What Happens When Employees Don’t Understand the Process

When an employee is injured, they’re suddenly faced with a series of questions:

What do I do next?
Who do I talk to?
How do I get medical care?
Will I still get paid?

If those questions aren’t answered clearly and quickly, uncertainty sets in. And uncertainty rarely stays neutral—it tends to evolve into concern, frustration, and eventually distrust. At that point, the claim is no longer just about recovery. It becomes about navigating a system the employee doesn’t fully understand.

How Confusion Impacts Claim Outcomes

Confusion doesn’t just affect how employees feel—it affects how claims perform. When employees are unsure about the process, common issues begin to surface. Injuries may be reported late because the employee wasn’t sure what to do. Medical care may be delayed or misdirected due to unclear instructions. Return-to-work opportunities may be missed because expectations were never explained.

Over time, these small breakdowns compound. They lead to longer claim durations, higher costs, and increased likelihood of disputes. In some cases, employees seek outside guidance—not because there is a true disagreement, but because they don’t feel confident navigating the process on their own.

The Experience Gap

One of the biggest challenges in workers’ comp is the gap between what employers understand and what employees experience. Employers deal with claims regularly. They understand the terminology, the timelines, and the procedures. For most employees, however, a workplace injury is their first exposure to the system. What feels routine to the employer can feel complex to the employee.

This gap becomes even more significant when factors like language barriers, limited experience with workplace systems, or lower familiarity with insurance processes are involved. Without clear communication, that gap turns into confusion.

Why “More Information” Isn’t the Answer

When employees don’t understand the process, the instinct is often to provide more information. But more information doesn’t always create clarity. In fact, too much detail—especially when presented in technical language—can make the process feel even more overwhelming. What employees need isn’t more information. They need clear, simple, and practical guidance.

They need to know:

• What happens next
• Who to contact
• What to expect
• What is expected of them

When these points are communicated clearly, the process becomes easier to navigate.

Simplifying the Experience

The most effective workers’ comp programs focus on simplifying the employee experience. They break the process into clear, understandable steps. They use plain language instead of technical terminology. They provide guidance at the moments when employees need it most—before an injury occurs, immediately after it happens, and throughout the recovery process.

This might include:

• A simple overview of the process at the time of hire
• Clear instructions for reporting an injury
• A straightforward explanation of medical care and wage replacement
• Ongoing communication to reinforce understanding

These steps reduce uncertainty and help employees feel more confident in the process.

Clarity as a Cost-Control Strategy

Reducing confusion isn’t just about improving communication—it’s about improving outcomes.

When employees understand what’s happening, they are more likely to:

• Report injuries promptly
• Follow medical guidance
• Participate in return-to-work efforts
• Stay engaged throughout the process

This leads to shorter claim durations, fewer complications, and lower overall costs.

Final Thought

Workers’ comp will always involve complexity behind the scenes. But for employees, it doesn’t have to feel complicated.

When the process is clear, employees feel more confident.
When employees feel more confident, they are more engaged.
And when they are engaged, claims move forward more efficiently.

In workers’ comp, clarity isn’t just helpful—it’s essential. The organizations that succeed are not the ones with the most complex systems, but the ones that make those systems easy to understand.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post Why Confusion Is Costing You More in Workers’ Comp Than You Think appeared first on Amaxx Workers Comp Blog.

They are common, often complex, and highly sensitive to how care is coordinated. When something breaks down in the system, MSK claims tend to be where it shows up first.

Recent discussions around bundled, value-based models like Paradigm’s HERO^SM MSK highlight an important shift. They move the conversation away from managing individual services and towards managing the full episode of care.

To understand why that matters, it helps to first understand a concept that is still relatively new in workers’ compensation: the bundle.

What is a bundle in workers’ compensation?

Bundled care is not a new concept in healthcare. In group health, bundled payments have been used for years, particularly for procedures like joint replacements, maternity episodes, and cardiac care. Large employers and Medicare programs have helped establish bundles as a way to bring structure, accountability, and cost predictability to defined episodes of care.

In workers’ compensation, however, bundled models are still relatively new.

Instead of paying for each visit, test, or procedure along the way, the bundle includes all care associated with a specific injury or episode.

In practical terms, that can include:

• Physician services
• Imaging and diagnostics
• Surgery, if needed
• Physical therapy
• Care coordination and case management

All of it is organized into one structure, with one accountable entity responsible for both the care and the outcome.

