Temporary Disability (TD) is a crucial benefit designed to replace lost wages for injured workers during their recovery period when they cannot return to work due to an industrial injury. Because many workers live paycheck to paycheck, it is paramount that the TD be paid on a timely and accurate basis. Paying TD accurately and timely is more complicated than most people realize. Complicating factors include multiple employers, overtime scenarios,…
During my early career as a claims adjuster, the industry was focused almost exclusively on providing prompt, accurate indemnity benefits to injured workers. Success was measured by speed and accuracy in benefits provision, with little emphasis on the worker’s psycho-social needs or the long-term recovery journey. Over time, however, the industry evolved toward a model of “advocacy,” prioritizing quality medical care to improve outcomes and reduce claim costs. This shift…
Introduction Medical care is the cornerstone of the entire system. Workers’ compensation is an administrative benefit system for individuals injured at work. Among its benefits, medical care is the most vital for achieving optimum recovery and the most expensive benefit. This paper aims to increase the participants’ understanding of the system by listing my axioms and observations regarding medical care within the workers' compensation system. Core Axioms of Workers' Compensation…
Introduction A fundamental axiom of workers’ compensation medical care is; “Better outcomes result when patients are actively engaged in their recovery.” Informed consent and consensus-driven care ensure that individuals understand their medical treatments, including the risks, benefits, and alternatives, empowering patients to make informed decisions. This paper explores the concept of informed consent, its application in pharmacy versus other medical care, consensus-driven medical treatment, special considerations for diverse populations, barriers…
During my tenure as the risk manager at Safeway, our managed care team achieved what many considered impossible: a forty percent reduction in overall workers' compensation spending. This extraordinary accomplishment was made possible through the implementation of the Örebro questionnaire, a tool designed to identify injured employees who were “at risk for delayed recovery.” By addressing the unique challenges faced by these workers—often rooted in stress, fear, or poor coping…
During my early career as a claims adjuster, the industry was focused almost exclusively on providing prompt, accurate benefits to injured workers. Success was measured by speed and accuracy in benefits provision, with little emphasis on the worker’s long-term recovery journey. Over time, however, the industry evolved toward a model of “advocacy,” prioritizing quality medical care to improve outcomes and reduce claim costs. This shift toward advocacy has had a…
At the start of each year, I like to revisit what the ideal workers’ compensation system should look like. Reviewing an ideal system helps all participants understand where they fit into it, and encourages them to look inward to determine whether they are helping achieve the optimum system. This view is not perfect, but it is a start. It is a very high-level view of the system. The challenges and…
Introduction Throughout my career in risk management and workers’ compensation, I witnessed a puzzling phenomenon: some workers with seemingly “minor” injuries never returned to work. In contrast, others with severe injuries returned remarkably quickly. My medical team and our medical director explained that a significant factor behind many of the high-cost cases was Adverse Childhood Experiences (ACEs). These early traumas contributed to disproportionate claim costs because the affected workers often…
Executive Summary Addressing sleep problems in injured workers is essential for ensuring a successful and timely recovery, as sleep quality significantly impacts physical healing, mental well-being, and overall outcomes. Key Findings: Sleep disturbances are common among injured workers and can hinder recovery. Factors affecting sleep quality include pain, medication side effects, environmental issues, and psychological distress. Addressing sleep problems requires a holistic approach involving healthcare providers, claims examiners, employers, and…
This paper provides insight into workers’ compensation insurance collateral requirements and collateral processes affecting employers that are self-insured or that retain risk associated with their workers’ compensation program. Collateral, which is an asset (cash, or securities) that is pledged by an employer as security to ensure payment of workers’ compensation benefits in the event of its default, is a significant part of the insurance expense for many employers. Understanding the…
