Ivan's Trip

Ivan is 2 years old and has retinoblastoma - cancer of the eye.

He lives with his mom, Rosa, age 25, in Santa Maria, CA.

I don't know how she's paying for Ivan's treatment, but she can't afford transportation to/from the specialized treatment necessary, which is at UCLA Medical Center.

Ivan, Rosa, Dwights

Fortunately Angel Flights West coordinates transportation for people with serious medical issues but insufficient means to get to the treatment.

I volunteered for the flight - Ivan and Rosa were perfect passengers. They'd done this before.

Volunteerism takes many different shapes and forms.

I can't change Ivan's retinoblastoma. I can't ease Rosa's fears for Ivan's future. But I do what I can, and in this case I was able to fly Ivan and Rosa from Santa Maria to Santa Monica so they could make their chemotherapy appointment.

Look at Ivan in the picture - looks like a normal 2 year old to me! And he acted like one - full of spunk, energy, and that smile... he loves flying.

We can look at others in the same way.

Rosemary helps injured workers in Australia get their dignity back first by providing sustenance, then providing, essentially, occupational therapy by getting them to "work" at her volunteer center.

She does more for the injured worker population in Australia than anybody simply by showing that there's people who care, and providing a path to return to society.

Some find fault in Rosemary's actions. She's not militant enough. She's just supplying groceries. It's just a waste of time...

Wrong - Rosemary, at once an injured worker herself, understands the deep emotional damage that a work injury can have, and how hard it is to return to dignity, to find that new path in life.

When I got back to my home airport the line guys fueling Forty One Mike asked about my Dwight Johnsons.

Dwight, as you likely know, is a double amputee, the result of two separate industrial accidents 18 months apart, who decided to give people something to look at other than his prosthesis, and has made a business out of his shoes.

The line guys were delighted to get Dwight's contact information. Maybe Dwight will make another sale, maybe not. But for sure, there's a couple more people that have a little more education about the work injured, about a return to dignity and a new path in life.

There are countless other stories of people thrown a curve in life, others stepping in to assist (volunteers or professionals) and new lines in the map of life drawn, and followed.

Sometimes it is the system. No doubt there are times when the system lets people down and there is misdirection.

But more often it is the person.

The person can't always choose the system.

But the person does have a choice how to react within the system.

One last thing - if an injured worker needs transportation, there are volunteers who will provide it, and they're only a phone call away...

It's Not HR

For some reason business likes to use workers' compensation for its human resources issues - namely to terminate an undesired employee.

All too often, when I was a defense lawyer, I was asked to include termination language in settlement papers, or asked what the effect would be on a case if the employee was formally terminated as part of, after, or prior to resolution of the comp case.

In all situations my answer was simply that the work comp case has nothing to do with employee termination or discipline, that it is an HR issue, and that if the company wished to include some termination process included in the work comp case then they should "man up" and just execute the termination.

Because in my experience and training an undesired employee costs far more to maintain than the possible consequences of termination - even if "wrongful" - due to non-production, morale amongst co-employees, and a whole host of other "soft" costs.

Still, workers' compensation gets used inappropriately to rid a company of employees that management is too chicken to deal with otherwise.

A case out of Ohio points to just such boneheaded management use of work comp to cull employment ranks, resulting in case law that isn't necessary and just may make things worse for the rest of the business management world.

Alexis Jones was a claims examiner for the City of Cleveland Department of Law.

Shortly after arriving at work on May 5, 2009, Jones slipped on a piece of cheese that was on the floor. She fell to her knees, but was unhurt. According to her court filings, she didn't even tear her nylon stockings.

About two hours before the end of her workday, the law department's office manager came to see Jones and directed her to submit to a post-accident drug and alcohol test.

The city's written testing policy provides that the city may send an employee for drug and alcohol testing following any on-the-job "accident." The policy defines an accident as an incident where "there is bodily injury to the person requiring medical attention."

The policy further provides that an employee may be disqualified for compensation and benefits under the Ohio Workers’ Compensation Act if the employee refuses to test, or the result of the test is positive. It also states that employees who "test positive after an accident remain subject to disciplinary action, up to and including termination."

At the testing center, Jones indicated that she did not want to be examined and stated she was not injured. Jones was also advised that she could not leave the premises or call her husband, and she was stopped when she attempted to do so.

Jones eventually underwent the medical examination, which revealed no physical injury from her fall, and a breath test, which revealed no trace of alcohol.

She then was given a plastic cup to provide a urine sample, she claimed she was unable to do so because the cup had broken and fallen into the toilet when she tried to collect her urine.

Jones was then given 20 ounces of water and a second cup, but she was still unable to provide a urine sample.

By the time Jones got the second cup, it was already past the end of her normal workday. After informing the testing center staff that her attempts to urinate had been in vain, Jones insisted that she be allowed to leave.

A representative of the city informed her that leaving the testing center and failing to provide a urine sample would be considered a “refusal to test” that had disciplinary consequences, but Jones left anyway.

Jones later testified that she had to leave because she needed to meet her husband, who normally picks her up from work, and she had a meeting that evening regarding her dying father’s end-of-life care.

The following morning, Jones reported to work and offered to return to the testing center to complete the urine sample. The city refused her offer and sent her home instead.

The city subsequently filed a workers' compensation claim on Jones' behalf, over her objection. The law department also held a disciplinary hearing regarding Jones' failure to complete the test.

The Bureau of Workers' Compensation eventually dismissed the claim the city had filed, determining there had been no injury.

The city, however, suspended Jones from work for 10 days.

Jones appealed the disciplinary action, but the Cleveland Civil Service Commission upheld the suspension. Jones sought judicial review, and Cuyahoga County Court of Common Pleas overturned the suspension.

The court found that the commission did not have a sufficient basis to find that Jones refused testing.

Even if she had refused, the court said, the city was not authorized to suspend Jones’ employment because the only ramification of a worker's refusal to take a post-accident test was a disqualification of workers’ compensation benefits.

The city appealed, insisting that the judge's ruling was "unsupported by preponderance of substantial, reliable and probative evidence."

The city lost.

Why did it go this far? What was the real reason for targeting Jones?

We don't know because that is not in the court record.

What we do know is that the city felt compelled to use the workers' compensation process to effect a termination of an employee, and all I can think of is that, for some reason, Jones was deemed an undesirable employee.

But no one in the Department of Law had the testes to effect a termination lawfully, likely in fear that Jones would "retaliate" and cost the department some unallocated funds.

Hey management - workers' compensation is for a work INJURY. If there is no work injury then don't use workers' compensation for your human resources issues.

To read the Ohio court's decision, click here.

Adjust The Portfolio

Peter Lynch is probably one of the most famous investors ever.

