For carriers, TPAs, and self-insured employers, the question is no longer whether automation belongs in claims operations. It does. The more consequential question is where automation should lead, where it should assist, and where a trained claims professional must remain fully accountable.

What Claims Automation Can Do Well

Claims automation applies technology to repeatable tasks and defined decisions across the claim lifecycle. It may capture first notice of injury data, validate fields, route claims by jurisdiction or injury type, trigger correspondence, assign tasks, identify missing documentation, process routine invoices, or alert a supervisor when a claim exceeds an established threshold.

These functions address real operational problems. Claims teams often work across high volumes, fragmented systems, state-specific requirements, provider documentation, employer communication, and demanding timeframes. When routine steps rely on manual follow-up, quality can vary by workload, experience level, and individual work habits. Automation can create greater consistency in the work that should be consistent.

The business case is straightforward. Faster intake can reduce delays. Automated diary management can help prevent missed deadlines. Rules-based routing can place a claim with the right resource earlier. Structured data can improve reporting and identify patterns that leadership teams may otherwise miss. Each of those gains can support lower expense, stronger compliance performance, and a more disciplined claims operation.

Automation is especially useful when the task has clear inputs, established rules, and a low risk of harm if the system follows the rule correctly. A statutory notice deadline, a missing authorization form, or a duplicate invoice review may be appropriate candidates. The technology is not making a human assessment. It is reducing preventable administrative variation.

Where Claims Automation Requires Human Oversight

Workers’ compensation claims are not merely transactions. They are recovery events that affect a person’s health, income, identity, family obligations, and relationship with an employer. Those realities rarely fit cleanly into a decision tree.

An injured worker who does not return a call may be disengaged, but they may also be in pain, unable to navigate a portal, worried about retaliation, or unclear about what happens next. A delayed treatment appointment may signal noncompliance, or it may reflect transportation barriers, language needs, provider availability, or confusion about authorization. An automated system can flag the event. It cannot reliably interpret the person behind it.

This distinction matters because claims outcomes are shaped by what happens after an exception appears. If the response is a generic notice, an avoidable misunderstanding may harden into frustration. If a skilled adjuster or nurse case manager makes timely contact, sets expectations, listens carefully, and coordinates the next step, the same issue can become manageable.

High-impact decisions require more than data confidence. Compensability questions, reserve strategy, complex medical management, return-to-work planning, settlement evaluation, and attorney involvement all demand context. They involve jurisdictional knowledge, clinical considerations, employer realities, and communication skill. Technology may inform these decisions, but it should not obscure who owns them.

The risk of automating a poor process

Automation does not correct weak claims practices by itself. It can scale them.

If intake questions are incomplete, automated triage will distribute incomplete information faster. If correspondence is written in technical language that injured workers do not understand, automatic delivery simply expands the reach of poor communication. If escalation rules focus only on financial severity, the organization may miss psychosocial, workplace, or recovery barriers that later drive duration and litigation.

Before expanding automation, organizations should examine the process being automated. What decision is being made? What information is required? What assumptions are embedded in the rule? Who reviews exceptions? How is the worker’s experience affected? Those questions turn automation from a technology project into an operational design discipline.

Human Skills Are Performance Controls

In workers’ compensation, empathy is often treated as a personal quality rather than a professional capability. That view is too limited. Empathy, expectation-setting, active listening, and clear communication are performance controls because they influence behavior at critical moments in the claim.

An injured worker who understands the claims process is better positioned to participate in care and return-to-work planning. An employer that receives clear, timely direction can offer appropriate transitional work. A provider office that understands authorization requirements is less likely to encounter avoidable administrative delays. These are practical operational outcomes, not soft benefits.

Claims automation can create capacity for this work. When adjusters spend less time moving data, chasing routine documentation, or manually generating standard reminders, they have more opportunity to address the conversations that determine whether a claim stays on course. That capacity only produces value if professionals have been trained to use it well.

Organizations should therefore measure more than cycle time and closed-claim counts. Useful performance discussions also include timeliness of meaningful contact, clarity of claimant communications, return-to-work coordination, appropriate escalation, complaint patterns, and litigation indicators. Efficiency without relationship quality can create a misleading picture of success.

Building a Responsible Automation Model

A responsible model begins with claim segmentation. Not every claim needs the same degree of human involvement, and not every claimant needs the same communication approach. Simple, low-severity claims with stable facts may benefit from highly automated workflows, provided the claimant can readily reach a person when needed. Complex claims, catastrophic injuries, behavioral health concerns, disputed claims, and cases with prolonged disability require earlier and more deliberate human engagement.

The next requirement is governance. Claims leaders should establish who approves rules, how frequently they are reviewed, what outcomes trigger revision, and how staff can override an automated recommendation. An override should not be framed as a failure of the system. It is an essential safeguard when the facts do not match the model.

Data quality also deserves executive attention. Automation depends on accurate coding, timely documentation, reliable jurisdictional rules, and meaningful outcome data. Inconsistent data can produce incorrect routing, inappropriate communications, and false confidence in management reports. A sophisticated platform cannot compensate for unclear operating standards.

Finally, organizations need role-specific education. Adjusters need to understand when to rely on a workflow and when to investigate further. Supervisors need to recognize automation bias, monitor exceptions, and coach for judgment rather than simple task completion. Nurse case managers, employer stakeholders, and provider-facing teams need clarity about handoffs, documentation, and communication responsibilities.

Training Determines Whether Technology Delivers ROI

The strongest claims organizations do not position automation and professional development as competing investments. They treat them as connected investments.

A new system may standardize tasks, but it cannot teach an adjuster how to explain a difficult benefit decision with respect. It cannot teach a supervisor how to identify when a claimant’s anger reflects an unresolved concern rather than resistance. It cannot teach a team how to coordinate a return-to-work conversation that respects medical restrictions while preserving the worker’s dignity and connection to the workplace.

Those capabilities must be taught, practiced, observed, and reinforced. Formal workers’ compensation education should integrate technical claims knowledge with whole-person recovery management, communication, and expectation-setting. This is the premise behind WorkCompCollege’s specialized approach: better claims outcomes require both technical competence and the human skills that help injured people move through recovery.

The most effective implementation plans introduce automation with a clear operating philosophy. Technology handles repeatable work. Professionals own judgment, relationships, and exceptions. Leaders monitor both efficiency and recovery outcomes. Training gives every role a shared language for applying that philosophy consistently.

Claims automation is valuable when it gives professionals more time to do the work only people can do: interpret complexity, establish trust, coordinate recovery, and make accountable decisions. That is where faster workflows become better claims outcomes.

A question I put to CFOs and VPs of Claims: what does it cost your organization when an adjuster handles a claim without the clinical and procedural grounding to do it well?

Most cannot answer with a number. They can describe the symptoms. Reserves that drift. Claims that stay open longer than they should. Files that escalate to litigation for reasons nobody can quite explain after the fact. What they usually cannot do is connect that symptom to a dollar figure they would defend in front of a board.

That gap matters more this year than it did just a few years ago. And the reason is demographic, not theoretical. The insurance sector is projected to lose roughly 400,000 professionals to retirement between 2021 and 2026, a wave that falls heavily on senior claims staff. This issue served as one of the founding plank for the creation of WorkCompCollege.com. Every organization I work with is backfilling experienced adjusters with newer ones faster than usual. The industry is not just managing a training problem. It is managing a training problem on a compressed timeline, with less institutional knowledge left to lean on while it happens.

Separate the symptom from the finding

The symptom is a feeling: “our newer adjusters just need more time.” The objective finding is different. It shows up in claim duration, reopen rates, and litigation frequency, and it is measurable well before an adjuster’s third or fourth year on the job.