This is a meaningful departure from the traditional fee-for-service model, where each provider is paid independently based on the volume of services delivered.

While group health has already moved in this direction for certain procedures, workers’ compensation has largely remained tied to fragmented, service-by-service reimbursement. As a result, bundles represent a more significant structural shift in workers’ comp, introducing something the system has historically lacked: accountability across the full episode of care.

The move from disconnected services to a defined episode is what begins to align incentives and bring greater clarity to both outcomes and cost.

From bundled care to value-based care

A bundle on its own organizes care. Value-based care goes a step further by tying that bundle to outcomes and cost certainty.

In a value-based bundled model:

• The total cost is established upfront as a fixed price
• Financial risk is shifted away from the employer and onto the managing entity
• Providers are aligned around achieving functional recovery, not generating volume

Rather than the employer or carrier absorbing the variability of the claim, the model stabilizes cost at the outset.

This changes behavior across the system.

When reimbursement is tied to the outcome of the episode, there is a stronger incentive to coordinate care, avoid unnecessary services, and address barriers to recovery early.

The focus moves from “What services were delivered?” to “Did the worker recover function and return to work?”

Why this matters for MSK claims

MSK injuries are particularly well suited for this type of model because they are highly variable under traditional structures.

Two workers with similar injuries can experience very different outcomes depending on:

• How quickly they are engaged
• Whether psychosocial risks are identified
• How well providers communicate
• How consistent the care plan is over time

Under a fragmented system, these variables are difficult to control.

Under a bundled, value-based model, there is a defined structure to manage them.

The episode is coordinated from the beginning. Risk factors are identified earlier. Providers are aligned around a shared goal.

In a model like Paradigm’s HERO MSK, this includes integrating clinical care with behavioral and psychosocial support, recognizing that recovery is not purely physical .

Engagement is the visible outcome of a structured system

One of the most discussed elements of value-based MSK care is engagement.

High engagement rates are often highlighted because they correlate strongly with better outcomes, shorter duration, and lower litigation. But engagement is not simply a communication strategy. It is a byproduct of how the system is designed.

When care is coordinated, communication is consistent, and expectations are clear; injured workers are more likely to stay involved in their recovery. When care is fragmented, even well-intentioned outreach struggles to overcome confusion and delay.

In this way, engagement becomes a signal of whether the underlying model is functioning effectively.

Fixed price does not mean reduced care

One common misconception is that a fixed price model limits care.

In practice, the opposite is often true.

Because the model is responsible for the full episode, there is greater incentive to invest in the right care at the right time:

• Early clinical intervention
• Behavioral health support
• Active care coordination
• Ongoing monitoring of progress

These elements may not always be emphasized in a fee-for-service system, where reimbursement is tied to discrete services rather than overall recovery.

With a fixed price structure, avoiding delays and addressing risks early becomes essential, not optional.

What changes for employers and claims teams

From an employer and claims perspective, the most significant shift is predictability.

Traditional MSK claims are often difficult to forecast. Costs develop over time, and risk becomes clearer only after delays or complications arise.

A bundled, value-based model changes that dynamic by:

• Establishing cost expectations upfront
• Providing earlier visibility into risk
• Creating a clearer path for the claim from injury through recovery

This does not eliminate complexity, but it reduces uncertainty.

It also allows claims teams to spend less time reacting to issues and more time managing outcomes.

A broader shift in how care is delivered

The movement toward bundled, value-based care reflects a broader evolution in workers’ compensation.

• From fragmented services to coordinated episodes
• From volume-based reimbursement to outcome-based accountability
• From delayed insight to earlier intervention

MSK claims, because of their scale and complexity, are where this shift is most visible.

They highlight the limitations of the traditional model and provide a practical opportunity to implement something different.

Final thought

The discussion around bundled, value-based care for MSK injuries is a structural change in how care can be delivered.

• Bundles organize the episode.
• Value-based care aligns incentives.
• Fixed pricing introduces predictability.

Together, they represent a move toward a system that is more coordinated, more accountable, and ultimately more focused on recovery.

And in a category like MSK, where outcomes depend heavily on how the system performs, that shift may be one of the most important developments in the industry today.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post What MSK Bundles Reveal About the Workers’ Comp System appeared first on Amaxx Workers Comp Blog.

The issue isn’t a lack of care. It’s a lack of consistency.

The Real Problem Isn’t Intent—It’s Execution

In many organizations, the success of a claim depends heavily on the individual handling it. One supervisor might immediately call the injured employee, express concern, and stay engaged throughout recovery. Another, equally well-meaning, may hesitate—unsure of what to say, worried about saying the wrong thing, or simply assuming someone else is handling it.