As the head of Magellan Fund for 13 years, he averaged returns of 29.2% annually. Assets under his management swelled from $18 million to $14 billion. Like a good athlete he left at the top - the size of the fund nearly too large to continue such incredible gains.

Lynch wrote several books on investing and I read a few. I won't say my investment prowess even came close to his.

Not even close.

Peter Lynch

Lack of trust, lack of research, lack of time ...

But the one maxim that Lynch repeated over and over in his writings was to buy what you know.

Lynch would watch the consuming habits of his wife, his kids, his friends - and ask about the products or services that were being purchased and why. Then he'd take a look at the sector, and the companies in that sector to determine whether a company was under valued based on his criteria.

It's really a simple evaluation. Basically, Lynch was interested in the early consumer adoption of a product to predict whether a company making that product would be successful.

The key, according to Lynch, is to buy what you already know and watch the cycles...

With that in mind, I'm intrigued by workers' compensation insurance at this point in time.

Work comp, as we know, is highly cyclical. While the rest of the economy cycles, work comp seems to have higher highs, and lower lows.

The mantra, of course: buy low, sell high.

The trick for investors is to spot the beginning of an up cycle, and it seems like we're entering that phase now.

NCCI, in its last state of the industry observation, noted that carriers for the first time in decades are posting combined ratios below 100. That means they're making underwriting profits - which is nearly unheard of in work comp.

That the business community is tolerating rates and premiums supporting an underwriting profit is unique; work comp carrier profits are typically the product of savvy investments. But investment returns lately have not been good because conservative products, e.g. bonds, have been suppressed by unprecedentedly low interest rates.

There are several trends emerging, though, that fare well for carriers.

In big states California and New York, the minimum wage will increase a third to $15/hour over the next several years. Quite simply, this just means more premium money into carrier coffers because policies are tied to payroll. The more payroll, the bigger the premium, the more money into the insurance company treasury.

In addition, the Department of Labor's recent change to exempt vs. non-exempt/overtime regulations means hundreds of thousands of individuals will see an increase in wages; again, more money in payroll means bigger premiums which means more money to the insurance companies.

The seventh or eighth largest (depending on who is measuring) economy in the world, California, is adding more jobs, faster, than any other state in the nation. The latest unemployment statistics put the state at 5.3% unemployment. More telling, employment in California increased 2.8% in the last twelve months, compared to 1.9% nationally. In addition, most of those jobs are in low risk sectors like IT, or professional services. And the most populous areas, the Bay Area, Los Angeles and Orange Counties, are seeing unemployment rates well below the national average...

Finally, interest rates are poised to head up. After seven years of near zero interest on Federal Treasury Bonds, the mainstay of the investment community, Wall Streeters are seeing signs that the Federal Reserve is getting ready to slowly raise rates as the global economy starts warming up - and there's no reason not to believe that it will since American consumers will, at least for a short period of time, have a bit more purchasing power due to the aforementioned increases in minimum wage and overtime.

So, lots of fresh money will be heading into insurance company treasuries.

But what about paying out that money in claims?

Here's what we know on a national basis: frequency continues to decline reflecting safety and the ongoing shift in the economy to office-type work; work comp medical inflation is at an historic low (unlike the general health sector); and severity is at an all time low.

So, the work comp line is going to be flush with cash for a few years until those high wage claims start hitting the books - which means that carriers will be investing more money into better instruments to make more money before it is needed to pay claims, thus greater dividends to investors which makes the stock prices go up.

Now, I could be a complete investing moron - certainly my track record does not speak to any Lynch-style wonderment.

And economists who watch the insurance industry, like the great Bob Hartwig, may disagree with my analysis.

But, if we follow Lynch's advise, this is something we know. Seems like a good time to adjust the portfolio...

Summit Notes

Bob Wilson from workerscompensation.com has posted links to the notes compiled by David Langham arising out of the 2016 Workers' Compensation Summit held in Dallas last week.

The notes are broken down into five categories; plagiarizing Bob's post hopefully with his permission:

Summit Notes – These are generalized notes of comments made during our two days of discussion. They are generally presented in the overall order they were made.

Friction Points – these notations were part of a discussion about those transactional points that slow down, increase the cost or potentially disrupt the claims process.

Paradoxical Incentive Points – these notes are related to discussions where incentive/payment structures may not be in line with desired outcomes.

Regulatory Points – a great deal of energy went into discussing regulatory burdens and oversight as related to workers’ compensation. These are broken out for your benefit here.

Imperative Issues* – These are the final points that the group identified as pain points or problem areas within workers’ compensation. *IMPORTANT NOTICE REGARDING THIS FINAL DOCUMENT: This is simply the release of a rough outline. The group will be working further on these points, and is currently undergoing a survey process to prioritize these particular issues. Once that is complete, we plan a more formalized document that contains a “Statement of Purpose” as well as extended commentary surrounding these points.

Bob's blog post where you can not only download these documents, but also leave comment for aggregation and inclusion is http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/23908-the-notes-from-the-workers-comp-summit-now-it-is-your-turn-to-join-the-national-conversation.html.

Summit attendees are encouraging comment and participation regarding these notes and documents. Please comment either at the bottom of Bob's post, or in any of the LinkedIn groups where these notes are available and/or discussed.

Thanks to Bob Wilson and David Langham for putting the Summit together and getting things moving. Thanks also to all of the participants for taking time to participate with no other agenda than hoping to improve work injury protection systems.

The Natural State

The relevancy of workers' compensation is in question, so that is bringing industry professionals, and injured workers, together in various forums to open dialogues about what a modern work injury protection system should do, how it should function and what it would look like, including the 2016 Workers' Compensation Summit in Dallas TX that starts today (I will miss the first day due to travels).

Work comp escapes general insurance/risk management definitions. Most lines of insurance/risk management are monopolistic - there is only one element to worry about, only one principle to manage.

For instance health insurance only deals with medical, life insurance only deals with (curiously) death. Even auto or home insurance, which could have a "medical" provision, is really monopolistic because the medical component is just reimbursed, not managed.

Workers' compensation, however, is a triad: disability and medical lines are directly controlled and managed in the work comp setting, and so is liability (because of the exclusive remedy portion).

There's a lot of ideas floating around, and a lot of concepts being discussed. Some of that conversation is fairly basic, working within the existing framework of work comp. Some of it is more radical suggesting strategies that dismember the triad.

Regardless of what the "ideal" system is (and I don't think there are any, just compromises), there are plenty of outside forces which the laws of physics and mathematics say will impact whatever is implemented.