A published case study from a self-insured workers’ compensation fund tracked what happened when a third-party administrator restructured its adjuster caseloads and reinforced early-file discipline over a three-year period. As caseloads dropped and structured file review improved, the accident-year closure rate rose from 28% to 49%, a 75% improvement; and the fund realized more than $1,400 in savings per closed claim compared to the prior cost baseline. Scaled across 100 files, which is over $140,000 in avoided cost, without a single change to benefit levels or medical fee schedules (Kern, “The Effects of Adjuster Case Load Size on File Closure Rates, Cost per Closed Claim and Ultimate Claim Cost,” Workers’ Comp News, 1997).

That study is not about training curricula. It is about what happens when adjusters are given the structure, time, and grounding to do the job correctly from day one. Training is how you build that discipline into a newer adjuster’s file handling before caseload pressure erodes it.

Where the mechanism actually works

An undertrained adjuster does not cost money because of one dramatic error. The cost accumulates through three quieter mechanisms; each tied to a specific point in the claim lifecycle.

The first is timing. Research from the Workers Compensation Research Institute found that claims receiving resource-intensive medical care after the first twelve months are 35 times more likely to become high-cost claims, compared to 5.7 times more likely when that same care is delivered within the first four months. An adjuster who cannot recognize the clinical markers that call for early intervention will not act early. The claim drifts into the high-cost tier by default, not by necessity.

The second is duration. NCCI’s most recent annual review put average lost workdays at 80, up more than seven days over five years, with medical and indemnity severity each rising 6 percent in 2024. Duration control is a trained skill: knowing when a claim should be closing and recognizing when it is not.

The third is scope. An adjuster untrained in mechanism-based clinical reasoning tends to accept whatever diagnosis arrives on the desk, whether or not it is supported by the mechanism of injury or objective findings. Degenerative findings get treated as compensable. Unsupported diagnoses go unchallenged. Scope creeps outward, and every dollar of that creep sits on your loss run permanently.

A number your CFO can defend

You do not need a single peer-reviewed study proving “trained adjusters save $X.” No such study exists, and any consultant who hands you one should be questioned. What you can build, defensibly, is a chain of components your own data will support.

Start with your average cost per closed claim at a given closure benchmark, the point in the claim’s life where roughly half your open claims are closed. Compare that figure for claims handled by adjusters with under two years of experience against claims handled by your most tenured staff. The gap between those two numbers, multiplied by your annual volume of new lost-time claims, is your exposure. It will not be a footnote. In organizations I have worked with, it is usually the single largest correctable line item in the claims budget that nobody has calculated.

What does this mean for your training calendar?

If the retirement cliff is filling your claims floor with newer adjusters faster than your prior training cadence assumed, your training calendar needs to move at the same speed. Waiting for a new adjuster’s second or third year to close the competency gap is waiting through the exact window where the highest-cost claims are being set in motion.

The fix is not more hours of training. It is training that targets the three mechanisms above: clinical timing recognition, duration benchmarks, and mechanism-based scope discipline, delivered early enough in an adjuster’s tenure to change file handling before habits set.

If you want to see how organizations are building that calendar around measurable claims outcomes rather than attendance sheets, WorkCompCollege.com has resources built specifically for claims leaders working through this exact math.

Sources

• Bureau of Labor Statistics retirement projections, cited via The James Allen Companies, “2026 Insurance Hiring Forecast” (2025): https://jamesallenco.com/2026-insurance-hiring-forecast/
• Gary W. Kern, ARM, “The Effects of Adjuster Case Load Size on File Closure Rates, Cost per Closed Claim and Ultimate Claim Cost,” Workers’ Comp News, Vol. 2, Issue 4, Sept/Oct 1997, republished by RiskSavers, LLC: http://risksavers.com/claims-handling/adjuster-case-load-management-a-new-approach/
• Workers Compensation Research Institute, “Key Factors Associated with High-Cost Claims”: https://www.wcrinet.org/news/news_info/wcri-study-identifies-key-factors-associated-with-high-cost-claims-in-workers-compensation
• NCCI, “2025 in Sight, 2024 in Review”: https://www.ncci.com/Articles/Pages/Insights-2025-in-Sight-2024-in-Review.aspx

A new healthcare workforce study reports that 70% of Gen Z healthcare workers expect to look for a new role (inside or outside their current organization) within the next year. Only 44% of Gen Z feel “very loyal” to their current employer. Those numbers seem to confirm Gen Z stereotypes:

• They aren’t loyal
• They’ll leave a job at the first opportunity
• They expect promotions too quickly
• They don’t want to “pay their dues”

If you’re an employer, that’s enough to make you question investing heavily in developing someone who may already have one foot out the door.

But keep reading.

The same research showed that 95% of Gen Z respondents said long-term job security is important. In addition, 65% said they expect to remain with one employer for at least five years.

Huh?

They expect to look for a new role. But they also want stability and expect to stay with one employer for years. The two findings actually don’t contradict each other. Together, they suggest how the next generation sees work, learning and loyalty.

Maybe they don’t want to leave. Maybe they want to grow.

The study, 2026 Healthcare Workforce Barometer, was conducted by The Harris Poll on behalf of Strategic Education, Inc. and Workforce Edge. It surveyed 1,514 full-time, patient-facing healthcare workers and 304 healthcare employers.

Important disclaimer: This is research within the healthcare industry, not workers’ compensation. Nobody should assume their findings automatically transfer to every industry or every Gen Z employee. But I would be equally cautious about ignoring what the data is telling us. Consider it a hypothesis worth testing in our own industry and across all generations.

Among Gen Z respondents, a strong majority felt professional development mattered: 89% said clear opportunities for advancement matter, 71% valued the speed of career progression, and 86% believed education or learning new skills would help them advance. They’re not afraid of work, but they do have clear expectations for progress in their careers.

To paraphrase, they’re asking: If I give you the next five years of my career, who can I become while I’m here?

That’s a fair question. Employers need an answer.

The following important statistics come from the same report but are not specific to Gen Z employees:

• 26% “have a great deal of trust that their employer will support their long-term career growth”
• 23% “trust their employer a great deal to be a partner in helping them advance their career”

Meanwhile, for employers:

• 47% point to “a lack of opportunities for career advancement, professional development, or education opportunities as the main reasons why employees leave”

These are the report’s exact words, and they should make every employer uncomfortable. Employers have a credibility problem with their own teams: they know development matters, but their employees aren’t convinced they’ll provide it. Eighty percent of healthcare employees say advancement matters, but only 26% trust their employer to support it. That 54-point gap is worth paying attention to.

Jill Anelli, Tanner Health’s senior vice president and chief human resources officer, told HealthLeaders, “People stay when they know they have a future in that organization.”

Retention isn’t simply about convincing someone not to quit. It is giving them a reason to stay.

A 24-year-old entering our industry today doesn’t just want to learn how to do the job. They want to know where it can lead and how far they can go.

For instance, someone may enter workers’ compensation as a trainee claims adjuster, but what’s next?

• Senior adjuster?
• Catastrophic claims specialist?
• Supervisor?
• Risk manager?
• Nurse case manager with the right credentials?
• Operations leader?
• Compliance specialist?
• Executive?

One of my favorite cartoons that I’ve used often in presentations on this subject asks two questions:

What if I train them and they leave? Developing someone who leaves can feel like an investment made for somebody else’s benefit.

What if you don’t train them and they stay? You now have an under-equipped employee on the team, and you’re the reason.

