Having just returned from several state annual work comp conferences, in speaking with training individuals a frequent question I heard was what do other organizations spend on training? It is a fair question. It is also a trap, because the answer depends entirely on which survey you open.

Symptom versus finding

These trainers have to deal with a CFO who noted  a specific article/review says, “We are below the industry average, so we are fine,” or “We are above it, so cut.” Either way, a single benchmark number is being treated as a verdict.

The objective finding is that the published averages are not measuring the same thing, and none of them measures effect on claims performance. A training average describes what organizations spend. It does not describe what they get back.

What the two sources actually say

ATD reported in its 2026 State of the Industry summary that direct learning expenditure was $846 per employee in 2025, down from $1,254 in 2024. Formal learning hours rose from 13.7 to 16.7 per employee over the same period. ATD gave no explanation for the drop in the summary, and the summary does not report spending as a share of payroll. A one-year fall of about 32%, alongside rising hours, is more likely a change in who was surveyed or how costs were counted than a real collapse in spending. That is my inference, and it is flagged as one.

The 2025 Training Industry Report from Training magazine reported $874 per learner, up from $774 the year before. It also split the figure by size: $468 for large organizations, $782 for midsize, and $1,091 for small. Hours per employee were 40, down from 47. The survey covered U.S. organizations with 100 or more employees.

Read those side by side. One source says spending per person fell sharply. The other says it rose. One counts about 17 hours. The other counts about 40. Neither is wrong. They define spending, learners, and hours differently, and they sample different organizations.

Why this matters for a claims operation

Take a 50-adjuster unit. The table shows what the same headcount costs under each published figure.

A $20,300 spread, on a unit this size, comes entirely from picking a different survey. Size matters too. The large-organization figure is lower per head because fixed costs spread across more people, not because large organizations value training less. Compare yourself only against your own size band and say which source you used.

What no survey will tell you

I searched for a published benchmark of training spend specific to claims adjusters or workers’ compensation operations and did not find a reliable one. APQC lists training and development benchmarks for insurance, but the public page names the metrics without giving values. If a vendor quotes you a claims-industry training average, ask for the source and the sample. If they cannot provide either, treat the number as an opinion.

This is the honest limit of benchmarking. You can learn roughly what organizations spend. You cannot learn from a survey whether your spend is producing the claim outcomes you want.

A better way to benchmark

Use the published averages for one purpose only: to show that your request falls inside a defensible range. Then move the argument to the numbers you can verify yourself.

1. Pick one source, one size band, and cite them in the request. Do not mix sources.
2. Record your own spend per adjuster and hours per adjuster, defined the same way each year. Consistency beats comparison.
3. Set the spend beside your scorecard: claim duration, reopen rate, attorney involvement, reserve accuracy, and first-two-year turnover.
4. Review the pairing every year. A flat spend line with a worsening scorecard is a finding. So is the reverse.

The sensitivity test

Earlier posts in this series used a break-even frame, and it applies here. At $846 per adjuster, a 50-adjuster unit spends $42,300. WCRI’s October 2024 attorney-representation study found representation raised indemnity payments by $7,700 to $12,400 per claim, so the low end of that range means 5.5 avoided represented claims cover the whole amount ($42,300 divided by $7,700). That is a threshold to test against your own loss run, not a forecast. The same arithmetic shows why chasing a lower benchmark to save $20,000 is a poor trade if it costs even three represented claims.

The takeaway

Benchmark to stay credible. Measure to stay funded. A published average gets you into the conversation. Your own claim outcomes win it.

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Roger Federer won almost 80% of the 1,526 singles matches he played as a professional. He won only 54% of the points.

Let that sink in. A man with 20 Grand Slam titles and 310 weeks ranked number one in the world lost nearly half the points he played. (In baseball, failing 70% of the time at the plate can get you into the Hall of Fame.)

During his 2024 commencement address at Dartmouth College, Federer explained why that statistic matters. In tennis, you must give everything to the point you’re playing. Once that point is over, win or lose, you have to move on. Whether you hit an incredible winner or made an embarrassing mistake, neither should dictate how you approach the next point.

As he put it, “When you’re playing a point, it is the most important thing in the world. But the truth is, whatever game you play in life, sometimes you’re going to lose.”

His comments caused me to think about something much bigger than tennis.

How often do we allow yesterday to determine what we’re willing to attempt today?

We’ve all experienced failure. A bad decision, a missed opportunity, a relationship that didn’t work, or an effort that fell short of expectations.

Those experiences can teach us valuable lessons but can also convince us that trying again isn’t worth the risk. We begin anticipating failure before we’ve even started.

Failure whispers, “Don’t try that again.”

Interestingly, success can create a similar problem. When something has worked well in the past, we can become convinced it will always work. We stop questioning assumptions, resist new approaches, and gradually become complacent.

When I first started warning about dangerous opioid prescribing and the need for a biopsychosocial treatment model, I heard the whispers. “We’ve always done it this way.” Polypharmacy was routine. Claims were financial transactions.

Success whispers, “Don’t change anything.”

Now think about an injured worker who has had a terrible workers’ compensation experience, or watched a coworker go through one. Perhaps an adjuster didn’t return phone calls to explain why the indemnity check was late. Maybe a physician dismissed legitimate concerns. It’s possible the employee felt like everyone involved was more interested in closing the claim than helping them recover.

Now that employee suffers another workplace injury.

Before the first appointment or conversation with an adjuster, they’ve already decided what will happen. Nobody will listen to them or believe them. They know for certain (because of their past experience) that everyone is looking for a way to take advantage of them.

That isn’t necessarily an unreasonable reaction. Their distrust may have been earned. Psychologist Michael Sullivan’s research calls it perceived injustice, and it’s linked to longer work disability.

Their distrust may have been earned through painful experience that has created perceived injustice which research links to longer work disability. As I wrote recently, distrust doesn’t begin with the denial.

But what happened previously can become an obstacle to what might be possible today.

We cannot expect someone to trust us because we tell them this time will be different. We must demonstrate it.

That means returning phone calls, explaining decisions, listening without immediately becoming defensive, and treating the injured worker as a person rather than a claim number. Consistency builds credibility, which creates opportunities for trust, which can influence someone’s willingness to participate in recovery.