Economist Daniel Kaheneman, in his book, Thinking, Fast and Slow, argues that most decision-making, even at the highest level, is impacted by swarms of intuitive biases, misinterpretations of data, illusions and misconceptions of which those making decisions are blindly unconscious and thus no one decision-maker (and thus, over time, no one decision) is consistently superior to another.

The theory of entropy also comes into play; that is, the natural state of all things is chaos, i.e. without order. Regardless of how much we implement rules, constrictions, fortifications, etc., eventually all order returns to its natural state of chaos.

Think about computers for instance. Computers essentially manage electricity to create the illusion that there is order and stability, so I can type this blog. It seems reasonably reliable and I can predict that when I hit the "R" key an R will appear on the screen.

But we know that computers eventually all crash and cease function. That's because the natural state of electricity is chaos - electricity is nothing more than the harnessing of electrons zipping around space into some short form utility until that energy is release and the electrons return to a disordered state.

Light bulbs exemplify this - light is temporary and transient. It is "on" only when the electricity is ordered to vibrate a filament, and when the electricity to the filament is terminated the light ceases.

If we take the theory of entropy, and apply Kahenaneman's argument about decision bias, then it would seem that no matter what we do with workers' compensation, or any work injury protection system, there will be, in mathematical terms, a return to the mean, a natural state of chaos, in part because of bias in the decisions that produce the design.

Which is to say there will always be winners and losers, there will always be a vast majority for which the system will work, and there will be outliers that fall between the cracks or get more than what they're supposed to.

The purpose of this dialogue that is occurring around the country is to propose work injury protection schema that serves the modern, information age, economy.

Trauma incidents for the most part are limited to a very small subset of occupations, for instance, so perhaps the triad of work comp isn't the best way to manage most exposures. Health care remains the biggest exposure for most of the populations, so perhaps that is a component that needs to be available to all working people, not just those who can afford it.

Disability is an even smaller subset than medical care. The vast majority of the working population won't ever be disabled, not even temporarily, at least not to the extent that work productivity is compromised.

Even liability - one of the most sacrosanct features of work comp is exclusive remedy, but perhaps that's not relevant to most employers in the 21st century as it was 100 years ago because of safety laws, oversight and simply the fact that we're not so industrial any longer.

100 years of work comp, 100 years of order, and we're seeing entropy creep in.

Court rulings, unconstitutional provisions, uncompensated workers, increasing costs, profiteering, and downright bad behavior; it simply is a return to the mean, a return to the natural state of things.

If we believe, as most do I think, that the vast majority of people are essentially "good", then the mean will function quite well no matter what the natural state is. The examination of entropy that is now ongoing is a product of the outliers; functions, actions, people and things that don't concern the vast majority of the population.

So while it may be time for a rebuild, a time to return order and a new architecture drawn, the reality is that theses discussions are about re-ordering the outliers and broadening the bell curve that got castrated over time as a consequence of entropy.

How all this plays out is anyone's guess. I'm just saying that no matter what is done, eventually it too will return to a state of entropy because decisions are not rational no matter how rational we believe the decision-maker to be and we can't control nature.

That's not to say that what is work comp now can't be better or that there is a better model for work injury protections.

But what replaces the work comp that we have known the past 100 years will also, eventually, regress to the mean, have outliers on the curve, and entropy returns.

But that may take another 100 years.

Assume Responsibility

I know I'm going to get flamed for this blog post, but I have always committed to telling the story the way I see it.

I have taken on insurance companies and their executives, doctors and other medical vendors, attorneys and the legal profession.

Politicians of course haven't escaped my vitriol, and employers also haven't escaped criticism.

The only workers' compensation population that hasn't been met with cynicism has been injured workers.

There's two sides to every story, as they say. 

Most in the work injury protection schema do good deeds most of the time for most people. There are some times when things go awry, either intentionally or negligently. I get that. There are also laws and regulations that don't work effectively, or have contraindications which contaminate too large a population. I get that too.

Workers' compensation, or any form of work injury protection system, requires a lot of people to synchronize. Synchronicity is not easy. Sometimes the harmony goes awry. That's how life is.

Recipients of system failures get a raw deal. Sometimes it's corrected. Sometimes not. Sometimes the correction doesn't meet the expectations of the recipient and other times it exceeds expectations.

Most move on, find their new paths in life and return some positive energy back to the world. They aren't in the same place they were before injury, and certainly it's a struggle to shift directions, particularly later in life and particularly if unprepared financially and emotionally for an alteration to the expected path.

The vast majority do move on, find positivity in life, strive to make the most out of it, and refuse to let life get in the way of living.

However, there's a vociferous militant minority of the injured worker population who have made it their mission to inform the world of the injustices imparted on them by "the system" and all its nefarious participants.

They have ridiculed most all work comp sectors named above, but have spared me for the most part. 

I'm sure that will change now.

Here's my gripe: these unmodulated venters are all about negativity, and offer nothing to resolve either their own issues, or the issues facing the workers' compensation institution.

These folks have taken to the immediacy and vast reach of the Internet to let the world know about the work injury commercial complex; how all of workers' compensation is out to get them, and you too. They rail about injustice, and about conspiracy, profits, and ill will towards all.

They hijack award systems to claim, incorrectly and falsely, victory and acknowledgment.

Even after being adjudged fraudulent themselves...

If your opinion opposes their's, then crucifixion and burning at the stakes begins and doesn't stop until the witches are excoriated.

But never, ever, is there a solution suggested, or any attempt to make a positive change. 

Just victimization.

You may not choose to BECOME a victim, but you do choose to REMAIN a victim...

You all know who I'm talking about. I know you’re upset at bloggers, at TPAs, and a whole host of other people connected to the work comp environment, and this is fueled by your personal experiences. I completely understand your emotions and what you believe in.

You have drawn ire from people in the industry, but it's not because you are being vilified, or because they have a disdain for the injured worker with a voice, or any other malicious reason.

It is very simple - you offer nothing positive relative to change.

Anyone can complain. Few do anything to effectuate change.

Drawing attention to the negative does nothing to further the conversation, offers no solutions, provides no road map.

It’s easy to foment revolution, but revolution without offering a solution (and not nationalization of work comp or calling in the National Guard) simply ends with anarchy.

Some have gone as far as criticizing their own - people who are working hard at making changes in their own way. There is a visible injured worker population who are doing something POSITIVE. They have taken their rage, disgust, observations, and done something that helps others. It is long, it is tough, it is out of the ordinary - but it is effective, demonstrates a solution and one that will likely result in positive change as organizations review and study what is being done and then implementing it it their own systems.

It simply is not enough to complain. Everyone has a complaint. A complaint without a solution is bullshit. You may as well just dig a hole and hide because no one is going to pay attention.