The survey found that 75% of healthcare employees are interested in continuing their education, and 81% would be interested in an employer-sponsored program. Yet only 48% of healthcare employers have a comprehensive workforce education strategy.

Talk about a disconnect.

Taking all of this into account, imagine interviewing a talented 25-year-old and being able to explain not merely the job you’re offering, but the education, certifications, mentoring and career pathways that can follow it. Now you’re not just offering employment, but a future. As one of the report’s section headers clearly states, “Purpose gets people into healthcare. Growth keeps them invested.”

A certificate sitting on someone’s wall is nice. Being better equipped to have a difficult conversation with an injured worker matters more. Understanding medical issues well enough to ask better questions matters more. Learning leadership skills that prepare someone to mentor the next generation matters more.

Education becomes professional development when employees can connect what they’re learning to what they can do, and what they can do to who they can become. Not education for education’s sake, but education that changes behavior, develops people, and creates possibilities.

Here’s the takeaway for two potential readers of this blog:

Employers: Resist interpreting Gen Z’s appetite for advancement as impatience. Instead, ask yourself whether you have shown them a future worth staying for.

• Have you identified the skills they’ll need to reach their potential?
• Are you providing education, coaching and mentorship to help them develop those skills?
• Do your youngest employees know what opportunities could exist two, five or ten years from now?

This week: pick one entry-level role, map its next two steps, and share the map with the person who holds it.

Gen Z professionals: If your employer invests in your development, invest in it too. Be curious, find mentors, ask questions. That approach has defined my career since 1980. Professional development isn’t something an employer does to you. It’s something you do together.

Whichever reader you are, here’s the good news: 86% of Gen Z healthcare workers believe education and new skills will help them advance, and 80% of all healthcare workers say clear opportunities for advancement matter to them.

They believe they can advance. They want to learn. They want to develop. They want to see what’s next.

The data is clear about what Gen Z wants, and just as clear about what many employers haven’t built. Every year that we wait, the people we most need to keep are deciding whether we mean it.

Instead of hoping they’ll stay, show them what their next five years look like. If you want help building the education that connects one step to the next, start a conversation about custom training. Gen Z doesn’t need convincing that growth matters. We do.

For carriers, the question is rarely whether training has value. The question is whether a particular learning investment can improve a business measure that matters: attorney involvement, indemnity duration, return-to-work performance, claim leakage, quality assurance findings, or employee retention. That requires a disciplined model. It also requires training that addresses the technical and human realities of workers’ compensation work.

What Makes a Carrier Training ROI Example Credible?

A credible ROI case starts with a defined operational problem, not a course catalog. If a carrier is experiencing avoidable litigation, for example, the training intervention should identify the behaviors contributing to that result. Those may include delayed contact, inconsistent expectation-setting, weak documentation, poor communication with treating providers, or uncertainty around jurisdiction-specific requirements.

The financial calculation should then isolate a practical measure of improvement. A simple approach is:

Training ROI = (measurable financial benefit – total training cost) / total training cost × 100

The total training cost includes enrollment or program development, learner time, management time, and implementation support. The benefit should be tied to an agreed baseline and measured over a meaningful period. For complex claims outcomes, six to 12 months may be more informative than a 30-day post-training snapshot.

Attribution deserves caution. Training is rarely the only change occurring in an operation. Claim volume, staffing levels, network performance, medical inflation, automation, and market conditions can influence results. The most responsible approach is to compare trained and untrained cohorts where possible, review performance by claim maturity, and pair financial indicators with behavioral evidence such as file audits and communication-quality reviews.

Example 1: Reducing Attorney Involvement Through Early Communication

Consider a carrier with a growing percentage of represented indemnity claims. File reviews show a familiar pattern: injured workers receive inconsistent information about benefits, next steps, and return-to-work expectations. Adjusters understand the statutory process, but they have not been consistently trained to communicate it in a clear, empathetic, and timely manner.

The carrier enrolls 80 frontline adjusters and supervisors in a role-specific program focused on first contact, expectation-setting, difficult conversations, documentation, and escalation management. The fully loaded cost is $1,200 per learner, or $96,000 total.

Before training, the operation averages 240 newly represented claims each year in the targeted population. In the year after implementation, after accounting for claim volume and jurisdiction mix, the carrier identifies 24 fewer newly represented claims than its expected baseline. If the organization uses a conservative estimated incremental expense of $7,500 per represented claim for defense activity, delay-related expense, and increased handling complexity, the modeled financial benefit is $180,000.

The calculation is straightforward:

($180,000 – $96,000) / $96,000 × 100 = 87.5% ROI

The point is not that every communication program will produce an 87.5% return. Representation decisions are influenced by many factors, including injury severity and local legal environments. The example demonstrates why communication training belongs in a carrier’s cost-management strategy. When professionals can explain the process with clarity, respect, and consistency, fewer routine concerns become adversarial disputes.

Example 2: Shortening Disability Duration Through Better Return-to-Work Conversations

Return to work is not simply an employer issue or a medical issue. It is a claims practice issue. Adjusters, nurse case managers, and supervisors influence whether stakeholders receive consistent information about restrictions, transitional work, functional recovery, and the value of timely workplace connection.

Assume a carrier identifies a segment of lost-time claims with extended disability duration despite medically appropriate modified-duty opportunities. It trains 50 claims and clinical professionals on coordinated recovery planning, provider communication, motivational interviewing principles, and respectful conversations with injured workers and employers.

The carrier spends $75,000 on the program, including learner time. In the following evaluation period, the trained group closes 30 disability claims an average of five workdays sooner than the comparable baseline group. If the carrier estimates the combined average indemnity and expense impact at $320 per day, the direct modeled benefit is $48,000.

On its own, that would not justify the investment. But the analysis should not stop there. The carrier also identifies 18 additional claims that move into transitional work sooner, reducing an average of 12 paid lost-time days per claim. That adds $69,120 in modeled benefit. The total is $117,120, producing a 56.2% return.

This is also a good example of why ROI depends on implementation. Training alone cannot create modified-duty jobs. Employers must have a viable return-to-work process, and medical partners must understand available work. Education delivers the greatest value when the carrier aligns claims practices, employer outreach, and clinical coordination around the same recovery objective.

Example 3: Reducing Claim Leakage With Technical and Human-Centered File Handling

Leakage often hides in ordinary moments: an incorrect reserve rationale, an unaddressed treatment delay, incomplete wage information, a missed subrogation question, or an unclear claimant conversation that produces avoidable repeat contacts. Traditional file reviews can identify these issues after they occur. Structured education can reduce their frequency by building stronger judgment before the decision point.

In this example, a carrier’s quality assurance team finds recurring deficiencies among newer adjusters handling moderate-complexity claims. The organization creates a 12-week onboarding and development pathway covering jurisdictional foundations, compensability analysis, documentation, medical management, empathetic claimant communication, and supervisor calibration.

The carrier trains 40 professionals at a fully loaded cost of $2,000 each, totaling $80,000. Six months later, calibrated audit results show a reduction in preventable financial handling errors. The carrier estimates that 60 claims avoided an average of $1,800 in leakage through more timely actions, accurate decisions, and better escalation. The modeled benefit is $108,000, for a 35% ROI.

The financial return is meaningful, but the operating benefit may be even more durable. Better onboarding reduces variation between handlers, gives supervisors a common coaching framework, and helps newer professionals develop confidence without relying on inconsistent informal instruction. That consistency is especially valuable in an industry facing retirements, staffing pressure, and growing regulatory complexity.

Building an ROI Model Leaders Can Defend

Carrier leaders should resist the temptation to promise a universal savings figure before they understand the baseline. A defensible business case identifies the population, the performance gap, the skills required, and the measures that will demonstrate change.