The result is two very different experiences for employees within the same company. One feels supported. The other feels forgotten. That inconsistency is where even well-designed workers’ comp programs begin to break down.

Why Inconsistency Creates Risk

When communication and follow-up are left to individual discretion, outcomes become unpredictable. Employees don’t know what to expect, and uncertainty quickly turns into frustration.

Over time, this leads to:

• Confusion about how the process works
• Delays in communication
• Perceived lack of support
• Erosion of trust

And once trust begins to erode, claims become more difficult to manage. Employees may disengage, delay their recovery, or seek outside help—not necessarily because something is wrong, but because they feel unsupported. This is where costs begin to rise.

The Gap Between Policy and Experience

Most companies already have policies in place. They outline how injuries should be reported, how communication should occur, and how return-to-work should be handled. But policies don’t guarantee behavior.

There’s often a gap between what the organization intends and what the employee actually experiences. From the employee’s perspective, the program isn’t defined by the handbook—it’s defined by how they are treated after an injury. If that experience is inconsistent, the entire system feels unreliable.

Why Systems Matter More Than Intentions

The most effective workers’ comp programs don’t rely on individuals to “do the right thing” in the moment. They build systems that make the right actions standard. Instead of hoping someone remembers to follow up, they create a process where follow-up is expected. Instead of leaving conversations to chance, they provide simple guidance on what to say and when to say it.

These systems don’t need to be complex. In fact, the most effective ones are simple and repeatable.

For example:

• A standard first-day check-in after every injury
• A consistent explanation of what the employee can expect
• Regular, scheduled follow-ups during recovery

These actions ensure that every employee has a similar experience—regardless of who is managing the claim.

Making Empathy Consistent

Empathy is often viewed as something personal—something that depends on personality or communication style. But in workers’ comp, empathy can and should be structured.

Simple actions, done consistently, create a meaningful experience:

• Reaching out after the injury to check in
• Acknowledging the employee’s situation
• Providing reassurance about the process
• Staying in contact throughout recovery

When these steps are part of a system, empathy becomes reliable. Employees don’t have to hope they’ll be treated well—they can expect it.

Moving Forward

If your program relies on individuals remembering what to do, it’s vulnerable to inconsistency. The goal isn’t to replace human care. It’s to support it with structure. When expectations are clear and processes are consistent, outcomes improve—not because people care more, but because care is delivered every time.

Final Thought

Good intentions are important. But in workers’ comp, they are only the starting point. Without systems to support them, even the best intentions become inconsistent—and inconsistency is where claims begin to fail. The organizations that succeed are not just the ones that care. They are the ones that ensure that care is delivered consistently, every time.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post Why Good Intentions Fail in Workers’ Comp Programs appeared first on Amaxx Workers Comp Blog.

At this conference, I attended a session presented by Bob Hartwig, Ph.D., Director of the Risk and Uncertainty Management Center and Clinical Associate Professor of Finance at the University of South Carolina. The presentation stepped back from day to day claims and focused on the bigger economic picture shaping workers’ compensation.

It was one of the more important sessions to understand because it reframed how the industry is performing today and where it is likely headed next. The core message was simple, but not obvious: workers’ compensation is one of the strongest performing lines in insurance right now, but it is not growing. That tension between profitability and stagnation showed up repeatedly throughout the presentation.

Workers’ Comp Is the “Calm” in a Volatile Insurance Market

One of the most striking takeaways was how differently workers’ compensation has behaved compared to the rest of the property and casualty insurance industry. While other lines have been hit by catastrophic losses, litigation pressures, and inflation, workers’ comp has remained relatively stable.

As Hartwig described it, the broader industry has experienced a “decade of woe,” driven by catastrophe losses, legal system abuse, and inflation, while workers’ compensation has been “kind of a calm and stable refuge” from an underwriting perspective.

That stability has translated into strong profitability. As Hartwig noted, over the past fifteen years, workers’ compensation has moved from being “an underwriting disaster” to “one of the best lines that’s out there.”

The Surprising Reality: Growth Has Stalled

Despite strong performance, workers’ comp has not kept pace with the rest of the industry. Premium growth has been essentially flat for years. Hartwig pointed out that workers’ comp has experienced “negative net growth of about two percent over the past decade,” while commercial lines overall have grown dramatically. In relative terms, the line has shrunk.

