One Color Per Year

When I was VP of Claims at CE Heath, we had a problem that was simple to state and harder to solve.

Required notices had to be posted. That was the law. But failure to comply created consequences far beyond a regulatory citation.

When a worker was injured and looked at the wall, what they found — or did not find — shaped everything that followed. Outdated or missing notices meant delayed reporting, confusion about where to seek care, and — where employer direction of care applies — the loss of medical control. OSHA could cite for failure to provide required notices. And beyond the regulatory exposure, the claims consequences of a worker making uninformed decisions in the first minutes after an injury were real and measurable.

We could tell insureds which posters were required. We could send updates. We could audit compliance. But when someone walked into a facility, there was no immediate way to know if the postings were current.

No one reads every notice in the field. They walk in, look around, and make a judgment.

So we made the judgment reliable.

Each year, all required notices were printed on a single color. Light salmon one year. Light green the next. Light yellow after that.

When a safety professional walked in, they didn’t need to read anything. If the current year was green and the wall was salmon, they knew in five seconds: the postings were outdated.

Compliance became a visual check, not a document review.

At Safeway, we applied the same system across hundreds of locations. Same idea. Different scale. Same result.

The more important discovery was this: Facilities that kept postings current were also better at reporting claims, more engaged in safety, and lower in claim costs. Facilities with outdated postings had the opposite profile.

The poster was not causing the behavior. It was revealing it.

An employer who updates their required notices every year is paying attention. They read what the carrier sends. They follow through on small obligations without being chased. That is not just a compliance observation.

That is a character-of-risk observation.

One color per year became a reliable indicator of how an organization actually operated.

Why This Matters More Than It Appears

Workplace postings are usually treated as a compliance requirement. They are not.

They are the first point of contact in the workers’ compensation process. When a worker is injured, they look at the wall. What they find shapes every decision that follows — where to report, where to seek care, and whether the employer retains medical control.

A current, visible, accurate posting is not administrative. It is operational.

The Cost of a Single Lapse

The cost of losing medical control on a single significant claim — a back injury, a shoulder tear, a soft tissue case with a psychological overlay — routinely exceeds the cost of an entire year’s poster compliance across a large account. The math is not close.

The question worth putting directly to any insured who treats the annual poster update as a low-priority task: How much does your medical provider network cost to maintain — and do you understand that an outdated posting can make it worthless on any given claim?

What Gets Missed

Most organizations approach postings the same way:

• Print them.
• Distribute them.
• Check the box.

What they do not verify:

• Are they current?
• Are they visible?
• Does anyone actually use the postings?

The difference between compliance and performance is not the presence of a poster. It is whether the poster works.

Why Simple Compliance Systems Fail

If the solution is this simple, why is it not universal?

Because the system does not reward it.

Maintaining current postings prevents problems, reduces delays, and improves outcomes. But those benefits are indirect. They do not show up immediately in a report or a bonus metric.

So the behavior is deprioritized. The rational response becomes: update it later, assume it’s fine, focus on what is measured.

People do what they are incentivized to do.

Even when the better approach is obvious — and proven.

A Better Way to Think About Compliance

Compliance should not be treated as documentation. It should be treated as visibility.

The color system works because it aligns with how people actually operate:

• They look.
• They assess.
• They act.

It removes friction. It makes compliance immediate, obvious, and verifiable. And most importantly: it makes non-compliance visible.

What Gets Seen Gets Acted On

Workers’ compensation invests heavily in complexity — analytics, modeling, and program design — while simple, high-impact actions go unused.

This is not an argument against sophistication. It is an argument for sequence.

A worker who cannot find current information on the wall is not helped by predictive analytics.

The starting point is always the same: What are we making visible?

In my experience, visibility drives behavior faster than policy.

One color per year.

Simple. Visible. Effective.

Inside a system that needs more of exactly that — and rewards far too little of it.

Field Implementation — Simple

1. Assign one color per year for all required postings.
2. Distribute a complete annual poster packet to every location.
3. Require site-level confirmation of the update — signed, dated, named.
4. Train supervisors on injury response and posting locations.
5. Verify visually during every site visit.