Start by selecting one primary outcome and one or two supporting indicators. For litigation reduction, the primary measure might be new attorney representation rates, while supporting indicators could include time to initial contact and claimant satisfaction feedback. For return-to-work training, the primary measure may be lost-time duration, supported by modified-duty offers and provider outreach timeliness.

Then establish the baseline before training begins. Review at least several months of comparable data and segment it by jurisdiction, injury type, claim age, and severity when possible. A single overall average can conceal the exact population where training is needed most.

Finally, measure application, not just attendance. Certification completion, assessment scores, manager observation, file audit results, and operational outcomes should form a connected evidence trail. This is where a formal education system has an advantage over one-time presentations. It can define competencies, assess understanding, reinforce learning, and give leaders a repeatable method for measuring whether practice has changed.

Why Whole-Person Recovery Changes the Equation

The most valuable training does not force a choice between technical excellence and empathy. In workers’ compensation, empathy is a technical competency because it affects trust, information quality, engagement in treatment, and willingness to participate in return-to-work planning.

WorkCompCollege’s Whole Person Recovery Method™ reflects this operational reality. A claims professional who can accurately explain benefits, hear concerns without becoming defensive, coordinate stakeholders, and set realistic expectations is better positioned to prevent friction that drives cost and delay.

That does not mean every claim will resolve quickly or without dispute. Serious injuries, difficult medical conditions, employment conflict, and legal complexity demand careful expertise. It does mean carriers can create measurable advantage by training their teams to handle the controllable moments well. The next ROI opportunity may be sitting in the first conversation an injured worker has after the claim is reported.

I felt the calling to return the blog to my horses.  So, for this week, nostalgia wins!

My horse trainer and I have spent countless hours since Lattie passed in April pounding the pavement in search of Harry Trotter’s next best friend. I use “best friend” a little tongue-in-cheek because Lattie was never particularly fond of Harry. Harry, for his part, was perfectly willing to be friends. Their relationship was, at best, a one-sided friendship that Lattie reluctantly tolerated.

What I’m learning through the shopping adventure is that finding the right horse is a long, arduous process. I could have another horse in our pasture tomorrow. It wouldn’t necessarily take a lot of effort, and it certainly wouldn’t have to cost an arm and a leg. What keeps me from taking the easy route is knowing that you get what you put into it. And when you’re talking about a 1,000-pound animal with a mind of its own, taking shortcuts can be extremely dangerous for everyone involved.

You might be asking yourself what this has to do with workers’ compensation or leadership. My response is: everything.

The more time I spend looking for Harry’s next pasture mate, the more I realize how remarkably similar this process is to finding the right employee.

Just as with a job description, I had to define what I’m looking for. What characteristics does the horse need to have? What physical capacity does he need? What experience is important? And what are the things that are non-negotiable?

Then the real search begins. Ads are posted, responses come in, and videos are scrutinized for everything from movement and training to behavior and soundness. If a prospect makes it through that first round, we hit the road to meet him in person. We watch him under saddle, looking for signs of lameness, how he moves, whether he is soft and responsive, how he handles himself and, yes, whether he has good manners. If all of that looks promising and we feel safe, we may climb aboard ourselves. And when we think we may have found the right match, there is still one more box to check: the pre-purchase veterinary exam. It is our version of a background check before making the final commitment.

Think about how much goes into that decision. We are considering the horse’s physical ability, experience, temperament, history and behavior. But there is another consideration that may be just as important: how will this horse fit into the herd that is already there?

It isn’t enough for me to like the horse. A chosen horse has to be right for me AND Harry. A horse can be beautiful, well-trained, experienced and physically sound and still not be the right horse for us.

That realization made me think about how we approach people in the workplace.

With a horse, we readily recognize the associated physical danger. If we choose poorly, someone could literally get hurt. The risk is obvious, so we tend to take the time to evaluate it carefully. We don’t skip the vet check because we’re excited about a particular horse. We don’t overlook concerning behavior because he’s pretty or because we’ve already spent a lot of time looking. We don’t say, “Well, he’s available, and we need another horse, so let’s just make it work.”

Yet bringing the wrong person onto a team can be just as consequential, even if the impact isn’t as immediate or visible. An under-qualified employee or someone who is simply a poor fit can contribute to turnover, conflict, poor communication, low morale and lost productivity. Managers may spend enormous amounts of time compensating for the situation, while other employees absorb the additional workload and the effects on trust and culture. Eventually, good employees may decide the best solution is to leave.

A horse may hurt you in an instant. A poor fit on a team can take months or even years for the full impact to become visible.

And that brings me back to the herd.

When we’re evaluating a horse, we don’t just ask, “Do I like this horse?” We also ask, “How will this horse fit with the horses already in my pasture?” Every herd has its own personalities, boundaries and relationships. Adding a new horse changes that dynamic, even when the newcomer is perfectly capable and well-trained.

Teams are no different.

We spend a lot of time talking about workplace culture, but how much attention do we give that culture when there is a vacant desk and work that needs to be done? The pressure to fill the position can be tremendous. Someone looks good on paper, has the right experience and can start Monday. Suddenly, the empty chair is no longer empty.

But filling the chair and finding the right person aren’t necessarily the same thing.

I’m not suggesting we spend six months interviewing every candidate for an open position. I’m suggesting that we pause long enough to consider the whole picture. Are we simply filling a vacancy, or are we choosing someone who will strengthen the team that is already there?

After all, I’m willing to spend considerable time making sure the next horse in our pasture is safe, sound, level-headed and a good fit for Harry. Maybe we should bring some of that same thoughtfulness to the people we invite into our teams.

My career has been blessed with some wonderful mentors who shared lessons I’m grateful to pay forward. One of the unexpected gifts of my horsemanship journey has been discovering many of those same leadership lessons from a completely different, yet remarkably applicable, perspective.

Lattie taught me when to hold on and when to let go.

Harry Trotter may be teaching me patience, composure, and perseverance.

For claims professionals, employers, and clinical partners, the operational standard is clear: manage the technical requirements precisely while managing the person respectfully. Strong outcomes do not come from empathy alone or technical knowledge alone. They come from applying both consistently, from first notice of loss through resolution.

Why Workers Compensation Claims Management Needs a Broader View

Workers’ compensation is a regulated benefit system, but injured workers do not experience it as a system. They experience it through phone calls, medical appointments, wage replacement questions, work restrictions, and the quality of the explanations they receive. When communication is delayed, vague, or inconsistent, uncertainty fills the gap. Uncertainty often becomes distrust, and distrust can escalate a routine claim into a prolonged and contested one.

This is why transactional claim handling creates avoidable exposure. A file may be technically compliant while the injured worker lacks a clear understanding of the recovery plan. A return-to-work offer may be available while the supervisor has not been prepared to support restrictions. A nurse case manager may coordinate treatment effectively, yet the employee may still feel unheard or pressured.

Whole-person recovery management recognizes that medical, vocational, psychosocial, and workplace factors interact. Claims teams that account for those factors are better positioned to identify barriers early and make decisions that support both recovery and financial performance.

Workers Compensation Claims Guide: The First 48 Hours

The first report of injury is more than an intake event. It establishes the quality of information the organization will use to make decisions and signals to the injured employee whether they will be treated with respect.

A prompt, well-structured report should capture the facts of the incident, the initial injury description, witnesses, job duties, and any immediate medical needs. It should also document the employee’s preferred contact information, language needs, concerns about missed work, and understanding of what will happen next. These details are not administrative extras. They shape the communication plan and reduce preventable friction.