We increasingly recognize that social determinants of health – things like financial stability, housing, access to healthcare, medical literacy, and social support – can influence recovery.

The same is true of adverse childhood experiences, commonly called ACEs. The term came from a groundbreaking 1998 research paper, “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” Childhood abuse, neglect, household instability, and other traumatic experiences can have lasting effects on how people respond to stress, perceive threats, develop relationships, and manage adversity.

An injured worker doesn’t shed that history before entering the workplace. Someone who has experienced repeated betrayal may struggle to trust authority figures. Someone who grew up with instability may perceive uncertainty about benefits or employment as especially threatening. Those are responses shaped by experience, not character flaws.

Regardless of their source, risk factors are not destiny.

People demonstrate extraordinary resilience, especially when they have meaningful support, appropriate resources, and relationships that help restore a sense of safety and control.

Our responsibility isn’t to diagnose someone’s childhood or investigate their personal history. Instead, we need to recognize that every injured worker arrives with experiences we may know nothing about, but that will affect their resilience, recovery, and (for those who care about the bottom line) the total cost of a claim.

Federer’s point isn’t that yesterday doesn’t matter. It matters enormously.

His failures helped him improve. His victories demonstrated what was possible. But neither could win the next point for him.

I think there’s an important lesson here for everyone involved in work comp.

A difficult previous claim doesn’t guarantee another difficult experience for an injured worker. Recovery may still be possible, even when the path forward looks different from what they expected.

For claims professionals and clinicians, an injured worker who has been distrustful, angry, or disengaged isn’t necessarily destined to remain that way. Our next interaction may be an opportunity to change the relationship by proving that we are worthy of their trust.

None of this means ignoring legitimate trauma or pretending failure didn’t hurt. Positive thinking doesn’t overcome every obstacle. It simply means refusing to confuse a prediction with a certainty.

We can’t change what happened yesterday. However, we can learn from it, acknowledge its influence, and make better choices because of it.

Somewhere in your caseload today is an injured worker who already expects to be ignored. The next call you return is the next point.

Their past is a lesson. It doesn’t have to be a life sentence.

For carriers, TPAs, self-insured employers, and provider partners, this shift is not a philosophical exercise. Delayed recovery increases indemnity exposure, medical spend, attorney involvement, administrative workload, and workforce disruption. Better recovery management means building the capability to identify barriers early, communicate with purpose, coordinate the right resources, and maintain focus on safe, sustainable function.

Recovery Management Trends Are Moving Upstream

Traditional claims models often reserve intensive attention for claims that have already become complex. By that point, a missed appointment, unresolved pain concern, breakdown in supervisor communication, or delayed authorization may have developed into extended disability or litigation.

A defining trend is earlier, more deliberate triage. Organizations are increasingly looking beyond diagnosis and injury severity at first notice of loss. They are assessing job demands, recovery expectations, psychosocial concerns, prior claim history, access to care, language needs, and the worker’s relationship with the employer. The goal is not to label people as difficult or predict failure. It is to recognize where a standard workflow may be insufficient.

Early contact is becoming a performance discipline

Early outreach is most effective when it is more than a scripted acknowledgment. A skilled claims professional explains what happens next, confirms immediate needs, sets realistic expectations, and gives the injured worker a reliable path for questions. That interaction can reduce uncertainty at the moment uncertainty is highest.

Speed matters, but quality matters more. A rushed call that sounds transactional can create the same distrust as no call at all. Training should therefore address both technical accuracy and the conversational skills required to establish credibility. Claims teams need to know how to listen for concerns, explain benefits without jargon, and document information that will guide the recovery plan.

Whole-Person Recovery Is Becoming an Operating Model

Workers’ compensation has always involved medical treatment and indemnity benefits. Recovery management is now expanding the lens to include the conditions that influence whether treatment translates into restored function. Transportation barriers, caregiving responsibilities, financial stress, health literacy, fear of reinjury, workplace conflict, and behavioral health needs can all affect a claim’s trajectory.

This does not mean every claim requires intensive case management or clinical intervention. It means the response should fit the barrier. A worker who needs clearer return-to-work expectations requires a different intervention than a worker facing a complex comorbidity or a delayed specialty referral.

The operational challenge is consistency. Whole-person recovery cannot depend on whether an individual adjuster happens to ask better questions. Organizations need defined workflows, escalation criteria, role clarity, and education that helps frontline professionals recognize when a recovery barrier is within their scope to address and when it requires coordinated support.

This model also changes the way performance is discussed. Closing a claim quickly is not always a meaningful success measure if the worker returns without appropriate support and experiences a setback. The stronger objective is durable recovery: appropriate care, safe work participation, informed expectations, and a resolution that holds.

Return to Work Is Becoming More Collaborative

Return to work remains one of the most powerful levers in workers’ compensation, but the language around it is evolving. A release to modified duty is not, by itself, a return-to-work strategy. The transition succeeds when the job is available, the restrictions are understood, the supervisor is prepared, and the employee sees a credible path back to productive work.

Forward-looking employers are involving supervisors and operational leaders earlier in the process. They are treating transitional work as a planned business function rather than an exception arranged after disability has extended. That requires supervisors to understand their role without being asked to interpret medical restrictions or manage information they should not receive.

Expectations must be aligned across the claim

Misalignment creates avoidable friction. The treating provider may believe modified duty exists, while the employee believes there is no meaningful work available. The employer may offer a role that does not match stated restrictions. The claims professional may communicate timelines that conflict with the care plan.

Recovery management requires a disciplined expectation-setting process. Every party should understand the current functional status, the next decision point, and who is responsible for action. Clear communication does not guarantee agreement, but it reduces the confusion that often drives disengagement and attorney involvement.

Data Is Becoming More Useful When It Drives Action

Claims organizations have more data than ever, including lag time, provider performance, duration benchmarks, litigation indicators, pharmacy activity, and return-to-work measures. The trend is not simply toward more analytics. It is toward practical analytics that help the right professional intervene at the right time.