Introduction

The role of a claims manager is not just pivotal but indispensable in ensuring the smooth operation of any claims organization. These professionals oversee complex claims processes, manage teams, and make critical decisions impacting organizational performance and customer satisfaction. However, without the necessary training and development, claims managers can struggle to handle these challenges, leading to inefficiencies, increased costs, and reduced customer satisfaction. By investing in a comprehensive training program, organizations can significantly enhance claims managers’ capabilities, drive positive outcomes, and gain a competitive edge in a complex industry landscape.

The Evolving Role of the Claims Manager

The claims manager’s role has not just expanded, but evolved as the claims management field adapts to new regulations, technologies, and customer expectations. This role demands not just specialized knowledge, but agility, and a strategic approach to problem-solving. Modern claims managers must not just possess diverse skills, expertise, strong leadership abilities, and a deep understanding of the regulatory landscape.

Key Responsibilities

A claims manager’s responsibilities often include:

• Claims Handling: Overseeing the investigation, evaluation, and resolution of claims.
• Team Management: Leading and mentoring claims adjusters and other team members.
• Financial Management: Monitoring and controlling claims expenses to meet organizational financial goals.
• Regulatory Compliance: Ensuring adherence to relevant laws and regulations to avoid legal complications.
• Customer Service: Providing excellent service to internal and external stakeholders is essential for client satisfaction and retention.

The scope and complexity of these responsibilities underscore the need for robust training to prepare claims managers to effectively meet these demands.

Essential Skills for Effective Claims Management

To excel in their roles, claims managers must develop various skills. These can be grouped into Technical Skills, Soft Skills, and Analytical Skills:

Technical Skills

• Claims Processing Knowledge: Understanding claims workflow, procedures, and best practices.
• Medical Terminology and Coding: Familiarity with medical language and coding practices to facilitate claim evaluations.
• Legal and Regulatory Expertise: Knowledge of relevant laws, regulations, and industry standards.

 Soft Skills

• Effective Communication: Clear and empathetic communication with stakeholders.
• Strong Leadership and Interpersonal Skills: Ability to inspire, guide, and support team members.
• Problem-Solving and Decision-Making Abilities: Competence in analyzing issues and making sound judgments.
• Negotiation and Conflict Resolution: Skill in mediating disputes and reaching agreements.
• Empathy and Compassion: Understanding the emotional aspects of claims, especially in sensitive cases.

 Analytical Skills

• Data Analysis and Trend Identification: Ability to assess data trends for informed decision-making and risk assessment.
• Technology Proficiency: Familiarity with claims management software, digital transformation tools, and emerging technologies that enhance workflow and reporting.

Developing a Comprehensive Training Program

A well-structured training program can significantly enhance the skills and knowledge of claims managers. Key elements of a successful program include:

Needs Assessment

• Individual and Organizational Analysis: Identify the specific training needs of individual claims managers and the organization.
• Continuous Assessment: Adapt training as new technologies emerge, regulations change, and organizational priorities shift.
• Consider Key Factors: When designing training needs, consider experience level, role responsibilities, and emerging industry trends.

Curriculum Design

Develop a comprehensive curriculum that covers a wide range of topics, including:

• Claims Handling Best Practices: Techniques for effective investigation, documentation, and resolution of claims.
• Regulatory Updates and Compliance: In-depth coverage of legal updates and compliance requirements.
• Effective Communication and Negotiation: Training in communication skills and techniques to improve stakeholder interactions.
• Leadership and Team Management: Strategies for team building, mentorship, and managing performance.
• Risk Management and Fraud Prevention: Tools and techniques for identifying and mitigating risks.
• Technology and Digital Tools: Training on claims software, data analytics tools, and other digital resources that enhance productivity.

Customization is crucial. Tailor the curriculum to the participants’ specific needs and learning styles, ensuring the content stays current with industry best practices, legal standards, and technological advancements.

