meaningful safety leadership roles strongly echoes the management philosophy of W. Edwards Deming. Deming emphasized continuous improvement, eliminating fear in the workplace, and leadership that fosters pride in one’s work. By reframing injured employees as valuable contributors, this model replaces fear with trust, encourages open feedback, and promotes systemic learning—hallmarks of Deming’s principles. It also breaks down traditional silos between labor and management and shifts data usage from punitive enforcement to constructive insight. Most importantly, this strategy acknowledges that performance issues often stem from system design rather than individual failure, precisely the kind of systemic thinking Deming championed.

Conclusion: Turning Cost Centers into Culture Builders

The traditional approach to repeat injury is reactive: settle the claim, remove the employee, move on. But a better path exists.

By reframing these individuals as safety contributors—rooted in experience, guided by structure, and supported by leadership—organizations can reduce claims, improve compliance, and strengthen their culture from the inside out.

With the proper training, tools, and trust, what was once a chronic cost becomes a powerful catalyst for lasting, measurable change.

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 and asked, “How is your Friday three weeks from now?” I said I could play him then but did not expect him to show. To my surprise, he was there and played the entire hour. After the game, I asked him how he was doing. He smiled and said, “I just kicked your ass.”  Nick expected to recover entirely and quickly and did exactly what he had expected. I suspect he had some pain after the first game, but he never complained.

General Self-Efficacy is the confidence one has in oneself to solve problems, manage adversity, and navigate difficult situations.

Much attention is paid to diagnosis, treatment, and claims processing in workers’ compensation. Still, too little is invested in understanding how psychological readiness—specifically General Self-Efficacy —can make or break a recovery. Engagement isn’t just about attending physical therapy or following a treatment plan; it’s about the injured worker owning their recovery. GSE is the key to that ownership.

Understanding General Self-Efficacy is not just about grasping a concept; it’s about unlocking a powerful tool for empowerment. GSE is the belief in one’s ability to succeed in specific situations or accomplish a task. It is not just optimism or hope—it is a measurable, research-backed psychological trait linked to motivation, resilience, and behavioral follow-through. This potential for empowerment of GSE should instill a sense of hope and optimism in the audience.

GSE is typically assessed using the General Self-Efficacy Scale (GSES), a ten-item questionnaire that evaluates confidence in problem-solving, perseverance, and managing adversity. A higher GSE score indicates a stronger belief in one’s capacity to navigate difficulties and achieve goals—even when setbacks occur.

Why GSE Matters in Workers’ Compensation

In the controlled and often opaque world of workers’ compensation, injured workers can feel sidelined, reduced to a case number, and overwhelmed by a process they don’t understand.  This is where GSE becomes essential.

Workers with high GSE are more likely to:

• Participate actively in physical therapy and treatment
• Ask questions and seek clarity about their care
• Set and pursue recovery goals
• Return to work faster and more confidently
• Cope better with pain and setbacks

Conversely, low GSE is not just a trait; it’s a red flag. It’s associated with passivity, avoidance, and poor recovery outcomes. In many cases, a low-GSE worker may appear non-compliant or disinterested when, in fact, they lack belief in their ability to succeed. This is a problem that needs our attention. Low GSE can manifest as a lack of initiative, a tendency to avoid challenges, and a belief that one’s efforts will not lead to success. Recognizing these signs can help identify workers who may need additional support in their recovery journey.

High GSE in Action: Competitive Drive as the Opposite of Learned Helplessness

At the opposite end of the spectrum from low GSE are individuals who possess an extraordinary belief in their ability to overcome adversity—often accompanied by a fierce sense of personal drive and competition. Elite athletes like Michael Jordan and LeBron James exemplify this mindset. Their belief in their ability to succeed in nearly any circumstance defines high GSE in its most empowered form.

These individuals don’t just respond to challenges—they seek them out, believing that effort, discipline, and mindset will lead to success. In injury, this self-efficacy translates into exceptional compliance, ownership, and determination to return to peak function. While few injured workers may operate at this elite level, claims professionals and healthcare providers should aim to foster this same spirit of agency and belief in recovery.

Fortunately, GSE is not a fixed trait—it can be developed with the right support. Employers, providers, and claims administrators can adopt strategies that promote a worker’s self-efficacy. This effort must be collaborative and include a variety of stakeholders. Emphasizing each stakeholder’s role in fostering GSE helps ensure they feel both responsible for and integral to the recovery process.

•  Claims Examiners: Can reinforce progress, provide timely authorizations, and demonstrate belief in the worker’s recovery capacity.
• Employers: Supervisors, especially, can show personal concern and set positive expectations around return to work.
• Doctors and Physical Therapy Professionals: Can frame treatment as a path to empowerment, not a sign of impairment.
• Managed Care Nurses: Can coach and guide workers through challenges, celebrating milestones, such as completing a week of physical therapy, and addressing barriers, like providing resources for transportation to therapy sessions.
• Plethy Coaches: Provide personalized support and motivational feedback, reinforcing adherence and engagement.
• Family Members: Play a critical role in emotional support and reinforcing recovery goals at home.

Here are some practical strategies all these stakeholders
can use to build GSE:

• Set Achievable Goals: Break recovery into manageable milestones.
• Celebrate Small Wins: Recognize and reinforce progress.
• Use Shared Decision-Making: Involve the worker in choices about care.
• Provide Coaching and Education: Help them understand their role and empower them with knowledge.
• Model Positive Expectations: Express belief in their ability to recover.

These strategies send a powerful message: “You can do this—and we believe in you.”

GSE vs. Locus of Control: Clarifying the Distinction While closely related, GSE and Locus of Control (LoC) differ.