Everyone knows that bad things happens in work comp and that there are profiteers off of the injured. That’s no secret.

So what are YOU going to do about it? 

Working outside of the system, criticizing others, denigrating the institution, doesn’t help anyone, anywhere, and in fact makes one simply a militant.

The answer is to work WITH the system. Everyone does it in their own way. They work, and work hard, with other people that WANT to make a difference understanding that this is not a one person job; hell, it’s not even a job for a community, but a job for an industry of people.

Maybe I call them as I see them, but I also work with the top leaders to help with change.

It doesn’t happen quickly. Heck, sometimes it doesn’t happen at all.

But other than publish vicious attacks, why not study the system, study the law, the regulations, and PROPOSE solutions that a politician or regulator or chief executive, or any other leader can endorse and work with?

What has happened, through this militant virulence is that your credibility as an activist is suspect because you attack everyone (and I'm sure to end up on that attack list because of this post).

Here's the deal: Too many people don't want to assume the same level of responsibility that they presume for their rights.

If you want change then make change happen with action. Actually DO something POSITIVE. Blogging, calling others names, denigrating the institution - none of that matters. 

What's YOUR solution? How are YOU going to step up and BE change?

They're Off!

Some of my friends and colleagues are traveling to or are at the NCCI Annual Issues Symposium in Orland, FL.

The AIS is the national work comp data wonk-fest. Lots of information about how the business of workers' compensation insurance is doing around the country. It's an important event because without insurance, work comp can't function. Even the last couple of monopolistic states performance is measured, and that's interesting because it provides a comparison of private capital versus public capital.

I won't be there though. Instead my wife and I are headed to Kentucky to watch the 142nd running of this race.

We'll see the best that KY has to show of course, and thanks to the good folks at Ascential Care in Lexington for helping put our trip together.

The Artist Known as Dwight (double amputee from 2 separate work injuries 18 months apart) designed and made our Derby wear.

What we will see - the spectacle, the money, the party - of course, is in stark contrast to the reality of the rest of the state. High unemployment in the coal mining region and one of the highest rates of opioid addition in the nation bespeak a state with a very fragile economy and susceptible population.

In addition, as our Special Report on KY demonstrated, that edge of poverty is made even more sharp when a work injury occurs.

KY has also garnered the attention of the Workers' Compensation Research Institute, which has added the state to its CompScope reporting.

Last Friday the state Court of Appeals ruled that an injured worker does not have the right to have her father attend an independent medical exam, and as a consequence of state law, forfeits her temporary total disability benefits for the period of refusing the IME.

Oh, and it's the state's 100th anniversary of its work comp system.

Perhaps its coincidental that my attention is drawn to KY with all of this, perhaps it is serendipitous.

Maybe it's unfortunate.

In the face of such troubles though The Derby and horse racing in general is something KY is proud of and the citizens put forth their best while the world watches.

I'll learn how to fit a bowtie, Anne will wear her Dwight hat, we'll drink mint juleps from silver cups and 20 horses will thrill thousands for a couple of minutes. It's a once in a lifetime experience.

So we're off to the races...

Lack Of Control

A case out of Montana demonstrates that whether an injury falls within the ambit of workers' compensation jurisdiction has mostly to do with employer control, or in this case, lack of control.

Tamara L. Holtz worked as a flight attendant for Delta Air Lines. Oh June 21, 2014 she flew out of Salt Lake City and would have a layover in Cincinnati before a return flight to Salt Lake City on June 23.

Delta paid her a $2.40 per hour as a "per diem wage" for her time as soon as she signed in to work in Salt Lake as well as a hotel room in Cincinnati for the layover, but did not reimburse for layover meals. Flight attendant wages were paid as soon as the airplane’s brakes were released until they were engaged upon landing.

Delta neither restricted where Holtz could go nor what she could do during her layovers, but Holtz testified the airline could call "at any point" to tell her it had changed her schedule.

After arriving at her hotel in Cincinnati, Holtz took a nap and then met up with some friends for lunch.

The group proceeded on motorcycles southeast on U.S. Highway 52, also known as the Ohio River Scenic Byway.

The motorcycle Holtz was a passenger on crashed into one of the other motorcycles about 40 miles away from Holtz' hotel, and Holtz suffered a leg injury in the accident.

The Montana Workers' Compensation Court granted summary judgment in favor of the Delta's carrier, Indemnity Insurance Co. of America (the court opinion does not say why Montana was the state of jurisdiction).

Holtz was on a "break" from her employment during her layover, the court said, because "it was an interval within her scheduled work time when she was not required or expected to perform her job duties, and could attend to personal matters."

In addition, the court opined, it would be ludicrous to find that "the greater Cincinnati metropolitan area, in its entirety" was a Delta "worksite."

The coup d' grace was a slate of Montana high court rulings that essentially make the "lunch hour" non-compensable because the employer lacks control over the employee's activities during that break period.

The foundation for the Arising Out Of/Course Of Employment rule lies in the master/servant relationship. The characterization of that relationship is all about control - when the master has control over the servant then there shall be liability on the master for what happens to the servant when providing service or acting under the direction of the master.

Unfortunately for Holtz, hitching a motorcycle ride on a layover took her activity outside the control of Delta. That would seem to be a logical conclusion, but this is workers' compensation ... I guess the risk of asserting a claim did not offset the potential of success.

The case is Holtz v. Indemnity Insurance Co. of North America, No. 2015-3577, 04/06/2016.

Monday Morning

It's Monday morning - contemplating this past week.

My daughter paid a visit to get some Southern California weather after testing Alaska winter for the first time. The sun cooperated.

And of course Mom died. It was reasonably quick. She was comfortable.

My daughter was fortunate enough to visit with her grandmother while still alive, albeit Mom was severely limited - but I could tell by the look in her greying eyes that she recognized, and appreciated, Nichole's presence.

And certainly my daughter appreciated getting those last couple of hours with her grandmother.

It was last Saturday when we visited. Mom gave me "that look." It said, "I know you, I trust you, you can feed me and I'll eat what I can." She did. I did. Mom couldn't speak. She was too weak to even grasp my hand.

But she grasped my heart. I felt it.

Of course, then Mom checked out Wednesday evening. I was scheduled to visit the next day so I went anyhow to take care of the various tasks that would need my attention at some point in time. Now or later, may as well be now.

I was too busy to feel grief.

Yesterday I took Nichole to Burbank Airport for her return to Anchorage. She packed her bicycle in a box and checked it through. I said goodbye at the TSA checkpoint.

Now, Mom is gone. Nichole is gone.

When I woke up this morning, though, workers' compensation was still here.

Over 30 years of exposure to workers' compensation; I didn't realize until now - I have personally witnessed nearly one-third of the life of work comp.