Workers’ comp once made up around seventeen percent of commercial insurance premiums. Today, it is closer to ten percent. That does not mean the line is less important. But it does mean its influence on the broader insurance market is declining.

Why Workers’ Comp Didn’t Follow the Hard Market

One of the more interesting explanations from the session was why workers’ comp did not experience the same rate increases as other lines.

It did not need to.

As Hartwig explained, workers’ comp “didn’t need to participate” in the hard market because underwriting results were already strong. This ties directly into what we saw in the Claims Cost session, where costs are rising, but not yet forcing the kind of rate reaction seen in other lines.

Economic Slowdown Is Starting to Matter

Looking ahead, one of the biggest themes was economic deceleration. The broader economy is slowing, and workers’ comp is closely tied to that trend. Premium growth is expected to drop to around three to three and a half percent, much lower than recent years. At the same time, job growth has slowed significantly.

Hartwig highlighted that recent job creation levels are among the weakest outside of recession periods, and much of that growth is concentrated in a single sector. He emphasized, “if you remove employment growth in the health care sector, there is no growth in employment in the United States.”

That concentration creates risk. Workers’ comp exposure depends on payroll and employment. If job growth slows, exposure growth slows with it.

The Labor Market Is Sending Mixed Signals

One of the more nuanced parts of the presentation focused on the labor market. On the surface, unemployment remains relatively low. But underneath, there are signs of strain.

Hiring has slowed, layoffs are beginning to increase, and it is taking longer for people to find jobs. At the same time, wage growth is moderating, and benefit costs, particularly health care, are rising sharply.

This creates a more complex operating environment for employers and insurers alike.

AI: Threat, Opportunity, or Both?

AI was another major topic in the presentation, but the perspective was more balanced than many headlines suggest. There is a lot of concern about job loss. But the data presented did not support a widespread collapse in employment. Total employment and wages continue to grow, even in areas with high AI exposure. The more realistic impact is a shift in the labor market. AI is more likely to augment experienced workers while making it harder for entry-level workers to enter the workforce.

As Hartwig noted, “AI is not simply automating jobs, but it is augmenting the productivity of experienced workers.” There are also upside opportunities. Massive investment in data centers and infrastructure is creating new construction and energy-related exposures, which is positive for workers’ comp.

This connects with themes from the Complexity of Workers’ Comp session, where AI was discussed not just as a tool, but as a source of new regulatory, operational, and workforce challenges.

What This Means for Employers

For employers, the takeaway is not urgency. It is discipline.

Workers’ compensation is stable and predictable right now. But that stability is not automatic. It is the result of consistent execution over time.

As economic growth slows, exposure growth will follow. That may reduce upward pressure on premiums, but it also means fewer tailwinds supporting results. At the same time, underlying pressures like medical costs, workforce shifts, and changing job dynamics are still present.

This is where intentionality matters.

Employers who continue to execute on injury management best practices such as early reporting, directing care, strong communication, and return to work will be best positioned to maintain predictable outcomes. Those who become less disciplined in a stable environment risk seeing results deteriorate even if the broader system appears strong.

The advantage in this market phase, and every market phase, goes to consistency and intentionality with the implementation of injury management best practices.

What Matters Going Forward

The biggest takeaway from this session is that workers’ compensation is entering a different phase.

It is no longer defined by volatility or crisis. It is defined by stability, but also by slower growth and increasing external pressure. Economic conditions, labor market dynamics, health care costs, and technology shifts will all shape what happens next.

The line may not be growing as quickly as other parts of the insurance industry. But it is performing well. And that combination creates a different kind of challenge.

The question is no longer how to fix a broken system. It is how to adapt a stable system to a changing world.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post WCRI Notes and Takeaways: Why Workers’ Comp Is Profitable but Not Growing appeared first on Amaxx Workers Comp Blog.

At the recent WCRI conference, I attended a session titled “Hospital Closures and Impact on Outcomes,” presented by Bogdan Savych, senior policy analyst at WCRI. The discussion focused on how hospital closures are affecting workers’ compensation and highlighted a reality that is easy to oversimplify but much harder to fully understand in practice.

Hospital closures are often framed as a crisis of access. But as Savych emphasized, the story is far more nuanced. Care is not simply disappearing. It is shifting. And that shift is fundamentally changing how injured workers receive treatment, how far they must travel, and how employers need to think about care delivery.

