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…
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…
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…
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…
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”…
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…
Key Message: Memory gaps about painful experiences are not evidence of fraud. They are evidence of normal human biology functioning exactly as designed. A Claims Examiner's RevelationAs a claims examiner, when I was taking statements from injured workers, I used to believe that when they didn’t disclose previous accidents or surgeries, they were intentionally withholding information. The ISO search would often reveal prior accidents, yet the worker claimed to have…
As the GVP of Risk at Safeway / Albertsons, I was the victim of my biases. Once, when my VP of finance told me that we were overpaying for TD, I told him that our TD was higher due to our wages being higher due to our union contract. Soon after, Alex Swedlow told me we were overpaying the TD after he had analyzed our program. I responded with the…
In every organization, a small group of employees seems to defy the odds, repeatedly “getting injured on the job.” They’re often called “frequent flyers.” While easy to spot in the data, their stories are anything but uniform. Some are just unlucky, accident-prone (usually at home as well as on the job) or always seem to be in the wrong place at the wrong time. Some cut corners on safety to…
One of the most overlooked aspects of successful recovery from a work-related injury is the injured worker's mindset. Nick was a friend of mine who played racquetball. Famously, he hated to lose. One day, he told me that he was scheduled for a back fusion. As a claims adjuster, I had seen the usual time for recovery of a low back fusion to exceed two months. He turned to me…