My naïveté at the beginning was understandable of course, but alarming to me now. Reform after reform brought, and took away, various levels of medical control, indemnity increases and limitations, guidelines, reviews, and other assorted points of special interest to lawmakers, who for the most part, have the same level of understanding I did 30 plus years ago.

There's been fraud busts, and new fraud to replace those busted. Insurance companies have come, more have gone.

Rates have gone up, rates have gone down. Somebody, somewhere, is always complaining - one person's outcomes based incentives programs is another person's benefit denial target.

Courts make decisions that find compensability when no one thought there would be, and other courts have denied claims where others felt it unfair and unjust.

There's talk of constitutional challenges, federal review, and general media criticism.

Alternative work injury programs are hypocritically criticized by the work comp cognoscenti using the very same argument points they say is wrong with traditional comp.

There are audits, but perhaps not enough. There are penalties, but perhaps not enough.

Someone, somewhere, is going to take advantage of something that no one else thought would make a difference, until it does make a difference, and then the special interest matter ends up back in front of lawmakers, who for the most part, have the same level of understanding I did 30 plus years ago...

I was sad to see Mom go, of course, but the press of estate business, and my regular business, has retarded the grieving process. I'm sure there'll be a point in the near future when a tear sheds.

I was sad to see Nichole go too. We're always sad when our children leave. But I'm quite certain I'll see her again, though likely not soon enough for either of us.

And then there's work comp. I don't think I'll ever have to say goodbye to this incredible institution, at least not before I die.

For all its faults, for all of its negative traits, work comp is incredibly attractive and complex.

I see in comp "that look," those greying eyes that grasp my heart.

We can't fix everything, and we can't fix everyone.

To me, it takes only that one case though, where someone is profoundly affected by unfortunate circumstances and the benevolence of those trained in the system to rectify and bring some solace ...

My heart ...

This past week brought some perspective to my life.

There will be other times when that happens as well.

In the meantime I have the constant of work comp. For as much as it changes, it remains principally the same as I knew it some 30 plus years ago.

The Customer

It seems kind of silly and trite, but WHO is the customer?

Analogies to an experience every single person has as the end recipient of a business transaction were frequent at the Alliance of Women in Workers' Compensation mini-conference on advocacy based claims management in Boston the day before the annual Workers' Compensation Research Institute's meeting.

What is advocacy based claims management?

The short answer is - doing the right thing.

The challenge is changing a culture based on skepticism and mistrust.

Much of the panel discussions came from large, self-insured employers; a distinct minority in the work comp world, and a subset that has an entirely different agenda, different mind-set and with much greater resources, than the great majority of the insured work comp world.

For one thing, each of these big companies don't call their employees, "employees." Terms like partners, associates, and cast members come from a culture of top down appreciation for the human assets of the company and an understanding of the import these people have on the experience of the purchaser of the goods or services of the business.

When the folks doing the presentations talked about their injured workers they were nearly universally referred to as "customers." It's a change in mindset, a change in culture, a different way of looking at how we approach the issue of a work injury or illness.

Workers' compensation is a people business. It doesn't get any more simple than that. The job of work comp is to take care of people. When dealing with people, relationships matter. A lot. The customer analogy of the injured/ill worker fits. They are the end recipient of the goods and services of The Grand Bargain. The moment a worker comes into the work comp fold that customer relationship has started.

Business literature is replete with lessons about the customer relationship; the very best companies, those that excel over and above the competition, have a very basic, common core: solid relationships with their customers.

We know that intuitively. Even in the business of workers' compensation, really successful companies build and maintain relationships with their customers; and really successful claims management builds relationships with THEIR customers.

Just because it's simple, though, doesn't mean that it's easy.

Indeed, in one of the collaboration break outs one of the attendees, a vice president of an employer work comp trust acknowledged that many of his members don't have that same regard for workers as those self-insureds up on the stage, noting that their expectation for paying $50,000 in premium is that the insurance company just takes care of everything - and are surprised when asked to take the worker back!

So the business, the entity that has the workers, itself first needs to recognize that its workers have value and that workers' compensation is not a vehicle for other human resource issues.

And within a claims organization, how a successful claims experience and/or relationship often is not measured according to customer-based metrics. Instead of gauging the quality of the workers' compensation encounter, we measure compliance, either regulatory external compliance (don't want those penalties) or internal company compliance (get a bonus for closing 120% of your case load!).

Imagine if you were a retail customer and wanted to buy something, but in the store you were met with skepticism, the subject of investigation. Instead of a sales person showing you, for example, different shoes, you were instead asked why you would want any shoes in the first place ("What's wrong with the shoes you have now?")!

Or at a restaurant and you really wanted a rib-eye steak, but the waiter told you that you were too fat to be eating steak and that he would only serve you a salad...

Yet, that's how we traditionally meet the injured worker at first contact. Instead of a compassionate question about fears and expectations, we initiate investigations...

Know your customer (i.e the person being serviced). This seems obvious, but in workers' compensation we don't take much time to know our customers, or what they really need to return to health, and ultimately back to work. For various reasons, the culture of the workers' compensation claims process does not allow the development of beneficial customer relations, and consequently the customer, i.e. the injured worker, is disengaged from a process in which they should otherwise take ownership.

The devolution of workers' compensation has taken many, many years. Turning the culture around, bringing value back to the customer, making the injured worker a part of their own solution, will likewise take many years.

But efforts like those of the Alliance of Women in Workers' Compensation will, I think, build momentum because there's a very solid business case: continue to treat the customer poorly and eventually you go out of business.

It's that simple.

Holding Hands

I'd been through this once before.

I met with Carl, the hospice advisor, at Mom's facility yesterday and we went through the benefits - what is and isn't included. It was only a little more than 2 years ago when I was briefed on hospice for Dad, and most of it I recalled.

Nurse Margaret was the evaluating nurse. We went through Mom's medical history. Margaret called me later yesterday to advise Mom was eligible for hospice services and they would start immediately.

The chain of events that got us down this path started Saturday when my sister visited Mom and found her ill - her temperature was 101.9 and she was shaking, lethargic, tired and non-responsive, a radical departure of status from my visit just the day before when she seemed her normal, demented, 91 year old self.

Conservative treatment controlled the fever. Mom has had a respiratory infection for, it seems, a month, without resolution despite antibiotics and other treatment courses.

The doctor would see her Monday, and advise continuing the conservative treatment.

Tuesday the nurse in charge called me to say that Mom seemed to take a turn for the worse, and requested authorization for a hospital visit, which I granted. But the medical staff at the hospital found nothing extraordinary or unusual - vitals were normal, exam was normal, and referred her back to Mom's facility.