A predictive model can identify a claim with elevated risk, but it cannot explain a benefit decision with empathy, resolve a worker’s unanswered concern, or persuade a supervisor to support transitional work. Data identifies where attention may be needed. Professional judgment determines what should happen next.

The most effective programs connect data to specific actions. If a claim shows delayed treatment initiation, there should be a clear ownership path. If work absence exceeds expected duration, the team should know whether to review barriers, coordinate with the employer, obtain additional clinical information, or engage specialized resources. Alerts without accountability create more work rather than better outcomes.

Organizations should also be cautious about treating models as neutral. Historical claims data can reflect inconsistent access to care, uneven communication, or prior operational bias. Governance, human review, and role-specific education are necessary to ensure that data supports fairer recovery decisions rather than merely automating old patterns.

AI Is Raising the Standard for Human Skills

Artificial intelligence is beginning to assist with claim summarization, document review, workflow prioritization, communication drafting, and pattern recognition. Used appropriately, these tools can reduce administrative burden and give claims professionals more time for complex decisions and meaningful contact.

But AI also raises the stakes for communication, critical thinking, privacy awareness, and professional accountability. A generated summary may omit context. A drafted message may be technically correct but emotionally tone-deaf. A risk score may warrant investigation, not an assumption about the worker or the claim.

The practical opportunity is to train teams to use AI as decision support rather than decision replacement. They must understand the limitations of automated outputs, protect sensitive information, verify material facts, and retain ownership of the recovery conversation. As routine tasks become faster, the differentiating skill will be the ability to apply judgment with clarity and respect.

Training Is Shifting From Compliance Completion to Capability

Compliance education remains essential, particularly as state requirements, Medicare Secondary Payer obligations, and jurisdictional rules continue to demand precision. Yet completion rates do not prove that an organization has built recovery capability.

The stronger training model is role-specific and measurable. Adjusters need claim, communication, and expectation-setting skills. Nurse case managers need coordinated approaches that connect clinical progress to functional recovery. Supervisors need practical return-to-work education. Leaders need the ability to measure whether training is improving claim handling consistency, duration outcomes, and worker experience.

This is where formal education systems such as WorkCompCollege’s Whole Person Recovery Method™ can provide a more disciplined foundation. The objective is not to make empathy a slogan. It is to teach empathy, communication, and technical claims practice as operational competencies that can reduce friction and improve outcomes.

The Competitive Difference Will Be Recovery Confidence

The organizations best positioned for the next phase of workers’ compensation will not be those with the most elaborate claim workflows. They will be the ones whose people can make sound technical decisions while helping injured workers understand what is happening, what is expected, and where support is available.

Recovery confidence is built one well-managed interaction at a time. When professionals combine timely intervention, coordinated return-to-work planning, responsible use of data, and respectful communication, they create conditions where better claim outcomes become more likely – for the worker, the employer, and the organization responsible for the claim.

Every so often a statistic wanders through our industry that sounds too good to be true. Usually, it is. Someone shows a slide promising a 70 percent reduction in something, the room nods, and six months later we learn that the study involved eleven claims at a single bakery in 2009.

So I approached this one with my customary skepticism. According to claims data, communication grounded in empathy is associated with a reduction in claim costs of 20 to 50 percent. That is a wide range. It is the kind of range a weatherman gives when he has no idea whether it will rain. But here is the thing that keeps me from dismissing it: almost every serious piece of research in this space points in the same direction, and none of it points the other way.

Consider what Lockton found when it went digging through adjuster notes. The researchers examined notes covering $16 billion in workers’ compensation claims, representing 65 million transactions. They were looking for one thing: fear. Lost-time claims cost an average of 3.5 times more when words like “fear” and “afraid” appeared in adjuster conversations, and 84 percent of litigated lost-time claims costing more than $100,000 had those fear words in the notes.

Read that again. The most expensive claims in the system are not necessarily the ones with the worst injuries. They are the ones with the most frightened people.

The Hartford came to a similar conclusion through its own text mining. Its analysis found that the presence of “fear” in claim notes was more predictive of poor outcomes than a lumbar fusion surgery. Let that sink in for a moment. We have built entire cost containment strategies around avoiding spinal fusions, with utilization review, peer reviews, second opinions, and enough paperwork to deforest a small nation. Meanwhile, a scared worker on the other end of the phone was quietly the bigger predictor of disaster, and nobody had a form for that.

So what does a 20 to 50 percent reduction actually look like on the ground? It does not look like a software platform, although the vendors would love for you to believe otherwise. It looks like a phone call made on day one instead of day nine. It looks like an adjuster who explains what happens next before the injured worker has to ask. It looks like someone telling a frightened employee that yes, their job will still be there, and actually meaning it.

None of this is new. Research presented years ago from the Institute for Work & Health recommended listening to claimants with empathy, explaining the comp process in detail to reduce uncertainty, and making check-in calls to see how the injured worker is doing. That is not a revolutionary treatment protocol. That is what your grandmother would have told you to do.

And yet our system has spent decades doing the opposite. We send injured workers a letter full of statutory citations they cannot understand. We assign them to someone whose job title implies they are there to adjust something, presumably downward. We let weeks pass in silence, and then express surprise when the worker calls a lawyer whose television ad promises, above all else, that someone will finally listen. The attorney did not create that fear. We did. The attorney just answered the phone.

The good news is that the industry has noticed. Rising Medical Solutions’ benchmarking research found that advocacy-based claim styles were more prevalent in higher performing claims organizations, and that more training for adjusters in communication and soft skills like empathy was associated with higher performance. In other words, the organizations getting the best results are the ones treating injured workers like people. Imagine that.

I want to be careful here, because “empathy” has a way of being misunderstood by people who control budgets. Empathy is not giving away the store. It is not approving every treatment request or paying every demand. An empathetic adjuster can still deny a claim that should be denied. The difference is that the worker understands why, knows what comes next, and does not feel like they have been dropped down a well. Empathy is not softness. It is clarity delivered by a human being.

It is also, as it turns out, cheaper. That is the part that should get the attention of every CFO who has ever viewed claim advocacy as a nice idea for organizations with more money than sense. The research suggests the opposite is true. The money is being spent either way. You can spend it on early communication and trust, or you can spend it on litigation, extended disability, and the slow, expensive unraveling of a worker who no longer believes anyone is on their side.