The initial outreach from the employer or claims professional should be timely, calm, and specific. Avoid scripted assurances that cannot be supported. Instead, explain the immediate process: how medical care is arranged, who will contact the employee, what information may be needed, and when they can expect an update. Clear expectation-setting is one of the most practical litigation-prevention tools available to a claims organization.

Early contact also creates an opportunity to identify potentially complex claims. Serious injuries, delayed reporting, conflicting incident accounts, preexisting conditions, language barriers, and visible distress do not predetermine poor outcomes. They do signal a need for closer coordination, more frequent communication, or specialized support.

Build a Claim Plan, Not Just a File

A claim plan connects the legal, medical, employment, and human dimensions of the case. It should be updated as facts change rather than copied forward as a static diary entry.

Establish the Critical Facts

Claims professionals must confirm jurisdiction, coverage, compensability issues, employment status, average weekly wage, injury mechanism, and applicable reporting requirements. State rules vary materially, particularly around notice, benefit calculations, provider networks, utilization review, and dispute procedures. Teams should never rely on a generic workflow when state-specific compliance controls are required.

At the same time, fact gathering should not become an adversarial exercise. The objective is to obtain reliable information, not to create an avoidable sense that the employee’s account is presumed suspect. Professional curiosity, transparent questions, and accurate documentation protect claim integrity without undermining trust.

Coordinate Medical Care Around Function

Medical management should focus on functional recovery, not merely appointment completion. The relevant questions include whether the diagnosis is clear, whether treatment aligns with evidence-based care, whether restrictions are understood, and whether the employee has barriers to following the plan.

A missed appointment may indicate noncompliance, but it may also reflect transportation limitations, caregiving responsibilities, language access, fear, or confusion about authorization. The right response depends on the circumstances. Escalating immediately to a compliance concern can be appropriate in some files; solving the practical barrier first may be the better intervention in others.

Nurse case managers, adjusters, providers, and employer contacts should work from a shared understanding of recovery goals. Conflicting messages about restrictions, treatment, or work capacity can stall progress and erode confidence quickly.

Start Return-to-Work Planning Early

Return to work is most effective when it is framed as a recovery tool rather than a cost-containment maneuver. Appropriate transitional work can restore routine, income stability, workplace connection, and confidence. It can also reduce indemnity duration and support a more predictable claim outcome.

The employer’s role is central. A job offer must be meaningful, within documented restrictions, and communicated in a way that does not feel punitive. Supervisors need to understand the restrictions, the duration of the assignment, and how to address questions without making medical judgments. A poorly designed modified-duty offer can create conflict; a credible one can preserve the employment relationship.

Communication Is a Measurable Claims Control

Claims communication is often discussed as a soft skill. That understates its business impact. Poor communication drives repeated calls, delayed documentation, complaints, disengagement, and attorney representation. Effective communication helps claimants understand decisions, act on next steps, and remain engaged in recovery.

The most effective teams communicate with consistency. They explain what is known, what remains under review, who owns the next action, and when the employee should expect a response. They document material conversations without reducing the person to a note in the system.

Empathy does not mean promising an outcome or abandoning appropriate claim investigation. It means acknowledging the disruption of an injury, listening for concerns, and explaining decisions with clarity and respect. A denial or benefit change may still be difficult for an employee to hear. A clear explanation of the rationale, process, and available options can reduce confusion even when the decision itself is unwelcome.

Manage Escalation Before It Becomes Litigation

Not every disputed claim can or should be resolved informally. Compensability disputes, medical causation questions, permanent impairment issues, and complex statutory requirements may require formal legal involvement. The goal is not to eliminate legitimate disputes. The goal is to prevent avoidable escalation caused by silence, delay, mixed messages, or an absence of a credible recovery plan.

Warning signs include a sudden decline in responsiveness, repeated confusion about benefits, dissatisfaction with care, a missed return-to-work opportunity, or an employee who says no one has explained the process. These signals warrant purposeful outreach and internal coordination. They should not be dismissed as routine claimant behavior.

For complex or high-exposure claims, establish a multidisciplinary cadence. Claims, clinical, legal, risk, and employer stakeholders should align on the barriers, upcoming decisions, communication strategy, and desired functional outcomes. Meetings that only recite file activity add little value. Meetings that identify decision points and assign ownership can change the trajectory of a claim.

Measure What the Claim Experience Reveals

Traditional performance measures such as claim duration, indemnity payments, medical spend, closure rates, and litigation rates remain essential. But they are lagging indicators. Organizations also need measures that reveal whether their operating model is creating the conditions for better outcomes.

Consider tracking timeliness of first contact, time to medical authorization, frequency of documented status updates, return-to-work offer acceptance, and reasons for missed appointments or delayed recovery. Review complaint themes and attorney involvement patterns by office, adjuster, injury type, and employer location. The purpose is not to monitor activity for its own sake. It is to identify training gaps, workflow failures, and communication practices that affect cost and recovery.

This is where role-specific education becomes operationally valuable. Adjusters need technical decision-making and claimant communication skills. Supervisors need preparation for injury reporting and modified duty. Nurse case managers need coordinated recovery strategies. Leaders need a governance model that connects training to measurable claims results. WorkCompCollege’s Whole Person Recovery Method™ reflects this standard by treating human-centered practice as a core professional capability, not an optional add-on.

Make Consistency the Standard

A high-performing claims operation does not depend on a few experienced professionals who instinctively know how to handle difficult conversations. It builds repeatable expectations into onboarding, coaching, quality assurance, and leadership review. The organization defines what timely contact looks like, how benefits are explained, how recovery barriers are documented, and when a file requires escalation.

The practical test is simple: can an injured worker, manager, adjuster, and provider describe the next step in the recovery plan with similar clarity? When the answer is yes, the claim is more likely to move with purpose. When the answer is no, more technical activity alone may not solve the problem.

Better claim outcomes are built in ordinary moments: a clear first call, a prompt authorization, a supervisor who understands restrictions, and a professional who listens before deciding what the file needs. Those moments are where compliance, cost control, and whole-person recovery become the same discipline.

Recently, I found myself standing in a hometown crowd watching my dear friend Wes Dearth do what he’s spent a lifetime pursuing. Wes, better known professionally as John Wesley, is a guitarist, songwriter, and one of rock’s most respected touring musicians. For the past several years, he has served as lead guitarist for Vertical Horizon, the popular 90s band known for hits such as Everything You Want, You’re a God, and Best I Ever Had.

Over the course of his career, Wes has released several solo albums, toured internationally with Porcupine Tree, opened hundreds of shows for Marillion, and shared the stage with artists including Sister Hazel. Yet as long as I’ve known him, he’s remained remarkably humble about his success. I’ll admit I’ve always been a bit of a fan girl, getting excited whenever he tells a story about a performer I’ve followed for years. Still, what struck me that evening wasn’t his résumé or the impressive career that led him there. It was the joy. Seeing him glance toward family and friends in the crowd, I saw someone fully present in a moment he had spent years working toward.

It got me thinking about pursuing our dreams, refusing to give up on them, and even more fundamentally, what are our dreams in the first place?

As a professional guitarist, it might be easy to assume that touring with a successful band is the pinnacle of a career. Yet in speaking with Wes over the years, I’m certain there is much more to it than that. And I’ve learned that touring is not nearly as glamorous as we might think!  Success is rarely one destination. More often, it’s a collection of meaningful experiences along the way.

But what about the rest of us? Those of us who aren’t standing under stage lights or performing in front of thousands of people. What are our dreams?