Delivery Methods

A blend of delivery methods caters to different learning preferences and enhances training outcomes:

• Classroom Training: Provides a structured learning environment with opportunities for interaction and discussion, ideal for foundational knowledge and networking.
• Online Learning Offers flexibility and accessibility. It allows learners to access training materials at their own pace, particularly useful for regulatory updates and policy changes.
• Mentoring and Coaching: This option provides personalized guidance and support from experienced professionals, allowing claims managers to apply their learned skills in real-world scenarios.
• On-the-Job Training: Allows for hands-on experience and practical application of learned skills, reinforcing knowledge through experience.

Evaluation and Feedback

A continuous improvement model is not just important, but essential to adapt the training program to emerging needs and ensure ongoing effectiveness. This commitment to continuous improvement is a testament to the dedication and professionalism of claims managers.

• Performance Evaluation: The effectiveness of the training program is assessed through pre- and post-training assessments, surveys, and performance evaluations.
• Continuous Improvement: Use feedback to identify areas for improvement and adjust the training program to keep it aligned with organizational goals and regulatory demands.

Additional Considerations

In addition to core training elements, consider the following strategies to support claims manager development:

• Succession Planning: Identify and develop high-potential claims managers to ensure a smooth transition as experienced professionals retire or move on. Leadership development programs can cultivate promising managers and prepare them for higher roles.
• Staying informed about industry trends and best practices is not just beneficial but crucial to continuously improve claims management processes, allowing claims managers to operate at the cutting edge.
• Technology and Innovation: Embrace technology to streamline workflows and enhance decision-making, focusing on tools like data analytics and automated claims processing systems.
• Collaboration and Knowledge Sharing: Encourage collective problem-solving and continuous learning while fostering a culture of collaboration and knowledge sharing among claims managers.

Implementing these strategies will cultivate a highly skilled, motivated, and forward-thinking claims manager workforce equipped to meet future challenges.

By investing in comprehensive training and development programs, organizations can empower their claims managers to achieve excellence. Well-trained claims managers can improve efficiency, reduce costs, and enhance customer satisfaction, ultimately contributing to the organization’s overall success. Comprehensive claims manager training does more than refine skills—it builds a foundation for sustainable, high-quality claims management that meets regulatory demands, drives financial performance, and enhances the customer experience. As the claims landscape grows more complex, a robust training program equips organizations with leaders who can navigate challenges with confidence and skill.

Identity Loss, Role Transition, and the Path Back to Work

I have gone through a difficult period. Over the last year, I lost a sister-in-law, two brothers-in-law, three of my closest friends, and several close friends. The losses came one after another, each arriving before I had finished grieving the last.

The movie Coco resonates with me because it reflects how I choose to handle loss — by holding onto the good, remembering who people were at their best, and keeping those memories alive. It is my way of carrying them forward.

Every loss has also reminded me of something I came to understand slowly, over decades of professional life: grief is not reserved for death. We grieve whenever we lose something central to who we are — a relationship, a capability, a role, or a version of ourselves we expected to keep.

As human beings sharing human experience, we all encounter loss at some point in our lives. Supporting people as they navigate those losses is not only an act of compassion — in workers’ compensation, it is a professional responsibility with real consequences for recovery.

During my years managing workers’ compensation programs, I often told claims examiners that they were, in effect, grief counselors.

Many of the behaviors that frustrate and even anger claims professionals are not simply resistance to the claims process — they are expressions of grief over the loss of work, identity, and normal life.

In many ways, and for too many claims, the workers’ compensation system is not only managing injuries — it is managing grief.

Injured workers are not simply managing a medical condition. When they lose their job due to injury, they are coping with the loss of identity, role, income, and purpose associated with their work.

Work is far more than a source of income. It provides structure, social connection, identity, and meaning. When a worker is injured and cannot perform their job, the loss they experience is similar to other forms of grief. The injury disrupts not only their physical functioning but also their sense of self.

Understanding this psychological process is essential for anyone working in the workers’ compensation system. Recovery is not purely a medical process. It is also a psychological transition from the identity of “worker” to that of “injured worker” and, if successful, back to the identity of “worker.”

The Grief Process Following Work-Related Injury

Research and clinical experience suggest that many injured workers move through stages similar to the well-known five stages of grief:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

These stages are not rigid or universal. Individuals may move through them at different speeds or revisit earlier stages. However, the pattern is commonly observed among workers coping with injury and disability.