This is, of course, the whole reason I have been arguing for more than a decade that we should stop calling this system workers’ compensation and start calling it Workers’ Recovery. Compensation is a transaction. Recovery is an outcome. When the stated goal of the system is to pay people, we design processes around payment. When the goal is to help people recover, we design processes around people. The cost savings follow the people, not the other way around.

Several hundred professionals have now gone through our Workers’ Recovery Professional certification at WorkCompCollege.com, and the thing I hear most often from them is not that they learned some radical new technique. It is that they finally got permission to do what they always suspected was right.

So when someone tells you empathy can lower claim costs by 20 to 50 percent, you are welcome to be skeptical about the exact number. I am. But do not be skeptical about the direction. The data on fear, litigation, and outcomes is too consistent to ignore. A frightened worker is an expensive worker. A worker who feels heard is usually not.

It turns out the most effective cost containment strategy in workers’ compensation is treating people like people. Who knew?

Just thought you should know. It’s what I do. No need to thank me.

Sources referenced in this article:

Compassion as a KPI: Measuring Empathy in Claims Management – WorkersCompensation.com
Fearful claimants generate higher workers comp costs – Business Insurance
Psychosocial Issues Main Barrier to Successful Workers’ Comp Claims Outcomes
Empathy, measured approach can aid claims communication – Business Insurance

Why Claim Resolution Often Goes Off Track

Obtaining a resolution for a compensable injury is the ultimate goal of every workers’ compensation professional. However, the path to closure is rarely a straight line. Between clinical hurdles, occupational rehabilitation issues, and administrative friction, the process is often bogged down by “tangential factors” that distract from the primary objective.

A key component of this process is establishing a return-to-work (RTW) plan in a manner that is as safe and efficient as possible. Effective work restrictions must balance three critical elements:

1. The safety of the injured individual.
2. The physical ability to complete assigned tasks.
3. Objectified clinical standards that ensure the employee’s long-term health is never compromised.

The Problem: The “Vague Language” Trap

I recently reviewed a file with poorly communicated work restrictions that created a domino effect of issues. It muddled the claim process, compromised the treatment plan, and delayed compliance from both the employee and the employer.

The breakdown usually happens because of a lack of a standard format. We often see providers use non-specific terminology like “light duty,” which is virtually meaningless to an employer. There is a massive functional difference between “no lifting over 25 pounds” and the vague suggestion of “taking it easy.”

The Provider as the Gatekeeper

The foundation of any effective work restriction is a clear understanding of specific job standards. The treating provider acts as the gatekeeper. To do this job effectively, they must:

• Request Functional Language: Move away from “light duty” and toward precise functional capacity (e.g., “cannot reach above shoulder height with the right arm”).
• Review Job Descriptions: A provider cannot accurately restrict a worker if they do not know what the worker actually does. If a worker sorts eggs from a seated position, a “no prolonged standing” restriction is irrelevant.
• Validate Correlation: Does the restriction actually match the injury? (For example, restricting upper extremity use for a stubbed toe is a red flag).

The Employer’s Role: Preparation and Clarity

Employers often miss opportunities for early RTW because they have not done the groundwork. An employer’s obligation is to ensure that restrictions are accurately and rapidly applied. This requires:

• Comprehensive Job Descriptions: Including specific physical tests or requirements.
• Modified Duty Blueprints: Having a plan for “meaningful work” before the injury even happens.
• Direct Communication: If a restriction is unclear, the employer should feel empowered to call the provider (or the adjuster) for clarification rather than simply saying, “We can’t accommodate that.”

The Claims Professional: The Connective Tissue

As the claims handler, you are the link between the employer and the injured employee. You must be proactive rather than reactive.

• Get the Job Description Early: Do not wait for a permanent impairment rating to ask what the worker does for a living. Have the job description in the file from Day 1.
• Identify Mismatches: If the restrictions do not match the injury or the job description, pick up the phone. A quick call to the provider can often resolve a dispute before it turns into a litigated mess.
• Utilize Case Management: If the gap between the provider’s intent and the employer’s capability is too wide, involve a Nurse Case Manager to act as a clinical conduit.

The Bottom Line: Standards for work restrictions are not just more “bureaucracy.”

They are a protection for everyone involved. When we use precise language and objective standards, we protect the employee from re-injury and the employer from administrative burden.

By fostering forward-looking communication and educating the injured employee on the why behind their restrictions, we improve outcomes and reduce the likelihood of litigation. It is more than just paperwork, it is a demonstration of professionalism and a commitment to the recovery of the human being at the center of the claim.

For carriers, TPAs, self-insured employers, provider organizations, and public entities, the challenge is not simply knowing the rules. It is creating a repeatable way for people in different roles to apply those rules consistently. A strong program turns statutory requirements into daily behaviors, documented workflows, supervisory controls, and role-specific education.

What a Compliance Program Must Accomplish

Workers’ compensation compliance has several layers. State statutes and administrative rules govern reporting, benefit delivery, notices, medical management, record retention, and dispute procedures. Federal requirements may also apply, particularly in areas such as Medicare Secondary Payer obligations, privacy, employment practices, and workplace safety. Contractual requirements from clients, excess carriers, or network partners can add another layer.

The practical question is not whether your organization has a policy manual. It is whether an examiner, supervisor, nurse case manager, employer representative, or vendor can identify the required action, complete it on time, explain it clearly, and document the decision. A program that cannot answer those questions is not yet operational.

Effective compliance programs also recognize that technical accuracy alone does not produce better outcomes. An injured worker who receives a technically correct notice but does not understand what happens next may still disengage from treatment, miss appointments, or seek legal representation. Communication, empathy, and expectation-setting are therefore compliance-adjacent performance skills. They help people act on the information the system is required to provide.

Build the Workers Compensation Compliance Program Around Risk

Start with a risk assessment rather than a generic course catalog. Organizations operating across multiple states need a clear view of where requirements differ and where their internal process is most likely to fail. A single nationwide workflow may create efficiency, but it can also create exposure if it overlooks state-specific deadlines, forms, benefit calculations, utilization review rules, or reporting obligations.