But Mom's physician recommended an hospice evaluation... That usually means the end of the line is near.

So Forty One Mike conveyed me south Wednesday to check on Mom and meet with the hospice team.

Mom was not doing well. I got there about 11:45. She was in a wheel chair at a table in the dining area with oxygen (she had been on supplemental oxygen for months now due to inadequate O2 uptake). 

She, of course, was happy to see me, but any laughter induced coughing. She enjoyed being massaged above the shoulder blades when coughing. Her hands appeared more swollen than usual, and purple. They were cold and she could not open them or close them very well. 

I held at least one of her hands the whole time there - she enjoyed that.

But now Mom has tremors anytime she attempts any sort of muscular control, whether moving her arm, legs, whatever. She was not talkative, very unusual for Mom. She didn't smile much either - again, very unusual. 

She seemed more unsure of things, and was very tired. The caretakers said she ate a little bit for breakfast. Lunch was meatloaf, noodles and green beans. I fed her. She ate about 20% of her meal and a couple of spoons of ice cream. She drank all of her water (with a straw). 

She is not able to feed herself because of her lack of muscle control. She does not have a fever… After lunch she went to bed and I met with Carl and Margaret.

It was a really rough day for Mom. Is she dying? Perhaps. I’m not a doctor. But I do know that she won’t be able to carry on for long in the condition I saw her Wednesday.

You know, I write something nearly every day about workers' compensation.

It really doesn't matter much though. We think it's important, and perhaps on a grand, universal, social and economic scale it has some import.

But not in comparison to those acute reminders about life.

The process of death has a clarifying effect. Death itself is inescapable. We all know that. We tend to mute that reality.

Presumptions, utilization review, drug formularies, profits, losses, provider networks, fraud, compensability - at the end of the life, the only thing that really matters is having a beer with your family members in the garage, tinkering with motorcycles, preparing the grill, and reminiscing about childhood.

Mom's a great-grandmother now. She doesn't really know it because of her dementia. And it's unlikely she'll ever really "see" her great-grandchildren because they're just babies.

At 91, nearly as old as workers' compensation in this country, every day is an adventure and you never really know what the next day holds.

I hope when I see Mom again on Saturday she will smile at me and that I can warm her hands in mine.

Stop The Fantasy

It was really difficult to keep me away from posting over the holidays - all sorts of interesting things happened in the workers' compensation world: scandal, new rules and laws, studies, court rulings, controversy... some things never change.

And ProPublica published yet another story about workers' compensation, this time taking to task all of the intermediaries that have evolved in the past couple decades under the rubric of "cost containment."

Author Michael Grabell points to the lavish parties and other extravagances at industry conferences as examples that "cost containment" services have run amok. This drew fire, understandably, since most industries have wild parties and indulgent conferences - so why should workers' compensation be different?

Yet, if you see Vons/Safeway/Albertson's VP of Risk, Bill Zachry at any of these conferences, he is always carrying a camera and taking pictures of all of the vendor booths.

I asked him about this one day. He explained that when he gets back to the office he reviews all of the photos and counts up the number of vendors in any particular special service sector - that tells him where all the money is going and where he could potentially see some cost savings.

A brilliant strategy, I think.

Zachry has the luxury of working for, and with, a self insured, self administered (in most jurisdictions) business with the resources to conduct such investigation and implement mitigation strategies to drive the claim dollar where it has the most effect - providing medical care and indemnity to injured workers according to legal obligation.

Most employers don't have that luxury because they delegate the claims decision process to their insurance company.

So an outside observer notes that some of the marketing is over the top, perhaps creating in the least, as we were taught in law school ethics, an appearance of impropriety - not that there actually is any.

There's nothing wrong with promoting your business, even a "cost containment" business. Marketing is a necessary element of business. Without marketing people don't know you exist, much less know of the awesome service and/or products you provide.

And I like parties and shows, even though I won't stay up past 9 p.m. for any due to my unfortunate internal alarm clock that forces me awake at 3:30 a.m. every single morning (even on vacation ... ugh).

Why do we care if Grabell points out that there is lavish spending by vendors at big conferences? What's the big deal?

Some injured worker advocates have latched onto the story to express their opinion that all this money is better sent to injured workers and/or pay for their medical care. Maybe they are right, but maybe those are opinions that aren't well founded either - arguments go both ways.

And maybe stories like the latest in ProPublica need greater publicity and distribution, and provide more people with greater insight into workers' compensation - in my mind whether the portrayal is positive or negative is irrelevant; any time workers' compensation is before the public is good for the institution.

Workers' compensation should not be mysterious, should not be hiding, and should be exposed to the public good or bad, because it is for the public - each and every person that works in this country should be afforded reasonable work injury protection. It's good social policy. It's good economic policy.

Each time The Media comes out with a story, an expose, a critique, of workers' compensation is an excellent opportunity for the industry to reflect and look at ourselves: are we really doing as good of a job as we can with the resources we're given?

Every day I'm the recipient of numerous communications from someone that has seen, felt, heard or otherwise experienced something negative with workers' compensation. It could be from an authorized provider still not getting paid on time, or at fee schedule. It could be from an injured worker or his/her attorney describing some of the ludicrous machinations required to access benefits. It could be from an employer disgusted with the misdirection of its premium dollars. It could be from a claims specialist frustrated with relentless collection attempts by a vendor that should have been satisfied. It could be from a medical professional tired of the authorization gauntlet.

Overwhelmingly, though, such communications come from someone who is just doing their job, or in the least, performing the functions described in the "job description," be it attorney, doctor, claims specialist, broker, and yes, even injured worker.

Everyone has their job to do. In workers' compensation, everyone's job description is created in part by law, by regulation, by a company document and also by culture.

Getting upset about some negative portrayal in The Media is natural - after all, someone is taking to task something very close to us: our professional livelihoods in which a huge part of our egos are wrapped. It is absolutely natural to be defensive.

But it's not productive.

Here's the issue with ProPublica's latest story: "cost containment," despite what Robert Hartwig told ProPublica, ARE dirty words. That phrase sends entirely the wrong message. Yes, the category was started to stop the outflow of irresponsible money and, coincidentally, promote smart medicine. Whether it is used to in fact accomplish those goals is debated by physicians, injured workers and their attorneys (and some employers too).

As in any endeavor, particularly where social benefits are at stake, there are those who play well in the sand box, and others who don't.

Cost containment is an apt term if we, as an industry, are willing to accept its definitional reality - that the intent of cost containment is to save money for those who are paying it out.

Let's stop with the fantasy that cost containment is for the benefit of injured workers. It's not. Otherwise it would be called something else. That cost containment paradoxically results in medical treatment that should result in better outcomes is not the paramount reason for these businesses.