• Locus of Control refers to whether a person believes they have control over events in their life (internal) or whether outcomes are dictated by fate, luck, or others (external). In other words, it’s about who or what you believe is in control of your life and the events that happen to you.
• GSE reflects confidence in executing behaviors necessary to produce desired outcomes.

In other words, LoC is about who controls the outcome, while GSE is about your belief in your ability to act.

Injured workers with an external LoC may feel powerless, attributing delays or failures to the system or bad luck. Those with low GSE may feel they can’t influence the outcome, even if they are given tools or support. A truly engaged worker needs an internal locus of control and high self-efficacy.

The Role of Adverse Childhood Experiences (ACEs) Adverse Childhood Experiences (ACEs) refers to potentially traumatic events that occur in childhood (0–17 years), including physical or emotional abuse, neglect, caregiver mental illness, substance use, incarceration, domestic violence, or household dysfunction. ACEs have been shown to disrupt healthy brain development and impact emotional regulation, resilience, and coping mechanisms in adulthood.

Another essential factor that contributes to low GSE is a history of ACEs. Individuals with high ACE scores often develop poor coping mechanisms and are more vulnerable to stress and perceived helplessness.

In the workers’ compensation system, these individuals are especially at risk when they encounter doctors or attorneys who reinforce a disability mindset. When told, “You are disabled,” they may internalize that label. Instead of being supported to recover, they are subtly encouraged to adopt a passive, dependent role.

This is the exact opposite of GSE. Where GSE fosters empowerment, ACEs combined with negative messaging can lead to resignation and long-term disability. Recognizing these vulnerabilities is crucial to shaping the right clinical, legal, and claims-handling approach.

GSE and Informed Consent One overlooked but decisive moment to build GSE is during the informed consent process. Rather than simply handing over a form, use this time to explain options, clarify expectations, and encourage questions. This builds trust and reinforces the worker’s confidence in their ability to make decisions and participate in their care.

Conclusion: GSE as a Foundation for Recovery

Not many injured workers are like Nick. Few people possess the same internal drive, clear expectations, or competitive mindset that propels recovery forward without assistance. Most need support, guidance, and belief from those around them. That’s where we must step in as stakeholders in the workers’ compensation system.

Engaging injured workers isn’t just a best practice, it’s a business imperative. Disengaged workers stay out longer, cost more, and are far more likely to litigate. But engagement cannot happen without belief. We cannot expect people to participate actively in their recovery if they don’t believe they can succeed.

General Self-Efficacy is the foundation of that belief. By understanding, measuring, and nurturing GSE, we do more than manage claims—we foster recovery, rebuild lives, and promote resilience.

Empowered patients don’t just follow orders. They take ownership. They persevere. They heal. And ultimately, they return to work.

Recognizing what high GSE looks like is one step—now let’s explore how we can help build it in injured workers.

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 and interests within the healthcare system. While informed consent focuses on obtaining a patient’s agreement for specific treatments, patient advocacy encompasses broader support and representation throughout the healthcare experience. By understanding the distinctions between these two concepts, healthcare providers and patients can work together more effectively to ensure quality care and patient-centered decision-making.

Patient Engagement vs. Patient Advocacy: A Comparison

Patient engagement and advocacy are essential components of modern healthcare, but they serve distinct purposes.

Patient Engagement involves the active participation of patients in their own healthcare decisions.

Informed Consent:

• Definition: Informed consent is a legal and ethical requirement in healthcare. It involves a patient being informed about the potential benefits, risks, and alternatives of a proposed treatment or procedure and then voluntarily agreeing.
• Purpose: The primary goal is to ensure the patient understands what they are agreeing to so they can make an informed decision about their healthcare. This includes explaining the procedure’s nature, risks, potential side effects, and alternative treatments.
• Responsibility: The healthcare provider (e.g., doctor, surgeon) is responsible for obtaining informed consent and ensuring the patient has all the necessary information to make an informed decision.
• Legal and Ethical Implications: Informed consent is legally required before many medical procedures. Failure to obtain it can result in legal consequences for the healthcare provider.

While informed consent ensures a patient agrees to care, patient advocacy ensures they are supported throughout that care.

Patient Advocacy:

• Definition: Patient advocacy refers to the actions taken to support, protect, and advocate for patients’ rights and well-being within the healthcare system. This can involve helping patients navigate the system, ensuring they receive the appropriate care, and defending their rights and preferences.
• Purpose: The goal is to empower patients, ensuring they receive the care and respect they deserve while helping them make informed decisions that align with their values and needs.
• Responsibility: Patient advocacy can be carried out by various people, including nurses, social workers, family members, or professional patient advocates. They work to ensure that the patient’s voice is heard and their best interests are represented, especially when they are vulnerable or unable to advocate for themselves.
• Role in Healthcare: Patient advocates help patients understand their treatment options, make decisions, communicate between patients and healthcare providers, and resolve conflicts or concerns that arise during care.

Key Differences:

• Focus: Informed consent focuses on educating and obtaining the patient’s agreement for specific medical procedures. Patient advocacy is broader, encompassing overall support and representation of the patient’s interests throughout their healthcare experience.
• Responsibility: Informed consent is primarily the responsibility of the healthcare provider performing the procedure, while patient advocacy can be the responsibility of various individuals dedicated to supporting the patient’s overall well-being.
• Legal vs. Ethical: Informed consent is a legal requirement, whereas patient advocacy is more of an ethical commitment to ensuring patient-centered care.

Informed consent and patient advocacy are both essential for ethical, patient-centered care. Understanding how they differ—and how they complement one another—empowers healthcare professionals to respect patient autonomy while offering meaningful support throughout the care journey.