Map the claim lifecycle from first report of injury through closure. At each stage, identify the legal or contractual requirement, the accountable role, the triggering event, the required documentation, the deadline, and the escalation path when something goes wrong. This exercise often reveals gaps that are otherwise hidden between departments.

For example, first notice of loss intake may be timely, yet the employer may not provide complete wage information needed for accurate indemnity calculations. A nurse case manager may appropriately coordinate care, but claim notes may not explain how a medical recommendation informed the benefit decision. A closure process may be administratively complete while overlooking reporting or settlement obligations. Compliance risk often sits in the handoff, not in the individual task.

A useful risk assessment should address at least these areas:

• State-specific reporting, notices, forms, and benefit timelines
• Claim file documentation standards and supervisory review
• Medical management, utilization review, and provider communication
• Return-to-work practices and coordination with the employer
• Medicare Secondary Payer screening, conditional payment, and settlement processes
• Vendor oversight, data security, records retention, and audit readiness

Prioritize findings by likelihood, financial exposure, regulatory consequence, and impact on the injured worker’s recovery experience. Not every gap requires the same intervention. A missed statutory deadline needs immediate control and escalation. Inconsistent explanation of benefits may require coaching, call calibration, and better communication standards. The response should match the risk.

Assign Ownership Before Building Training

Compliance fails when accountability is distributed vaguely across operations, legal, human resources, and leadership. Every critical requirement needs a named owner, even when multiple teams participate.

Claims leadership should own execution quality and file-level adherence. Compliance or legal functions should interpret regulatory changes, maintain the control framework, and advise on high-risk issues. Human resources and risk management may own employer-side reporting, return-to-work coordination, and injury response protocols. Training leaders should ensure education is current, role-specific, and measurable. Executive sponsors must remove operational barriers when workload, staffing, technology, or vendor performance makes compliance difficult.

This structure should not create silos. The best programs establish a cross-functional governance group that reviews trends, material findings, regulatory changes, and corrective action progress on a defined cadence. The goal is not another meeting. The goal is timely decisions when an issue crosses departmental lines.

Convert Requirements Into Usable Workflows

Policies establish intent. Workflows determine whether intent survives a busy claims day.

Each workflow should make the correct action easier than the shortcut. That may mean system-generated alerts for jurisdictional deadlines, required fields before a file can advance, decision trees for complex benefit issues, standard letter review, and escalation protocols for exceptions. Technology can support consistency, but it cannot replace professional judgment. Poorly designed automation simply produces errors faster.

Written procedures should include the reason behind the task, not only the task itself. An adjuster who understands that prompt, plain-language communication can influence treatment engagement and return-to-work cooperation is more likely to treat the contact as meaningful rather than procedural. This is where whole-person recovery becomes operational: compliance is delivered through a person-to-person experience, not merely a transaction log.

Consider the difference between a checklist item that says, “Issue required notice,” and a workflow that requires the examiner to confirm delivery, explain the decision in understandable terms, identify questions or barriers, document the discussion, and set the next contact expectation. Both may support compliance. Only one strengthens trust while reducing uncertainty.

Train by Role, Not by Department

Annual, one-size-fits-all compliance training rarely changes behavior. Different roles face different decisions, risks, and communication moments.

Claims professionals need jurisdiction-specific knowledge, file documentation discipline, benefit and medical-management decision skills, and the ability to explain difficult decisions respectfully. Supervisors need coaching methods, audit calibration, and escalation judgment. Nurse case managers need clear boundaries, clinical documentation standards, and effective coordination with injured workers, providers, and claims teams. Employer stakeholders need practical instruction on incident reporting, transitional work, wage documentation, and communication after an injury.

Training should also be reinforced at the point of work. A learner may pass a knowledge check but still struggle to apply a rule during a complex claim conversation. Scenario-based instruction, file review, peer calibration, and targeted coaching are more reliable measures of applied competence than completion records alone.

WorkCompCollege’s approach to workers’ compensation education reflects this reality by treating communication and empathy as professional capabilities tied directly to claim outcomes, not as optional soft skills.

Measure Compliance as Performance, Not Attendance

Course completions and signed attestations are necessary records, but they are weak indicators of program effectiveness. Leadership needs evidence that learning and controls are changing operational performance.

Track timeliness for required filings, notices, payments, and reports. Review file documentation quality and the consistency of statutory or internal decision rationales. Monitor audit findings by business unit, jurisdiction, examiner, process stage, and root cause. Measure corrective actions not only by whether they were assigned, but whether repeat findings decline.

Pair these traditional measures with outcome indicators. Delayed contact, unclear communication, or inconsistent return-to-work coordination can contribute to extended disability duration, dissatisfaction, and litigation risk. Those outcomes have multiple causes, so they should not be used as simplistic compliance scores. They are, however, valuable signals that the organization should examine alongside file accuracy and timeliness.

A practical dashboard distinguishes between leading and lagging indicators. Training completion, workflow adherence, and timely supervisor review are leading indicators. Penalties, disputes, adverse audit results, and prolonged claim duration are lagging indicators. Both matter, but leading indicators give leaders time to intervene before exposure grows.

Audit for Learning and Accountability

An audit should test whether the program works under normal operating conditions, not whether employees can prepare a perfect file after receiving notice of review. Use a mix of random file audits, targeted reviews of high-risk claim types, and trend analysis following regulatory changes or system updates.

Audit findings should be specific enough to support correction. “Documentation incomplete” is not a useful conclusion. A stronger finding identifies the requirement, the missing or inconsistent evidence, the likely cause, the risk created, the responsible owner, and the date by which remediation will be validated.

Avoid a purely punitive model. Repeated or willful noncompliance requires accountability, but many defects point to unclear instructions, impossible workload conditions, poor system design, or inadequate training. Treating every error as an individual failure can hide the operational cause and guarantee that it returns.

Keep the Program Current

Workers’ compensation requirements change. Organizational operations change too. New jurisdictions, acquisitions, vendor relationships, claims platforms, remote work practices, and staffing models can all alter the compliance profile.