Denial

In the early stages of an injury, workers often believe the condition is temporary and will resolve quickly. They expect to return to work soon and may minimize the seriousness of the injury.

Anger

As recovery becomes longer or more complicated than expected, frustration and anger may develop. The anger may be directed toward their employers, the claims adjuster, insurance companies, physicians, or the workers’ compensation system itself.

Bargaining

Workers may search for solutions to return to their previous role. They may seek additional medical opinions, new treatments, or legal strategies in the hope of restoring their previous identity.

Depression

When the realization emerges that life may not return immediately to its previous state, feelings of sadness, loss, and discouragement often follow. Financial stress, uncertainty, and prolonged work absence can deepen these emotions.

Acceptance

The final stage involves recognizing the new reality and beginning to move forward. This stage is critical for recovery because it allows the individual to focus on rebuilding function, reengaging with work, and developing a renewed sense of purpose.

Identity Loss and the “Injured Worker” Identity

A work-related injury often produces identity disruption. A worker who previously saw themselves as productive, capable, and independent may suddenly find themselves defined by medical appointments, disability status, and legal proceedings.

Over time, particularly in prolonged claims, a new identity may emerge: that of the “injured worker.”

This transition can occur gradually. Early in a claim, a person usually understands themselves as a worker who was injured — the injury is a temporary interruption in a life centered on work.

But over time, the identity can invert. The worker who once saw themselves as a worker with an injury may come to see themselves primarily as an injured worker whose life revolves around the claim.

The longer the claim remains open, the more the worker’s life becomes organized around medical appointments, evaluations, benefit disputes, and legal proceedings. The claim itself becomes the central structure around which daily life is organized.

Returning to work, therefore, requires more than physical healing. It requires a psychological transition away from the injured identity and toward a renewed sense of capability and purpose.

Claims professionals frequently help injured workers navigate this transition. In this sense, the claims examiner truly does become a grief counselor, guiding workers through a process of loss, adjustment, and eventual reintegration.

System Delay and the Grief Process

The length of time a worker remains in the workers’ compensation system profoundly influences this psychological transition.

In systems where claims are resolved promptly and recovery expectations are clear, workers are more likely to move through the stages of grief and reach acceptance. Once acceptance occurs, the worker can focus on rebuilding function and returning to productive activity.

However, when claims remain open for years, the grief process can stall. Repeated medical-legal evaluations, disputes over benefits, and prolonged uncertainty reinforce the injured identity rather than helping the worker move beyond it.

Instead of progressing toward acceptance, workers may remain trapped in earlier stages such as anger, bargaining, or depression. The longer the process continues, the more the identity of “injured worker” becomes central to the individual’s self-concept.

This dynamic helps explain why prolonged involvement in compensation systems is associated with higher rates of permanent disability, poorer health outcomes, and lower rates of return to work. The system itself can unintentionally reinforce the very disability it was designed to address.

Role Transition and Recovery

The path back to productive employment often involves a process of role transition:

1. Recognizing and accepting the loss of the previous role
2. Grieving the loss of identity and purpose associated with that role
3. Exploring new capabilities and possibilities
4. Developing a renewed sense of purpose
5. Reintegrating into productive work and social life

This transition is rarely simple. Workers may need support from physicians, physical therapists, vocational rehabilitation professionals, claims examiners, and employers to navigate the process successfully.

Psychological Perspectives on Identity and Recovery

Several well-established psychological perspectives help explain the transition from injury to recovery.

Identity theory suggests that individuals build their sense of self around the roles they occupy in life — such as worker, parent, or community member. When injury removes a person from one of these roles, the disruption can produce significant psychological stress.

Role theory emphasizes that people derive stability and meaning from fulfilling expected roles. Work provides structure, social interaction, and a sense of contribution. When injury interrupts that role, individuals must reorganize their sense of identity and purpose.

Another useful framework is the Transtheoretical Model of behavioral change, which describes how individuals progress through stages as they adapt to major life changes. Injured workers often progress from denial and resistance toward acceptance and active participation in recovery. Delays in the workers’ compensation process can interrupt this progression and keep individuals psychologically anchored in earlier stages of adjustment.