Is it happiness and health? Raising children who become kind, capable adults? Building a successful business? Creating financial security? Contributing to our communities? Leaving things a little better than we found them?

Deep stuff.

Do we have to know exactly what our dreams are? Do they need to be lofty or life changing?

Can we pivot?

According to Angela Duckworth in her book, Grit, we absolutely should. In fact, she argues that perseverance is not about rigidly holding onto one specific goal forever. It’s about remaining committed to a larger purpose while being flexible about the path we take to get there. Sometimes the dream evolves because we evolve.

When I think about my own life, I realize that I never grew up dreaming of becoming an entrepreneur. Starting a business was never on my vision board. In fact, if you had asked me years ago what I wanted to be, “CEO” would not have made the list.

Yet somehow, that’s exactly where the journey led.

What I did dream about, though I may not have had the words for it at the time, was making a difference. I wanted meaningful work. I wanted to build something worthwhile. I wanted to surround myself with people who could grow, thrive, and become more than they thought possible.

Over the past twenty-plus years of building ReEmployAbility, I’ve discovered that entrepreneurship was not the dream itself. It was the vehicle that allowed me to pursue a larger vision.

A vision for myself. A vision for the people who choose to spend a significant portion of their lives working alongside me. A vision for an industry that serves people during some of the most vulnerable moments of their lives.

Workers’ compensation is often viewed as a business process, a claim, a transaction, or a cost. But behind every claim number is a person. Someone whose life was unexpectedly interrupted. Someone worried about their health, their family, their livelihood, and what comes next. Our industry’s responsibility extends far beyond managing claims. We have the opportunity to help people regain confidence, purpose, and a pathway forward.

That vision is what gets me excited.

Not because we’ve arrived, but because there is still so much opportunity to improve the experience of injured workers. To challenge conventional thinking. To create workplaces where employees feel valued and empowered. To leave our corner of the world better than we found it.

Looking back, I can see that my dream wasn’t a title, a company, or even a career. It was impact. The business simply became the platform through which that impact could happen.

And perhaps that’s true for many of us. Sometimes we spend so much time looking for a specific dream that we miss the larger purpose unfolding right in front of us. The destination may surprise us, but the values guiding us there often remain remarkably consistent.

This thought led me back to a book I was given years ago, Mother Teresa’s Prescription, where she talks about doing one small thing to make a difference.

One small thing.

Not changing the world overnight.

Not becoming famous.

Not accomplishing some grand achievement that earns applause.

Just one small thing.

I love that concept because it takes the pressure off. Sometimes we look at our dreams and think they have to be monumental. We think we need a five-year plan, a vision board, and a perfectly mapped-out strategy. Yet some of the most meaningful accomplishments in our lives begin with a conversation, a decision, a risk, or a simple act of kindness.

Perhaps our dreams are not always destinations. Perhaps they are directions.

A dream might start as becoming a musician and evolve into inspiring others through music. It might start as building a career and evolve into mentoring future leaders. It might start as wanting success and end up being about significance.

Looking back on my own life, many of the things that have brought me the greatest fulfillment were never part of a master plan. They emerged from opportunities I couldn’t have predicted and lessons I never would have chosen. Some dreams came true exactly as imagined. Others transformed into something entirely different, and better.

What I’ve learned is that dreams don’t have expiration dates. They don’t disappear because we reach a certain age, change careers, experience setbacks, or discover new passions. They simply adapt along with us.

Maybe the question isn’t, “Am I following my dream?”

Maybe the better question is, “Am I moving toward what matters most to me?”

Am I growing?

Am I contributing?

Am I becoming the person I want to be?

When I stood in that crowd and watched Wes on stage that evening, I wasn’t inspired solely by his success because I wasn’t witnessing a single successful moment. I was witnessing thousands of ordinary moments that came before it. I was inspired by the evidence of that long journey. Years of practice. Faith. Sacrifice. Persistence. Countless small decisions that led to that stage.

The same is true for each of us. Most dreams aren’t achieved in dramatic leaps. They’re built in ordinary days through consistent effort and small acts of courage.

Soif you’re not entirely sure what your dream is today, that’s okay.

If your dream has changed, that’s okay too.

And if you’re still figuring it out, perhaps start with Mother Teresa’s advice. Do one small thing. Take one step. Help one person. Learn one new skill. Say yes to one opportunity.

Those small things have a way of leading us exactly where we’re meant to go.

And who knows? One day you may look back and realize that what seemed like a series of small steps was actually your dream unfolding all along.

For carriers, TPAs, self-insured employers, and provider partners, the current environment is raising the standard for claims performance. Technical proficiency remains essential. Yet technical proficiency without empathy, expectation-setting, and disciplined coordination can leave avoidable cost and recovery risk on the file.

Workers Compensation Trends Are Changing the Claims Operating Model

The most consequential shifts in workers’ compensation are interconnected. Artificial intelligence is changing how work is prioritized. Workforce demographics are influencing injury patterns and recovery needs. Medical and behavioral health complexity are extending disability in cases that might once have resolved quickly. Regulatory responsibilities continue to demand precision.

The common thread is that claims organizations can no longer treat each task as an isolated transaction. A delayed call, an unclear treatment plan, or a poorly framed return-to-work conversation can affect attorney involvement, duration, indemnity exposure, and the injured worker’s confidence in the system.

AI is moving from experimentation to workflow discipline

AI is becoming a practical part of claims operations, particularly in document intake, file summarization, triage, correspondence support, predictive analysis, and quality assurance. Used well, these applications reduce administrative friction and help experienced professionals focus on decisions that require judgment.

The trade-off is clear. Faster information processing does not automatically create better claim outcomes. An AI-generated summary may identify medical milestones, but it cannot independently establish trust with an injured worker who believes their concerns have been dismissed. It may flag litigation risk, but it cannot replace an adjuster’s skilled conversation about what will happen next.

Organizations need governance that addresses accuracy, privacy, bias, documentation standards, and human accountability. They also need training that teaches employees when to rely on AI-enabled insights, when to question them, and how to preserve the human judgment that workers’ compensation demands. The strongest AI strategy is not automation for its own sake. It is a clearer, more consistent claims process supported by capable professionals.

Workforce change is reshaping recovery planning

An aging workforce, physically demanding job roles, labor shortages, and increased reliance on contingent or less experienced workers are all influencing claims. Older workers may have more comorbidities or longer recovery timelines, although age alone should never be used as a proxy for prognosis. Newer employees may be less familiar with safe work practices or may hesitate to report an injury promptly.

At the same time, employers face real operational pressure to restore productive capacity. That pressure can produce poorly designed return-to-work efforts if leaders focus only on a release date rather than functional ability, transitional duties, transportation, scheduling, and the worker’s understanding of the plan.

Return to work is most effective when it is treated as a recovery intervention rather than a staffing transaction. A meaningful transitional assignment preserves connection to the workplace, reinforces progress, and gives the employee a credible path forward. A vague or unsuitable assignment can have the opposite effect.

Medical complexity now includes the whole person

Claims teams have long managed diagnosis, treatment plans, pharmacy issues, utilization review, and provider communication. What is increasingly visible is the impact of nonmedical barriers on medical recovery. Anxiety, financial stress, family caregiving obligations, language barriers, transportation limitations, and fear about job security can all affect engagement with treatment and return to work.

This does not mean every claim requires intensive intervention. Resource allocation should match claim complexity. A minor injury with stable recovery may need clear communication and efficient coordination. A claim involving delayed recovery, pain concerns, psychosocial stressors, or conflict with the employer may require earlier nurse case management, more frequent outreach, and a coordinated recovery plan.