Establish a formal change-management process. When a rule, process, or technology configuration changes, identify affected roles, update procedures and job aids, deliver targeted education, test understanding, and verify application through quality review. This is especially important when changes affect time-sensitive notices, benefit calculations, medical authorization procedures, or settlement activity.

The strongest compliance programs create confidence without becoming complacent. They give professionals the technical standards, practical tools, and interpersonal judgment needed to do the right thing when a claim is complicated and the consequences are real. That is how compliance becomes more than a defense against penalties: it becomes a disciplined commitment to better recovery, better work outcomes, and better claim performance.

So here we are. Two major moves in one year.

An office we’re being asked to leave and a home we’ve been waiting years to enter. Different journeys, same lesson: sometimes growth begins with letting go of what’s familiar and trusting what’s next.

Last month, I changed two addresses. ReEmployAbility is relocating its headquarters, and after nearly two years of renovations, Phil and I are finally moving into our new home. On the surface, one is a business move, and one is personal. But the more I’ve reflected on them, the more I’ve realized they’re teaching me many of the same lessons about leadership, decision-making, patience, trust, and the people who help us navigate change.

After seven years in our current office, we’re moving again.

Moves are not new for us. As we’ve grown, we’ve relocated several times. But this one wasn’t part of the plan. In fact, I thought our current space would be our last move.

I love this space.

It’s where we’ve grown, solved problems, celebrated milestones, and welcomed team members and clients who have become friends. We celebrated our 20th company anniversary here. We navigated COVID together here.  We’ve hosted holiday parties and epic Halloween family events. We’ve watched employees earn promotions, pursue new opportunities, and begin exciting new chapters of their lives. We’ve welcomed new faces, said tearful goodbyes to others, and shared countless moments that make up the story of our company.

Like most things that last for several years, it’s filled with memories.

But our landlord sold the property, and soon apartments will stand where our office sits today.

My initial reaction was probably the same reaction many leaders have when confronted with unexpected change. I saw it as a problem to solve and a major distraction from the work that mattered most.

What does this mean? How quickly do we need to act? What are the risks? What’s the plan?

Leadership often requires decisive action, but experience has taught me that not every challenge is solved by immediately charging forward. Sometimes the best decision is to accept reality, gather the facts, understand your options, and trust that an unexpected change may ultimately create opportunities you cannot yet see.

As we began planning the move, something became very clear. This wasn’t the move I was making. It was a move WE were making.

Our leadership team immediately stepped up. Employees took ownership of major initiatives. People volunteered to solve problems before they were asked. What could have easily become a burden became a reminder that leadership is not about carrying everything yourself. It’s about building a team capable of carrying the organization through change together.

That lesson wasn’t limited to the office.

It showed up again during our home renovation.

After two long years, Phil and I are finally moving into our renovated home. Ironically, he was the one who saw the vision first. I had a much harder time seeing what the house could become. It took some imagination and more than a little convincing before I fully bought into the dream.

Looking back, that feels a lot like leadership.

Sometimes we know change is necessary long before we can clearly see the destination. We know we need to pivot, evolve, invest, or take a different path, but we don’t always have a crystal-clear picture of how everything will turn out. We move forward because we believe the vision (or our spouse does!) is worth pursuing, even when we can’t yet see all the details.

What started as an exciting renovation quickly became an exercise in endurance.

Over the past two years, we’ve navigated permitting challenges, design revisions, equipment delays, contractor schedules, furniture backorders, inspections, and countless unforeseen hurdles. Then, almost immediately after purchasing the house, Hurricanes Helene and Milton changed everything. What began as a renovation project quickly became a lesson in adaptability as storm-related disruptions created delays in contractors, permitting, inspections, scheduling, and nearly every aspect of the project. Timelines shifted, expectations had to be reset, and what we thought would take one year ultimately took two.

At some point, every major project reaches a phase where the finish line felt no closer than it did months before. Excitement gave way to frustration. Progress felt invisible. Timelines shift. Expectations have to be reset.

And then there’s decision fatigue.  Paint colors. Fixtures. Flooring. Furniture. Layouts.  OH MY!  You make hundreds of decisions and somehow discover there are hundreds more waiting for you.

As much as I wanted to push harder, solve faster, and control the outcome, I learned a difficult truth: some things simply take the time they take.

Patience isn’t passive. Patience is continuing to show up when progress feels slow. It’s trusting the process when the timeline disappoints you. It’s making the next right decision while acknowledging that some variables remain entirely outside your control.

But patience alone isn’t enough. Patience requires trust. Trust in the destination. Trust in the process. And perhaps most importantly, trust in the people around you.

Our designers, contractors, project managers, and countless other professionals brought expertise we simply didn’t have. The finished product is the result of talented people doing what they do best.

The more I thought about it, the more I realized both moves were teaching the same lesson.

No meaningful transformation happens alone.

Whether you’re moving a company, renovating a home, launching a new technology initiative, or leading organizational change, success is rarely the result of one person’s effort. It comes from the collective contributions of people who bring different perspectives, skills, and expertise to the table.

In the office move, it was our leadership team, employees, partners, and colleagues who helped move the vision forward.

In the home renovation, it was designers, contractors, project managers, and craftsmen who turned ideas into reality.

The same principle applies to every successful organization. None of us reach the next level alone. We get there because of the people who stand beside us, challenge us, support us, and contribute their talents to something bigger than themselves.

Another lesson from this season of change is that change creates clarity.

Whether you’re packing up an office or moving into a new home, you’re forced to make decisions. What stays? What goes? What deserves a place in the future?

The same thing happens in organizations.

Over time, businesses accumulate processes, traditions, habits, assumptions, and initiatives. Some continue creating value. Others remain simply because they’ve always been there.

Periods of transition provide a unique opportunity to evaluate both.

Not every transformation is about adding something new. Sometimes growth comes from having the discipline to let go of what no longer serves the mission. Every move, whether personal or professional, forces us to decide what is worth carrying forward.

Perhaps the biggest lesson of all is that buildings don’t create culture. People do.

I’ve loved this office. We’ve become attached to the building because it has been the backdrop for an important chapter of our story. But when I think about what made it special, it wasn’t the walls, the conference rooms, or the address.