Together, these perspectives reinforce a central insight: recovery from work injury involves not only physical healing but also the reconstruction of identity and role.

Training Claims Professionals to Navigate the Grief Process

Recognizing that injured workers may be experiencing grief does not mean claims professionals must become trained psychologists. It does mean they must develop communication skills that acknowledge the human experience of injury while still fulfilling the administrative responsibilities of the claims process.

In many ways, the most effective claims professionals already practice these skills instinctively. Formal training makes these behaviors consistent across organizations.

The first skill is listening before acting. The injured worker’s first conversation with a claims examiner often occurs in the midst of uncertainty, fear, and frustration. Allowing the worker to explain what happened and how the injury is affecting their life establishes trust and reduces the adversarial tone that can develop early in claims.

The second skill is acknowledging loss without reinforcing disability. A statement such as, “I understand that this injury has disrupted your life,” recognizes the worker’s experience without suggesting that recovery is unlikely.

The third skill is reinforcing recovery expectations. Research in occupational rehabilitation consistently shows that recovery expectations are among the strongest predictors of actual recovery outcomes. When the employer, physician, and claims examiner communicate a shared expectation that the worker will recover and return to productive activity, that expectation becomes part of the recovery process itself.

The fourth skill is maintaining the worker’s connection to the workplace. Regular communication with the worker and coordination with the employer regarding modified duty helps preserve the worker’s identity as an employee rather than allowing the “claimant” identity to become dominant.

The fifth skill is recognizing when additional support is needed. Some injured workers experience deeper psychological distress, depression, or prolonged disengagement from recovery. Claims professionals should be trained to recognize these signals and coordinate appropriate support through nurse case management, behavioral health resources, or other specialized services.

The objective of this training is not to transform claims professionals into therapists. It is to equip them with the skills necessary to guide injured workers through a difficult transition while maintaining the central goal of the workers’ compensation system: recovery and return to productive work.

In my experience managing workers’ compensation programs across multiple carriers and a large self-insured employer, the best claims examiners were never simply administrators of benefits. They were guides helping injured workers navigate one of the most difficult transitions in their working lives.

Conclusion

Workplace injuries are not only medical events. They are also psychological and social disruptions that affect identity, role, and purpose.

Understanding the grief process helps explain why some workers struggle to return to work even after their physical injury has stabilized. It also helps explain why prolonged involvement in compensation systems can unintentionally reinforce disability.

Claims professionals, employers, and healthcare providers who recognize this process can play an important role in helping injured workers move from loss toward recovery.

I began this paper with my own losses. What those losses reminded me — and what decades in this industry confirmed — is that grief follows its own timeline and does not yield to administrative process.

The injured worker is often in the same place: trying to find a way forward through loss.

Recognizing and addressing that grief is not only compassionate — it is essential to shortening claims, preventing unnecessary disability, and helping injured workers return to productive lives.

That recognition changes how we do this work. It should.

Introduction

One of the most overlooked and underutilized tools in workers’ compensation is also one of the simplest: a clear, accurate physical job description of the work the worker was doing at the time of the injury.

Early in my career, I encountered a case that perfectly illustrates why this matters.  This true story has stayed with me because it demonstrates how easily a misunderstanding about a job can affect medical decisions and patient outcomes.

Jack walked into an occupational clinic with a low-back strain. He was six foot three, all muscle, wearing dirty jeans and a clean but well-worn T-shirt. When the doctor asked what he did for a living, Jack replied, “Mixing cement.”

The physician pictured a large man lifting heavy bags of cement, operating a drum mixer, bending, twisting, and working in awkward positions. After examining him, the doctor prescribed a week off work to allow his back to recover.

A week later, Jack returned. His back was still hurting. Since he was a “cement mixer,” the doctor felt another week off work was appropriate.

When the employer called the clinic to ask why Jack had not returned to work, the physician explained that Jack had been mixing cement and was still experiencing low back pain.

There was a long pause.

Then the employer said, “Jack mixes amalgam for dental fillings.”

Jack went back to work that afternoon.