We all know that - so let's stop trying to pretend that it is something which it is not.

If the services are intended to benefit injured workers then there should be a better term for those services that should reflect that beneficial treatment,

Maybe we're misunderstood. Maybe our good intentions aren't appreciated.

But maybe cost containment really is an accurate term - and at whose expense?

Hate to say it folks, but we're getting the attention we all deserve.

The old Pogo comic strip is oft quoted because it is all too true, "we have met the enemy, and he is us." (Walt Kelly, 1953)

My Dream

In just five days hundreds of people from around the nation will gather for the Fourth Annual WorkCompCentral Comp Laude Awards and Gala.

That's a mouthful of a title for a dream I've had for some time - get as many different workers' compensation interests together into one space for just an evening, and recognize what goes right with work comp.

I know it sounds Polly-Annish, and perhaps it is just wistful thinking; the hope is that if claims executives meet the subjects of benefit distribution; if the medical community meets the employers that pay into the system; if lawyers meet service providers; if government meets vendors ...

That if everyone that has anything to do with workers' compensation all get together for one day, one evening of recognizing that there are good things that can happen with the work injury protection system(s), stories will be told, messages will be heard, understandings will occur - and maybe, just maybe, people will work towards the common good for the sake of society, rather than for individualistic opportunism.

I'm not completely naive. I know that one night of education, camaraderie, and celebration isn't going to solve the problems we face in workers' compensation.

But it's a start.

Every conference I go to around the nation there is a recurring theme: silos.

Each independent interest in workers' compensation has their own conference or two.

Attorneys that represent injured workers have their own conferences;  Employers have their own conferences; Physicians and the medical community have their own conferences; there are even smaller gatherings for regulators, special vendors, researchers, insurance executives, and sub-specialty gatherings.

Even the single biggest gathering of broad workers' compensation participants, the annual WCI Conference in Orlando, FL every August, is still a hegemony of special interests - there are a dozen different education tracks that cater to each of the silos but none that speak to everyone.

Each of these conferences and seminars come with content specific to the interests of their singular groups, each of them focused on how to take advantage of some aspect of the system or law to minimize costs or maximize outcomes.

Not one of these gatherings includes injured workers. Many include their representatives, but that faction again speaks to their own interests first, and the needs of the beneficiaries second. And not one of them tells success stories.

For every story of failure, grief and hardship that we read about in the general media, there are dozens of stories where individuals go above and beyond to good outcomes, and sometimes these stories are of compelling, remarkable accomplishments.

Comp Laude is the only event where everyone from all segments of workers’ compensation are not only welcome, but encouraged, to attend and participate: executives, injured workers, claimant attorneys, defense attorneys, doctors, case managers, claims adjusters, researchers - you name it. 

My goal is to get EVERYONE under one roof at a nice event where people actually TALK AND LISTEN to one another, hear the stories, and understand all the diverging points, conflicts, interests, and perhaps, come to some understanding as to why certain things are the way they are.

At a time when workers' compensation, as a system, is under attack from the general media, the public, and lawmakers, it's important that we come together.

We don't have to change the way things are, and we don't have to solve all that ills workers' compensation.

We just need to come to a collective understanding of why things are the way they are.

It is my hope that we will, with Comp Laude, eventually help shape policy for the future that benefits all of society. 

It’s a big mission and a big risk.

But the dream is compelling to me. That dream drives me like a locomotive pulling a train, a long train filled with many people on a singular destination.

Some may disembark, some may never get aboard. Those that do ride along, I know, are aligned with that dream - that the single largest privatized social benefit system in the world can not only work, but work well, protecting people and businesses and provide stability to the economy.

We've made it easy for YOU to attend. We have special pricing for injured workers and claims examiners. We have deals for professionals that are members of recognized associations (nearly all of them!). Bring a Toy for Tots and there's a discount.

We're all in this thing together. We need to recognize that, if for only one night.

Back Into Perspective

Adam started fueling my plane less than 6 months ago.

perspective

30 years old, seven years in the Army, two tours in Iraq, married, seven month old daughter, going to college to complete his Bachelors, and working part time at the local Fixed Based Operator keeping airplanes washed  and fueled to make ends meet.

He would listen to tower frequency and when he heard me coming in for a landing he'd fire up the fuel truck and meet me at my hangar - I never had to call for fuel when Adam was on duty.

He told his supervisor that he liked fueling Forty One Mike because I was "nice."

It was curious when his supervisor drove the fueling truck to meet me Friday after returning from Vegas. She said Adam was "no longer with us."

I thought he had quit or was fired. My facial expression conveyed that.

"No, I mean, Adam died..."

I was floored. I just saw him - he fueled Forty One Mike on Tuesday for my Vegas departure.

He left work at 3:30, said his supervisor, went home to get his motorcycle, and was killed when the driver of an SUV made a left hand turn directly into the path of Adam. There was no room or time to maneuver. Adam died instantly.

That I was "nice" made the news particularly biting.

Alison was my college girlfriend for a couple of years. We stayed in touch after that relationship ended. She went through a couple of husbands, and had a son and daughter.

The last couple of years I did not have much communication with her. She told me she was writing a novel, and that a character in her story was based on me. I thought that was flattering.

I knew she was sick, and guessed it was cancer.

I saw some photos of her on Facebook - she did not look healthy, or happy.

After about a year of battling brain cancer she died about two weeks ago at age 56.

Woody was in the Army. At 24, he was the only child of my cousin, police officer Joey. I got the text message Saturday.

He was found, unresponsive, in his barracks after a night of drinking with his buddies. CPR failed.

And of course the Paris ISIS attacks removed from this existence 129 people who had no inkling their time was up. One was a 23 year old Long Beach State college student finishing up her senior year with studies abroad.

Nohemi Gonzalez won't graduate.

I think about workers' compensation all the time. It seems big. There are billions of dollars involved. There are tens of millions of people impacted. Goods and services reflect the cost of this social program. People get hurt. People get medical care. Some get denied. Some people get money for disability. Some go back to work, others don't. Some people cheat. Some get cheated.

Some people die.

And every once in a while, it all gets put back into perspective.

Displacement of The Bargain

I expected vitriol in response to my posts on the realities of workers' compensation, justice and wealth re-allocation ("Ain't No Justice" and "You Don't Belong Here"). I didn't expect to see frustrations expressed so violently.

Most of these comments have been removed by their authors from my blog. They are disturbing, and I hope are NOT indications of homicidal ideation, but they certainly should not be dismissed as rantings of unhealthy thoughts.