It was the people.

It was the trust we built, the challenges we navigated, the milestones we celebrated, the laughter we shared, and the mission that united us. Culture doesn’t live in a building. Culture travels with the people who create it.

The same is true at home.

After two years of renovations, delays, disrupted routines, and more decisions than I can count, I’m reminded that a house doesn’t become a home because of beautiful finishes or updated spaces (although that doesn’t hurt!). Home is where your people are. It’s where family gathers, traditions are created, and memories are made and I can’t wait to make new ones starting with our first holiday, Thanksgiving.

As leaders, we naturally focus on the logistics of change. We think about timelines, budgets, risks, plans, schedules, and execution. Those things matter. But what matters even more is maintaining trust, protecting morale, and helping people remain connected to the vision during the long stretch between where they are and where they’re going.

When I look back on these two moves, that’s the lesson I’ll remember most.

The office move wasn’t really about relocating a company. The home renovation wasn’t really about construction. Both were lessons in leadership. Both required making decisions with incomplete information, adapting when circumstances changed, exercising patience when progress felt slow, and trusting people whose expertise was greater than my own.

Most importantly, both reminded me that every meaningful transformation is ultimately a people story.

This year I’m making two major moves. One I didn’t choose. One I couldn’t wait for.

And while the addresses are changing, the things that matter most are coming with me.

The relationships. The culture. The lessons. The memories.

Because every major move eventually asks the same question: What are you carrying forward?

Completion rates alone cannot make that connection. They show participation, not competence. A certificate confirms that a professional met an educational standard, but the organization must still determine whether new knowledge is being applied consistently in intake conversations, file documentation, medical management, return-to-work coordination, reserve decisions, and communications with employers and injured workers.

For workers’ compensation leaders, measurement should not be a post-training administrative task. It is how training becomes an operating discipline rather than a catalog of courses.

Why completion rates are not enough

A 98% completion rate may look successful on an executive dashboard. Yet a team can complete every assigned module and still struggle with delayed first contact, unclear expectations, inconsistent escalation, poor documentation, or communication that drives an injured worker toward attorney involvement.

That gap is especially significant in workers’ compensation. Claims performance is shaped by technical knowledge, but also by the human moments that influence trust. Does the adjuster explain the process in plain language? Does the nurse case manager listen for barriers that could delay recovery? Does the employer understand its role in transitional duty? Can the claims professional set realistic expectations without sounding dismissive?

These are trainable capabilities. They are also measurable when the organization defines the expected behavior before training begins. The goal is not to prove that every positive claim result came from a course. Claim outcomes are affected by injury severity, jurisdiction, provider networks, labor conditions, employer practices, and many other variables. The goal is to establish credible evidence that training is improving the controllable parts of claims handling.

Claims training measurement guide: use four levels

The most useful measurement systems track a chain of evidence. Each level matters because it explains a different part of the training-to-outcome relationship.

1. Learning and demonstrated competence

Start with the question: did participants actually gain the intended knowledge or skill? Post-course quizzes can test technical knowledge, including compensability concepts, Medicare Secondary Payer obligations, jurisdictional requirements, or documentation standards. They are necessary, but they should not be the only assessment method.

For communication, empathy, and expectation-setting, scenario-based assessments are more revealing. Present a realistic situation: an injured worker is frustrated by a perceived treatment delay, the supervisor has not supplied an accurate job description, and the treating provider has recommended restrictions. Ask the learner to identify priorities, choose language for a claimant conversation, and document the next steps.

A strong assessment requires application, not memorization. It also identifies where additional coaching is needed before a learner manages complex files independently.

2. Behavioral adoption on the job

The next question is whether trained behaviors appear in live work. This is where supervisors, quality assurance teams, and calibrated file reviews become essential.

A review tool might examine whether first contact was timely and meaningful, whether the claims professional explained benefits and responsibilities clearly, whether barriers to recovery were documented, and whether return-to-work discussions involved the appropriate stakeholders. For a medical management program, reviewers might look for appropriate care coordination, outreach cadence, and escalation when recovery is not progressing as expected.

Use defined scoring criteria. “Good communication” is too subjective to manage at enterprise scale. “Explains next steps, confirms understanding, documents stated concerns, and establishes a follow-up commitment” is observable. Calibration among reviewers matters just as much as the scorecard itself. If two reviewers interpret the same call or file differently, leadership cannot rely on the trend data.

3. Claims process and quality indicators

Behavior should lead to improvements in the claims process. Choose indicators that are close enough to the trained skill that the relationship remains plausible.

For example, training focused on early injured-worker engagement may be measured through timely initial contact, completed expectation-setting documentation, claimant satisfaction feedback, early identification of recovery barriers, and referral timeliness. Training on return-to-work coordination may be measured through documented employer outreach, transitional-duty offers, and time from restrictions to work-plan action.

Technical training should have equally specific indicators. A compliance program may monitor audit findings, documentation errors, required notice timeliness, or rework rates. A reserve-setting curriculum may monitor file review accuracy and variance patterns. The measure should fit the capability being taught.

4. Recovery, financial, and organizational outcomes

The final level includes the outcomes executives care about: duration, return-to-work results, litigation rates, expense management, indemnity performance, quality leakage, and customer experience. These indicators are vital, but they are lagging measures. They should be read with discipline.

If training is intended to reduce attorney involvement, do not expect a single quarterly figure to settle the question. Review comparable cohorts over time. Segment the analysis by jurisdiction, injury type, severity, tenure, employer group, and claim maturity where possible. A change in the case mix can make a training program look ineffective or more successful than it really is.

Establish the baseline before assigning training

Measurement becomes unreliable when the organization first defines success after the program has launched. Establish a baseline period using the same definitions and data sources that will be used afterward. For many claims measures, six to twelve months of historical data offers a more useful view than a single pre-training snapshot, though the appropriate period depends on claim volume and development patterns.

Then identify the target population. Are you training new adjusters, experienced examiners with quality variation, nurse case managers, supervisors, or a cross-functional employer service team? Each group requires different performance expectations. A new-hire program may appropriately emphasize time to proficiency and early file quality. An advanced program for experienced professionals may focus on complex claim strategy, escalation judgment, and consistency across jurisdictions.