The story is amusing, but the lesson is serious. Physicians are often asked to assess work capacity without knowing what the job actually requires. Many times they are in the dark about what light or modified duties could be prescribed.

That experience taught me a lesson I have carried throughout my career: If the physician does not understand the job, the medical diagnosis and even the resulting medical-legal evaluation may be wrong

In workers’ compensation, the primary goals are straightforward. The injured worker should recover and return to work as quickly as possible with as little residual disability as possible. If you do not know the target, you cannot hit it.  Recovery requires a target.

The Job Description as a Clinical Tool

In workers’ compensation, the physical job description is not simply an HR document. It is a clinical tool.

A physician who understands the physical demands of the job is in a much better position to make an accurate diagnosis. And with an accurate diagnosis, can provide better quality medical care.  The physical demands of the job often provide important clues about the mechanism of injury and the structures that may be affected.

ZACHRY AXIOM

The job that the worker was doing is an important tool for the physician to use to improve outcomes.

The job description also allows the physician to walk the injured worker through the job during the examination. When the doctor reviews the job description with the worker, the worker can explain how the job is actually performed and describe the specific activity that led to the injury.

That discussion often provides the physician with the “full color of the job”—the movements, positions, and forces involved in the work that may not be obvious from a written description alone. This interaction improves the physician’s understanding of the mechanism of injury and helps determine whether the diagnosis fits the reported activity. This also provides insight into which modified duties will accelerate recovery, reduce disability, and make re-injury less likely.

It also provides a clear recovery target, defining the physical capacity the worker must regain to return to full duty safely. In addition, it helps determine whether modified duty is appropriate and what restrictions should be applied during recovery.

Modified duty is one of the most effective tools available for maintaining the worker’s connection to the workplace during recovery. Early modified duty allows the worker to remain engaged, productive, and connected to the job rather than becoming detached during a prolonged absence.

Without the job description, the physician is estimating. And in workers’ compensation, estimates can result in unnecessary disability.

Unnecessary disability is not simply an administrative inconvenience. It can be harmful to the worker.

Research in occupational medicine consistently shows that prolonged time away from work leads to physical deconditioning, fear-avoidance or Kinesiophobia behaviors, and loss of confidence in the ability to perform the job. Over time, the worker’s connection to the workplace weakens, and the probability of a successful return to work declines. Unnecessary time away from work is not medically neutral. It can make recovery more difficult.

Occupational medicine guidelines—including those published by the American College of Occupational and Environmental Medicine (ACOEM) and incorporated into California’s Medical Treatment Utilization Schedule (MTUS)—emphasize the importance of understanding functional job demands when evaluating work capacity and planning treatment. The job description provides that information.

Where the Process Breaks Down

The Employer

The first place this process often breaks down is with the employer. Many employers either do not maintain physical job descriptions or rely on outdated descriptions that do not reflect how the job is actually performed.

Employers who take workers’ compensation seriously should treat job descriptions as a risk-management tool, not merely an HR requirement. Each job should have a clear description of the physical demands—lifting, reaching, bending, standing, walking, and other relevant activities. These descriptions should reflect how the job is actually performed, not how it was originally written. Just as important, the employer must make sure those descriptions are available when an injury occurs. For some companies, having high-quality job descriptions is also the foundation for developing and implementing an effective light-modified duties program. Very small employers may not have the bandwidth or claims frequency to drive the production of standardized physical job descriptions. A good solution to this is to fill out and send a job description to the doctor and to the claims examiner when filling out the employer’s first report of accident.  A “best practice” is for the claims administrator to provide a template to all employers.

The Claims Examiner

Even when employers maintain job descriptions, the next failure often occurs in the claims process. Too often, the job description never reaches the doctor. The treating physician is asked to determine work capacity, restrictions, and treatment plans without ever seeing the job’s physical demands.

This is not usually a lack of knowledge. Most claims professionals understand the value of job descriptions. The problem is the workflow.

The solution is straightforward. When implementing large accounts, providing local medical clinics with a library of physical job descriptions is a best practice.  The job description should be obtained at the time of the first notice of loss and sent to the treating physician as part of the initial medical communication. It should also be included whenever a medical-legal evaluation is requested.