Whole-person recovery is not a soft alternative to sound claims management. It is a disciplined method for identifying the factors that can extend disability or create conflict. When professionals understand those factors early, they are better positioned to direct the right resources before a claim becomes more costly.

Workers Compensation Trends Raise the Stakes for Communication

Communication is often described as a soft skill, but its operational impact is measurable. Injured workers who understand their benefits, treatment process, wage-replacement expectations, and return-to-work options are less likely to fill information gaps with fear or misinformation. Employers who receive timely, appropriate updates can plan modified work more effectively. Providers who understand job demands can make more functional recommendations.

Poor communication creates friction at every point in the claim. A worker who does not receive a callback may seek legal guidance before the adjuster has had a meaningful conversation. An employer that receives unclear restrictions may conclude that modified duty is impossible. A claims professional who avoids a difficult discussion about delays may lose the opportunity to reset expectations constructively.

The answer is not scripted empathy or excessive contact. It is purposeful communication. Professionals need to explain what is known, acknowledge what is still pending, state the next action, and follow through. They must communicate with respect without making promises outside their authority. That balance is trainable, auditable, and central to litigation prevention.

Compliance complexity remains a performance issue

Workers’ compensation compliance is not limited to meeting continuing education requirements or following jurisdiction-specific filing rules. It also includes consistent documentation, appropriate handling of medical information, Medicare Secondary Payer awareness, and adherence to state-specific processes that may materially affect claim outcomes.

As claims become more complex, gaps between technical knowledge and day-to-day execution become more expensive. A professional may know the rule but fail to recognize the moment when it applies. Enterprise leaders should therefore assess whether training is producing recall alone or demonstrable performance in real claims scenarios.

Role-specific education matters. Claims adjusters, nurse case managers, employer representatives, and compliance specialists do not face the same decisions, even when they touch the same claim. Standardized foundational knowledge should be paired with practice that reflects each role’s operational responsibilities.

What Claims Leaders Should Build Next

The most effective response to these trends is not another isolated course or annual compliance event. It is a workforce development system that connects technical competency with outcomes. That system should establish a common claims philosophy, define role-specific expectations, and give professionals repeated opportunities to apply knowledge to realistic situations.

For leadership teams, this begins with identifying the performance problems training must solve. Is attorney involvement rising in a particular claim segment? Are return-to-work discussions occurring too late? Do documentation audits reveal inconsistent rationale? Are new adjusters technically trained but unprepared for difficult conversations? The answers should shape the curriculum, coaching model, and quality metrics.

Education should also be measured beyond completions and attendance. Organizations can examine cycle time, contact timeliness, litigation rates, return-to-work duration, claim handoffs, audit results, and employee confidence. No single metric proves that training caused improvement, because claim outcomes are influenced by many variables. But a disciplined measurement approach can show whether new behaviors are taking hold and where reinforcement is needed.

WorkCompCollege’s Whole Person Recovery Method™ reflects the direction the industry must take: develop professionals who can manage the technical, human, and operational dimensions of a claim at the same time. That means building fluency in regulations and medical management while strengthening the communication and expectation-setting skills that influence worker trust and recovery engagement.

The organizations best prepared for what comes next will not merely process claims faster. They will equip their people to recognize the person behind the claim, make defensible decisions, coordinate recovery with purpose, and prevent small points of friction from becoming lasting sources of cost and conflict.

Every training budget review starts with the same question. What did we get for the money?

Most learning and development teams answer it with the wrong data. They report how just many adjusters attended, how they rated the session/training provided, and a completion percentage pulled from the learning management system. None of that tells the CFO whether the training changed anything that eventually shows up on a loss run.

This is not a criticism of the people running the training programs. It is a description of how corporate training measures have worked for the better part of seven decades, and why that habit is now colliding with tighter budgets.

The numbers on measurement are not encouraging. The Association for Talent Development’s 2026 State of the Industry report, based on 2025 data from 340 organizations, found that less than a quarter of respondents actually measure whether their training programs achieved the organizational goals for which they were built. A smaller share still measures return on investment.

Meanwhile, average direct learning spends per employee fell from roughly $1,254 in 2024 to $846 in 2025, a drop of about a third, even as the average employee logged more training hours than the year before, 16.7 hours versus 13.7 (Association for Talent Development, 2026 State of the Industry Report). Organizations are spending less and asking employees to sit through more of it, without much evidence of what any of it produces.

For a workers’ compensation claims organization, that gap is not just an L&D problem. It is a claims cost problem. If a training investment cannot be tied to claim duration, litigation rate, or reserve accuracy, the finance committee has no defensible reason to protect it the next time the budget gets cut.

Symptoms Versus Findings

The perception that training is overhead is a symptom. It shows up as skepticism at budget time and as the first line item cut when premium volume softens. The objective finding, when anyone bothers to look for it, is usually different. Training tied to measurable claim behavior tends to survive budget reviews. Training measured only by attendance does not, because nobody in the room can defend it with a number.

A Framework, Not a Slogan

Donald Kirkpatrick published his four-level model for training evaluation in 1959, and it remains the standard reference point in the field (Kirkpatrick Partners, “The Kirkpatrick Model”). It is worth restating, because most organizations use only the first two levels without realizing the third and fourth exist.

Level one is reaction. Did the adjusters find the session useful and well delivered? This is what a post-training survey captures, and it is the easiest data to collect, which is exactly why most organizations stop here.

Level two is learning. Did the adjuster actually absorb the material, measured with a pre- and post-test or a scored case exercise, not a show of hands?

Level three is behavior. Is the adjuster applying what was taught on an actual file three or six months later? This requires a supervisor, or a file audit, to observe and document a change in practice.

Here at WorkCompCollege.com, we have direct antidotal data demonstrating that the certifications obtained went directly to a change in professional behavior and resulted in significant improvement in claims outcomes.

Level four is results. Did the organization’s numbers move? Claim duration, litigation rate, reopen rate, medical cost trend, reserve accuracy.

Jack Phillips later added a fifth level, converting the level four results into a financial return: program benefit minus program cost, divided by program cost (Training Industry, “Phillips ROI Methodology”). The useful part of the Phillips method is not the formula. It is the requirement to isolate training’s effect from everything else moving at the same time, such as a shift in claim mix, adjuster tenure, or a state fee schedule change. Phillips’s answer is a control group where practical, or a documented trend comparison where it is not. Either way, the estimate has to be conservative and written down, not asserted.

What a Claims Scorecard Looks Like

Applying this to adjuster education does not require new software. It requires picking numbers the organization already tracks and connecting them to the training calendar before the training happens, not after someone asks for a budget justification.

1. Claim duration by adjuster cohort, trained versus untrained, or before versus after a specific course.
2. Litigation rate on claims handled by adjusters who completed a defined training module within the prior twelve months.
3. Reopen rate, which often reflects premature closure driven by thin documentation rather than genuine medical resolution.
4. Reserve accuracy, comparing initial reserve to final paid on a rolling basis.
5. Medical cost trends on comparable injury types, segmented by whether the handling adjuster completed relevant clinical education.

None of these requires a new system. Most claims organizations already have this data in their reporting stack. What is usually missing is the discipline to tag which adjusters received which training and when, so the numbers can be split and compared later.

The Measurement Gap Is the Opportunity

Because so few organizations measure past level one, a claims leader who builds even a basic level three or four scorecard has an advantage that has nothing to do with clinical sophistication.

It is better to do bookkeeping. When the budget conversation comes, that leader has a defensible answer instead of an attendance sheet.

This is not an argument for measuring everything. Specific training, particularly compliance refreshers, will always live at level one or two, and that is fine. The scorecard belongs to the training that is supposed to change claim outcomes, which describes most clinical and causation education.