Many of comments reflect a lack of understanding of what workers' compensation can, or can't accomplish, but more so, are evidence of increasing class stratification and social resentment, and while workers' compensation isn't the cause of that greater social ill, it is reflective of that.

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YOUR (sic) right the only way the injured get justice is if they take the law into their own hands and hold those suits to account for the wrongs.

THEIR (sic) is no justice one has to seek that from their oppressor with out the courts.

THE ONLY WAY FOR THE injured to get justice is to take the law into your own hands.

LOOK at Nevada, that adjuster got what he had coming and more will follow.

NO JUSTICE in COMP means NO JUSTICE for the whores who try to eff us over...

I will have JUSTICE against those who conspired to harm me, law of the land or not.... those who harmed me will pay for their crimes in the end..

THE ONLY way for the injured to get justice is to extract it on their own from their oppressors.

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The abused and oppressed will rise up and fight back weather the systems condones it or not. WERE (sic) PITTING one class against another, then allowing the suits, to hide and walk away from their crimes. An injured worker will rise up and seek revenge with or with out the system.

THE power players need to beware, for their days of effing over injured workers are coming to an end.

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IT is all about justice and principle. You see if I had an attorney, I would not have been allowed to fight on just principle, for that's not worth a lawyers time, but for an injured worker, Principle is worth all our time, 24.x7. That is how our claims becomes or (sic) lives, fighting for this root injustice, thats suits seem to just demises with ease. .

Justice, is what its all about for the VICTIMIZED.

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Employers have gotten away with a lot. Especially in the health and safety laws that employers laugh at. Employers do not have to abide by the rules and many injured/ill/disabled are purposely harmed and some after the injury by vile "medical staff". Where is the justice when a claim is denied from the onset and that insurance whores (doctors) who will knowingly write a false report as instructed by the insurer. The greatest injustice here is that the Worker comp courts do not listen to the injured when there is more than obvious malfeasance & fraud by the employer & the insurer. So who represents us against the fraud & corruption against the court. Now that is an injustice that can be fought but everyone that could help, turns their heads for a meager percentage. Judges do not acknowledge fraud even though they are supposed to. The same goes for the District attorneys, they don't because the same employers pay their salaries as is done in CA. AND therein lies another injustice with those who are supposed to protect us against deliberate harm or fraud do not because they are bought and paid for by the same employers who don't care if their employees are exposed to harmful work environments. AND then there is the injustice of our law makers who keep writing up laws that hurt the injured workers from the onset. So yes there are injustices that can be fought for, only IF those who represent us get the courage to do so. No one should wind up in the poorhouse with ongoing injuries or illnesses all to protect the employer/corporations. Now that's the biggest injustice that should be gone after and isn't.

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One other injustice is that when claims aren't paid to the injured/ill/disabled worker that that money does go directly back into the employer/insurer for profit at the end of the day, month, year. To profit off of injured/ill/disabled workers by not paying out claims is also vile. It is very much a parasitic system, all and just for CEO's & others to live high on the hog on the corporations producing injured/ill/disabled workers. This is a repeat of the 1900's Gilded age. Where the working class is just used & beaten up, all just for profit. tsk tsk, that history has repeated itself is really so sad and reprehensible, lets hope nothing else of history follows.

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ONE of the injured will rise up and show this COUNTRY what JUSTICE really is.... the comp workers in NEVEDA learned the hard way. NOW we need to teach all the other players as well. YOU DO NOT LIE In our care then live to brag about it. A WAR that the elite pure breed have started but US LABORERS will finish, by dancing on the elite whores graves.

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ITS a CLASS WAR Period. AND THE Victims will rise up and kill their abusers in the end. Count on it.

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The Nevada case that is referenced by the commenters above involved a claimant seeking permanent total disability indemnity for a 2003 injury sustained when he tripped over a baggage cart at the Bellagio in Las Vegas.

Leonard Sullivan is scheduled to stand trial November 16 for the October 13, 2014, shooting of Michael Kogler, a hearing rep for Alverson, Taylor, Mortensen & Sanders. Kogler survived the shooting.

Sullivan filed a civil rights complaint against Kogler, a former hearing rep for MGM, as well as his nurse case manager, claims adjuster and MGM. The complaint was dismissed.

Some people can't or won't be helped. They have their mission and will seek to accomplish it to the end, like Sullivan.

But most people just want to move on, though they don't really know how to do it, and the workers' compensation system isn't designed to help with that process.

In fact, it is The Process of workers' compensation that gets in the way. In its evolution, workers' compensation has become more about making sure the right boxes are checked on a form, ensuring that some paper is filed correctly, worrying about this procedure or that procedure.

The concern with the details of procedure has displaced delivery of the bargain.

Work comp is about providing some form of medical treatment and indemnity in accordance with rules dictated by legislatures and meted by rules. The disconnect, I believe, is expectations.

Expectations of the injured worker, expectations of the employer, the doctor, the claims payer, attorneys, judges, shareholders....

Each of these constituents has different, opposing expectations.

As a consequence of attempting to manage these opposing expectations, checks and balances have been implemented over time that have ended up taking precedence over the actual act of delivery of benefits.

The retorts above also demonstrate the most dangerous aspect of getting hurt at work and falling into the workers' compensation system: isolation.

The community of injured workers who complain and express harmful thoughts exists because of the isolation of injured workers. At least in their community there is understanding and relation based on a common denominator: workers' compensation.

At home, alone (at least psychologically), without any real support system - a recipe for disaster.

Sometimes a case manager will be assigned to interface, but typically the role of the case manager is cost containment. The title, "case manager" denotes that role. These hard working, compassionate people have a lot of forms and reports to generate, and that takes time away from their real jobs: listening and understanding.

We know that "relationships matter." In fact, there's good argument that relationships take precedence over nearly any other element of human existence.

Yet we do a terrible job in workers' compensation of establishing and maintaining, or repairing, relationships with the people the system is supposed to service. And this leads to unreasonable expectations.

I don't have an answer other than getting a lot of people together, all of the different constituencies in this complex world we call workers' compensation, and starting a dialogue.

The answer isn't more laws, or regulations, or penalties, or hearings, or fines. Nothing will get solved today, and maybe not tomorrow, unless there is trust.

Trust doesn't happen over night and requires the one thing that most people are terrible at: listening.

What the injured workers above "hear" from workers' compensation is that they aren't wanted, and that they are discounted as human beings. 

My guess is that each of these folks were discarded early on in their cases, and by "discarded" I mean were not counted as human beings with issues from the very beginning. Maybe those issues were/are personal, but they deeply influence the workers' compensation case and can't be discounted simply because they are "co-morbidities."

Listening takes time and patience, things we're short on because we're so concerned with the process.