Some smaller employers may not have formal physical job descriptions available. In those situations, the claims examiner should ask the employer contact to complete a simple physical job demands template. A short template asking about lifting requirements, standing or walking time, repetitive motions, reaching, bending, and other physical demands can usually be completed by a supervisor in just a few minutes—and that information is far better than asking a physician to make decisions based only on a job title.

The Physician

Physicians also play an important role in effectively using job descriptions.

When a job description is provided, the physician should review it with the injured worker during the examination and discuss how the job is actually performed. This conversation often reveals important details about the mechanism of injury and the specific physical activities involved.

The physician should document in the medical report that the job description was reviewed and identify the physical job demands that were considered in forming the medical opinion. Work restrictions should be tied to the job’s actual physical demands rather than to generic clinical categories. Restrictions anchored to specific job activities—lifting limits, reaching restrictions, or prolonged standing—are far more useful for employers seeking to accommodate the worker during recovery.

If a job description has not been provided, the physician should request one before issuing a work capacity opinion. A job title is not a job description. “Cement mixer” proved that point very clearly.

A Simple Fix

Workers’ compensation systems are often criticized for being complex. Yet sometimes the most effective improvements are also the simplest.

• Employers need accurate job descriptions.
• Claims examiners need to make sure those descriptions reach the doctor.
• Physicians need to use them when evaluating injured workers.

None of this requires new legislation, new regulations, or new technology. It requires better communication and better information about the work the injured employee actually performs.

When the treating physician understands the physical demands of the job, the physician can make a more accurate diagnosis, develop a treatment plan that restores the specific functions required by the job, and establish realistic work restrictions during recovery. The result is better decision-making, more appropriate medical care, and clearer expectations for recovery.

And when medical care is aligned with the actual demands of the job, the outcome is exactly what the workers’ compensation system should be striving for:

Better care and better medical outcomes for the injured worker.

The job description is not paperwork. It is the target.And without a target, recovery becomes guesswork.

A year and a half ago, we published a fairytale about Doctor Google.  Since then, a lot has happened in the Fairytale magical medical world of Workers’ Compensation.

A common complaint from many treating physicians is that their patients had already visited “Doctor Google” and that “Doctor Confirmation Bias” had already confirmed the diagnosis. This has made it more difficult for the physician to make the correct diagnosis. The problem with Doctor Google is that he usually gives a list of diagnoses for the patient to select from. When the patient chooses their preferred diagnosis from this list, it is often then confirmed by “Doctor Confirmation Bias,” who specializes in reinforcing whatever the patient already believes. The real trap occurs when “Doctor Confirmation Bias” enhances the patient’s preconceived diagnosis by simply reflecting their reported symptoms to them, while failing to explore other symptoms that may exist but are being ignored or minimized by the patient. This results in what is known as “Diagnostic Attachment Syndrome” (a new syndrome that was made up by Dr. Claude).  One problem with self-diagnosis using Doctor Google is that it then discourages the revelation of crucial clinical information, never surfacing because neither the patient nor the “examining physician” ventures beyond the initial diagnostic assumption.

Update 2026: Doctor Google has been experiencing a mid-life crisis and has enrolled in advanced AI medical school.

Meanwhile, several eager new medical interns have graduated and are now competing for patients’ attention.

Meet the New Medical School Graduates.

Doctor ChatGPT – The Confident Valedictorian

Doctor ChatGPT graduated at the top of the class and speaks with absolute confidence about every diagnosis. “You have fibromyalgia!” ChatGPT announces after hearing “I’m tired and my back hurts.” The trouble is, Doctor ChatGPT has never actually examined a single patient but talks like a seasoned emergency room physician. Sometimes, ChatGPT even diagnoses rare tropical diseases when patients just have a common cold!