WorkCompCollege.com builds its curriculum around the claims outcomes adjusters and supervisors are actually accountable for. If your organization wants help mapping a training calendar to a measurement framework like the one above, that conversation is worth having before the next budget cycle, not during it.

Sources: Association for Talent Development, 2026 State of the Industry Report (td.org). Kirkpatrick Partners, “The Kirkpatrick Model” (kirkpatrickpartners.com). Training Industry, “Phillips ROI Methodology” (trainingindustry.com).

For claims leaders, the practical question is not whether every disputed claim can be prevented. It cannot. Compensability questions, complex medical conditions, jurisdictional rules, and permanent impairment disputes will continue to require formal resolution in some cases. The operational opportunity is to identify which litigation drivers are preventable and build the capabilities that keep routine friction from becoming adversarial.

What Causes Workers Comp Litigation Most Often?

Workers’ compensation litigation usually begins where the injured worker perceives a gap between what they need and what the system is delivering. That perception may arise from a denied claim, but it can just as easily arise from silence, confusing explanations, inconsistent direction, or a return-to-work process that feels punitive rather than supportive.

Claims professionals should distinguish between legal exposure and relationship exposure. A claim can be legally defensible and still produce attorney involvement if the injured worker does not understand the decision, does not know what happens next, or believes no one is accountable for moving the claim forward. Conversely, a difficult claim may remain collaborative when communication is credible, respectful, and consistent.

Delayed Decisions and Unexplained Gaps

Time is one of the strongest predictors of frustration. Delays in reporting, investigation, authorization, benefit delivery, or scheduling can leave an injured worker without income certainty, treatment direction, or confidence in their employer. When no one explains the reason for the delay and provides a specific next step, an attorney can appear to be the only available advocate.

Some delays are unavoidable. A carrier may need medical records, a recorded statement, an independent medical examination, or additional facts about the mechanism of injury. The differentiator is not simply speed. It is active expectation-setting: explaining what information is needed, who is responsible, when a decision is expected, and how the worker can obtain an update.

Disputed Compensability, Causation, and Medical Necessity

Litigation is more likely when the parties disagree about whether an injury arose out of employment, whether work materially contributed to a condition, or whether proposed treatment is reasonable and necessary. Preexisting conditions, cumulative trauma allegations, delayed reporting, and conflicting medical opinions can make these disputes especially complex.

Technical accuracy matters here. Claims teams need a working command of jurisdiction-specific rules, documentation standards, medical management protocols, and benefit requirements. But technical accuracy alone is not enough. A denial or utilization review decision that is correct but delivered in opaque, impersonal language can still escalate conflict. Injured workers need a plain-language explanation of the decision and a realistic understanding of their options within the applicable process.

Poor Communication Across the Claim Ecosystem

Workers’ compensation is a multi-party system. The employer, supervisor, adjuster, nurse case manager, provider office, pharmacy, attorney, and injured worker may all hold different pieces of the recovery plan. When those parties communicate inconsistently, the worker experiences the system as disorganized, even if each individual participant believes they are doing their job.

A supervisor who tells a worker to stay home, an adjuster who expects modified duty, and a provider who has not received a job description create an avoidable contradiction. The issue is not merely service quality. It is claim strategy. Conflicting messages can undermine return-to-work, delay recovery, and give rise to allegations that the employer is not acting in good faith.

Communication competency should therefore be treated as a formal claims skill. Professionals need to know how to listen for concerns, explain decisions without overpromising, document meaningful contacts, and recognize when a worker has stopped trusting the process. Empathy is not a substitute for compliance or sound reserving. It is a performance discipline that improves the quality of information, cooperation, and decision-making.

Return-to-Work Failures Create Avoidable Conflict

Return-to-work is often discussed as a cost-control initiative. It is also a litigation-control initiative. Meaningful transitional work maintains connection to the workplace, supports functional recovery, and reduces the uncertainty that can drive prolonged disability. A vague or poorly managed program can have the opposite effect.

Problems emerge when modified duty is not actually available, restrictions are ignored, managers resent the accommodation, or the worker believes the assignment is designed to pressure them out. Employees may also receive little information about wage replacement, transportation, appointments, or how their restrictions will be reassessed. Under those conditions, an attorney becomes more likely to enter the claim as a source of clarity and protection.

Effective programs begin before an injury occurs. They define available transitional assignments, train supervisors, establish a process for obtaining functional restrictions, and make sure the employee hears a consistent recovery-focused message. The right assignment depends on medical restrictions, job demands, state requirements, and the worker’s functional capacity. It should never be reduced to a generic light-duty offer.

Administrative Errors and Compliance Breakdowns

Missed deadlines, incorrect wage calculations, late benefit payments, incomplete notices, poor documentation, and mishandled medical authorizations can transform an otherwise manageable claim into a dispute. These failures may create penalties or legal leverage, but their broader damage is relational: they signal to the injured worker that the system is unreliable.

For organizations managing claims across multiple jurisdictions, compliance risk is not static. State forms, deadlines, provider rules, reporting obligations, and dispute procedures vary. A centralized workflow without state-specific education can produce inconsistent execution at the frontline. That inconsistency becomes especially costly when turnover, high caseloads, or outsourced functions weaken institutional knowledge.

Training should connect compliance requirements to the worker experience. A timely notice is not only a filing obligation. It is often the worker’s first clear explanation of benefits and responsibilities. A complete claim note is not only an audit requirement. It preserves context so that the next professional does not force an injured worker to repeat a stressful story.

Claims Handling That Feels Transactional

A transactional claim process focuses narrowly on tasks: obtain the statement, issue the payment, schedule the appointment, close the file. Those tasks matter, but they do not capture the human factors that influence recovery. Pain, financial anxiety, fear of job loss, family responsibilities, language barriers, and uncertainty about medical care all affect how a worker responds to the claim.

Ignoring those factors does not make them disappear. It leaves the claims team with less information and the worker with fewer reasons to cooperate. Whole-person recovery management recognizes that clinical, occupational, psychosocial, and administrative issues interact. It asks professionals to manage the claim with disciplined empathy, not sentimentality.

That approach also requires boundaries. Claims professionals should not make medical promises, provide legal advice, or imply outcomes they cannot control. They should communicate clearly, follow through on commitments, escalate barriers promptly, and treat questions as indicators of what the process has failed to explain.

Reducing Litigation Requires More Than a Script

Organizations sometimes respond to rising attorney representation by issuing a new call script or adding a service metric. Those actions can help, but litigation reduction requires a broader operating model. Leaders should examine where claims first lose trust: first notice of loss, initial contact, benefit explanation, treatment access, supervisor engagement, modified duty, or dispute handling.

Useful performance measures extend beyond closure rates and indemnity spend. Consider attorney involvement by claim type and office, time to first meaningful contact, time to first payment, treatment authorization turnaround, return-to-work duration, complaint themes, and reopened claim patterns. The objective is not to discourage legitimate representation. It is to identify recurring operational failures before they become embedded in claim outcomes.

WorkCompCollege’s Whole Person Recovery Method™ reflects this principle: technical claims capability and human-centered practice should be developed together. A well-trained professional can interpret policy and statutes, coordinate appropriate care, set realistic expectations, and communicate with respect under pressure. That combination protects both recovery outcomes and organizational performance.

The most productive litigation strategy begins long before a petition is filed. Give injured workers timely information, credible explanations, appropriate care coordination, and a genuine path back to work. When the claim experience demonstrates competence and respect, fewer routine problems need to become legal battles.