Where possible, compare trained and not-yet-trained cohorts with similar caseloads. This does not create perfect experimental conditions, but it helps leaders avoid mistaking broad market changes for a training effect. At a minimum, track results by learner group and training date rather than rolling every participant into one undifferentiated average.

Build a scorecard people can use

A measurement framework fails when it becomes a reporting burden nobody can act on. A practical scorecard should show leaders what changed, where variation remains, and what action follows.

Use a small set of measures for each program: one learning measure, one or two behavior measures, one process measure, and one outcome measure. Pair the numbers with a defined review cadence. Supervisors may review behavior scores monthly, while senior leaders review claim and financial trends quarterly because those outcomes take longer to mature.

The scorecard should also name an owner for every metric. Learning teams can report completion and assessment performance, but claims operations must own behavioral adoption. Quality teams may validate file-review trends. Finance, analytics, and actuarial partners can help interpret longer-term cost patterns. Training works best when it is treated as shared operating infrastructure, not an isolated learning function.

Avoid common measurement mistakes

The first mistake is overclaiming causation. A favorable outcome after training is encouraging, not automatic proof. State what the data supports and continue testing the relationship.

The second is relying on averages that conceal variation. A carrier may show improved overall file quality while one office, jurisdiction, or supervisor team continues to underperform. Segmentation turns broad results into a coaching plan.

The third is measuring only what is easy to extract. System data is valuable, but it may not reveal whether an injured worker felt heard, understood the process, or received a clear commitment for follow-up. Call monitoring, targeted surveys, and structured quality reviews can supply that missing evidence.

Finally, do not use measurement solely to judge employees. When leaders use scorecards to identify coaching needs, workflow friction, unclear authority, and curriculum gaps, professionals are more likely to engage honestly. When measurement feels punitive, people learn to optimize the metric instead of improving the claim experience.

Turn results into a better standard of practice

The purpose of a claims training measurement system is not a polished dashboard. It is better decisions at the moment a claim needs them. If results show that learners know the policy but struggle to explain it with empathy, reinforce scenario practice and supervisor coaching. If quality improves but return-to-work results do not, examine employer engagement and available transitional-duty options rather than assuming the claims team has failed.

WorkCompCollege’s whole-person recovery approach reflects this practical standard: technical competence and human-centered claims practice should be developed and measured together. The strongest organizations do not ask employees to choose between compassion and performance. They build the capabilities that make both possible.

A useful measurement program keeps returning to one disciplined question: what should a trained professional do differently on Monday, and what evidence will show that the difference helped an injured worker move forward? That is where training earns its place in claims strategy.

How Spinal Fusion Can Create New Complications

The words “spinal fusion” can represent a significant problem in addressing workers compensation cases. With the assumption that the need for a lumbar fusion has been adjudicated, and the perceived need is a function of the compensable event, one must realize that in an effort to address these pain complaints, a solidly healed spinal fusion may ameliorate the symptomology (or relieve the symptoms noted). What needs to be incorporated into the mindset of the claims professionals is that with this fusion, normal spinal anatomy is compromised, and the stressors normally encouraged at the level(s) involved is translated either above or below.

Red Flags for Adjacent Segment Diseases

Therefore, one of the long-term unfortunate consequences of a spinal fusion is a disease process known as adjacent segment disease. Clearly, if there is adjacent segment disease identified at the time of injury, this is a clear indicator of a long-standing, pre-existing, and unrelated comorbidity. However, if this particular pathology is identified months or years after the noted fusion, this represents a significant complication. The clinical literature notes that between 5% and 30% of the patients will develop this process after spinal fusion.

This is not a new disease; however, this diagnosis represents an additional degenerative change in the region of the spine compromised by the surgical fusion. One must be clear that the pathology is not limited to x-ray findings alone; the noted findings must be combined with appropriate clinical examination demonstrating objectified symptomology (or clinically confirmed symptoms) at the proximal or distal level. To be clear, this complication can occur months or years after the surgical intervention.

In Texas, the clinical standard is that all care reasonably required to address the sequelae of the compensable event must be treated. The original injury must be a “producing cause” of the current pathology.

Therefore, a successful lumbar fusion, one that has noted to have reached maximum medical improvement, has been assigned an impairment rating, and the claim has been closed; this individual can return seeking an additional surgical intervention to address this pathology. And if adjacent segment disease has been objectified, you as the claim file handler must engage this diagnosis and provide appropriate treatment.

Questions That Must Be Resolved

If such a scenario lands on your desk, a careful analysis of all cogent facts must be completed to ascertain that this is clearly adjacent segment disease that has been objectified both from a physical examination perspective, and a diagnostic perspective, and is clearly a function of the compensable injury sustained. One must confirm the original injury, confirm that surgical intervention with a solid fusion had occurred, that the pain complaints are at a different level than the original injury, and the identified degeneration of an adjacent level was not previously symptomatic. While not ruling out this diagnosis, a careful clinical assessment needs to be obtained to ascertain if this particular finding is in fact related or a sequela of the compensable event.

One must ensure that the detailed clinical history provided includes several factors. These would include a clinical analysis of degeneration at adjacent level before the fusion, are the current symptoms anatomically consistent with the adjacent segment (note the nerve root function and corresponding findings), is there a cogent clinical argument explaining and linking the previous fusion to the current newer pathology. An additional consideration is whether there are noted comorbidities such as age, obesity, tobacco consumption, multiple level fusions or other risk factors. One must note if all non-operative options been fully explored.

As soon as this file lands on your desk, initiate a comprehensive, evidence-based medicine review so that the appropriate determination of adjacent segment disease can be established as opposed to a coincidental degenerative pathology.

The Bottom Line on Adjacent Segment Disease

Bottom line, adjacent segment disease is very real. However, it is not an automatic or inevitable sequela of lumbar fusion surgery. Your investigation has to include a careful analysis of the anatomy involved, the biomechanics, the clinical presentation, and timing of the symptomology. If you, as the adjuster, fully understand adjacent segment disease, and ask the appropriate questions, you will be in a better position to assign medically defensible claims decisions.