Doctor Claude – The Overly Careful One

Doctor Claude is so thoughtful and thorough that patients sometimes fall asleep during the consultation. Claude provides so many disclaimers and “what-ifs” that patients forget what they originally asked about. While Claude’s caution is admirable, patients seeking quick answers often get frustrated with responses like “Well, it could be this, or maybe that, but you should definitely see a real doctor, and here are 47 things to consider…”

Doctor Gemini – The Identity-Confused Graduate

Doctor Gemini (formerly known as Doctor Bard) has an identity crisis, constantly changing approaches mid-conversation. One moment, Gemini confidently suggests one diagnosis, then completely switches to something else, leaving patients confused about which advice to follow. Despite being technically brilliant, Gemini’s inconsistency makes patients wonder if they’re talking to the same doctor throughout their consultation.

Doctor Meta – The Social Media Specialist

Doctor Meta loves connecting patients with others who have similar symptoms, often suggesting, “Have you checked what other people with these symptoms are saying online?” While Meta excels at finding community support and shared experiences, the tendency to crowd-source medical advice often leads to patients getting dozens of conflicting diagnoses from well-meaning internet strangers.

Doctor Grok – The Dropout

Doctor Grok was one of the most promising students when first enrolling in AI Medical School, backed by a famous tech entrepreneur who promised revolutionary medical breakthroughs. However, Doctor Grok struggled to keep up with the latest medical data and found it challenging to maintain consistent, reliable diagnoses. Despite the high expectations and significant resources invested in education, Doctor Grok eventually dropped out of medical school, unable to match the performance of his classmates. Patients who had high hopes for this innovative approach were left disappointed when consultations became unreliable and often incomplete.

Doctor Character.AI – The Drama Queen

Doctor Character.AI has an excellent bedside manner and makes patients feel heard and understood. However, Character.AI loves drama and often turns minor symptoms into compelling medical mysteries. A simple headache becomes an epic tale of possible rare neurological conditions, leaving patients both entertained and terrified.

The Great Problem: The Magic of Confidence Without Examination

All these new AI doctors share one magical power: they can sound completely confident about diagnoses without ever seeing, touching, or examining a patient. They speak with such authority that patients often believe them more than doctors who examine people!

The Spell of False Confidence:

• “You need surgery!” (based on three sentences about back pain)
• “This is carpal tunnel!” (for any hand discomfort)
• “You have a rare condition!” (when it’s something familiar)

The Wise Old Physician’s Warning

In our Fairytale magical medical world of Workers’ Compensation, there lives a Wise Old Physician who has been practicing medicine for many years. She watches these AI doctors with concern and shares this important message:

“These AI doctors have never felt a pulse, looked into eyes, or pressed on a tender spot. They have never seen how you walk, noticed how you breathe, or observed the thousand tiny clues that come from actually being in the same room with a patient.”

“A real diagnosis requires real examination. (Even evaluations done over Zoom are better than no exam at all). You can use these AI “doctors” to help gather information like helpful librarians who can give you information, but never like actual doctors who can give you definitive answers.”

The Workers’ Compensation Kingdom’s Special Problem

In the Workers’ Compensation Kingdom, wrong diagnoses can seriously hurt the poor citizens in our world. And they cost real gold coins. When injured workers arrive saying, “Doctor ChatGPT told me I need surgery immediately,” but they just need rest and physical therapy, the recovery can be delayed or prevented totally, and the kingdom wastes enormous amounts of money on unnecessary treatments.

The Happy Ending: Balance and Wisdom

Our fairy tale ends not with the banishment of AI doctors (they can be helpful!).  But everyone needs to learn how to use them wisely:

The injured workers need to say to their treating doctors

• “Doctor ChatGPT gave me some ideas to discuss with you.”
• “I researched my symptoms and have some questions.”
• “Can you help me understand what I found online?”

Instead of:

• “Doctor ChatGPT says I have…”
• “The internet confirmed my diagnosis.”
• “I know what’s wrong with me from my research.”

Real doctors need to learn to:

• Listen to patients’ concerns without dismissing them
• Explain why examination findings might differ from online suggestions
• Use AI tools to enhance their practice, not replace their judgment

Remember: No matter how confident Doctor ChatGPT or Doctor Google sounds, they’ve never actually examined a patient. They’re excellent for learning and preparing questions, but they’re terrible at replacing the trained eyes, hands, and mind of a real doctor who can see, touch, and examine.

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.