One of the most important takeaways from Savych’s research is that “not all hospital closures are the same.” Some hospitals shut down entirely, while others eliminate critical services such as inpatient or emergency care but continue offering outpatient services.

That distinction matters more than most people realize.

Access to Care Is Changing Shape, Not Just Disappearing

When people hear “hospital closure,” the natural assumption is that access to care disappears. But the data Savych presented tells a different story. Even in areas where hospitals fully closed, workers were still receiving care. In fact, about 24 percent of workers in those areas still received emergency care on the day of injury.

The issue is not that care stops. It is that accessing that care becomes more difficult.

As distance increases, utilization patterns change. In areas where hospitals are farther away, only about 17 percent of workers accessed hospital-based emergency care. That drop reflects what Savych’s findings make clear: access is not just about availability, it is about usability.

This reinforces a broader theme seen throughout the conference. Having providers available on paper does not guarantee real-world access if workers face practical barriers like travel distance, time, and inconvenience.

That same idea came through clearly in the Access to Care panel discussion, where availability on paper often did not match real-world access.

When Hospitals Close, Care Moves Elsewhere

As Savych explained, “workers still have to get their care, but perhaps not in an emergency room setting.” That single point captures the core shift.

Care is not disappearing. It is relocating.

The data showed increases in office visits, physical medicine, and other services delivered outside hospital settings. Injured workers are turning more frequently to urgent care centers, physician offices, and ambulatory surgical centers, with a corresponding decrease in hospital-based care across multiple service types.

This is exactly what was highlighted in the Employer Panel session, where employers described taking a much more active role in directing care and reducing friction across the claim.

Distance Becomes the Real Cost

One of the clearest impacts Savych highlighted is increased travel distance.

Workers are already traveling significant distances for care, especially in rural areas. For specialty services, average travel distances can exceed 30 miles, and in some cases more than 60 miles. Hospital closures add to that burden, even for more routine care.

As Savych noted, hospital closures increase the distance to medical care, and that added distance introduces real friction into the system.

This is not just an inconvenience. It affects how quickly workers receive care, how consistently they follow treatment plans, and how engaged they remain in their recovery.

Surprising Finding: Costs and Outcomes Do Not Change Much

Perhaps the most unexpected insight from Savych’s research is what did not change.

Despite increased travel distances and shifts in care delivery, there was no strong evidence of increases in medical costs, indemnity costs, or disability duration.

At first glance, that seems counterintuitive.

But as Savych explained, this may be driven by what he described as “setting effects.” While workers are traveling farther and, in some cases, receiving more care, a larger share of that care is being delivered outside of hospital settings.

And that matters.

Hospital based care is typically more expensive than care delivered in physician offices, urgent care centers, or ambulatory surgical centers. As care shifts into these lower cost settings, it can offset the impact of increased utilization or added travel burden.

So while the system is clearly experiencing more friction, the overall cost impact remains relatively stable because where care is delivered is changing.

That said, this ties into a broader trend seen in the WCRI cost data session, where rising claim costs are being driven less by simple utilization changes and more by complexity, pricing, and high-cost cases.

The Real Impact Is on the Worker Experience

If costs are not significantly changing, then where is the real impact?

According to Savych’s findings, it is the worker experience.

When care becomes less convenient and more fragmented, it introduces friction at every step. Workers may delay care, miss appointments, or struggle to navigate a more complex system.

As Savych emphasized, increased distance makes the care less convenient. That inconvenience may not immediately show up in cost data, but it has the potential to influence outcomes over time.

This aligns with a broader theme across multiple sessions, including the Complex Perspectives panel, where system changes, workforce dynamics, and infrastructure shifts are all contributing to a more complex claims environment.

What This Means for Employers

The takeaway for employers is not simply that hospital closures are a problem. It is that the model of care is evolving.

As care shifts away from hospitals and into a more distributed network of providers, employers need to adapt their strategies accordingly.

This may include:

• Being more intentional about directing care
• Building relationships with non-hospital providers
• Supporting transportation and access
• Improving coordination across multiple care settings

It may also include exploring newer options such as telemedicine. While Savych noted this as a potential avenue for employers to consider, he also made clear that it was not directly analyzed in the study and remains an area for future research.

Many employers have already faced these challenges in rural environments. But as Savych’s research shows, hospital closures are accelerating the need to operate this way more broadly.

What Matters Going Forward

The biggest takeaway from Savych’s session is that hospital closures are not simply reducing access. They are redistributing it.

Care is moving from hospitals to outpatient settings, from local providers to more regional ones, and from centralized systems to more fragmented networks.

• For workers, that often means more effort to receive care.
• For employers, it means more responsibility to guide that care.
• And for the system as a whole, it reflects a broader shift already underway.

Access to care is no longer just about whether providers exist. As Savych’s research makes clear, it is about how the system functions in real life.

And that is where this conversation is headed.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post WCRI Notes and Takeaways: When Hospitals Close, Where Does the Care Go? appeared first on Amaxx Workers Comp Blog.

Why Safety Messaging Falls Short

The reality is simple. Safety culture is not built through messaging. It’s built through decisions—specifically, the small, everyday decisions employees make when no one is watching.

Every worker, in every role, is constantly balancing three things: safety, production, and convenience . Do I take the extra time to do this the right way? Or do I move faster and get the job done? Do I follow procedure, or take the shortcut?

In that moment, the poster on the wall has no influence. What matters is what the employee believes will actually happen based on how the company operates. That’s why slogans fail. They don’t shape belief. And belief is what drives behavior.

What Employees Actually Pay Attention To

Employees are not asking themselves what the company says about safety. They are asking something much more practical: What really matters here when safety and production conflict? If leadership says safety is the priority, but consistently rewards speed and output, employees notice. If a supervisor ignores a hazard to keep work moving, that becomes the real message. If someone speaks up and nothing gets fixed, people stop speaking up.

Over time, those experiences—not the slogans—define the culture. This is where many organizations get it wrong. They invest heavily in safety branding instead of safety behavior. They create campaigns, messaging, and visuals, believing that awareness will drive action. But awareness is not the problem. Alignment is.

Behavior Always Beats Branding

Culture is shaped by what leaders do repeatedly, not what they say . Employees watch behavior far more closely than they listen to messaging. And when there is a gap between the two, trust erodes quickly. That gap is where safety programs begin to fail. You can have the best messaging in the world, but if daily decisions contradict it, employees will follow what they see—not what they hear.

The Three Things That Actually Drive Safety Behavior

If slogans don’t work, what does? It comes down to three core drivers: leadership behavior, worker participation, and reporting systems .

Leadership is the strongest of the three. Employees take their cues from what leaders do in real situations. When a leader stops a job because something is unsafe, that sends a powerful message. When a leader follows up on a reported hazard and ensures it gets fixed, that builds credibility. But when leaders prioritize deadlines over safety—even occasionally—it undermines everything else.

The second driver is worker participation. Employees already know where the risks are. They see them every day. The question is whether they feel comfortable speaking up. A strong safety culture is built on a simple framework: ask, listen, and fix . When employees are asked for input, when their concerns are taken seriously, and when action is visibly taken, trust builds. But when issues are raised and nothing happens, reporting stops. And when reporting stops, risk becomes invisible.

The third driver is your reporting system—your ability to capture what is actually happening inside the organization. Many companies rely heavily on lagging indicators like injury rates. But those numbers can be misleading. A low incident rate does not necessarily mean a safe workplace. It may simply mean employees are not reporting issues. A strong safety culture makes reporting easy, safe, and visible. Employees understand that reporting a hazard is not creating a problem—it’s contributing to the solution.

The Real Test of Your Safety Culture

At the end of the day, safety culture is revealed in one simple way: what happens when no one is watching. Do employees take the extra step to do things safely? Or do they take the shortcut? That decision is not influenced by a poster. It’s influenced by trust. By experience. By what they’ve seen happen before.

<!– END SILOS SMALL CALLOUT →

Final Thought

Instead of asking whether your safety messaging is strong, ask a better question: What are your employees learning from your actions? Because the gap between what employees know and what they report—that gap is your safety culture . And closing that gap has nothing to do with slogans. It has everything to do with behavior.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post Safety Slogans Don’t Work: Here’s What Actually Drives Behavior appeared first on Amaxx Workers Comp Blog.

Total cost per claim is now growing at about six percent per year across most study states. That shift matters because for years, workers’ comp was considered one of the more stable lines in property and casualty insurance. As was noted in the session, it has historically been “one of the strongest lines” in the industry. That stability is now being tested.

This Is Not a One-Driver Problem

One of the most important takeaways from this session is that rising costs are not being driven by a single factor.

Instead, three major components are all increasing at the same time:

• Medical payments
• Indemnity benefits
• Benefit delivery expenses

Together, these make up the total cost per claim. And right now, all three are trending upward. Before the pandemic, cost growth was relatively predictable. Most components increased at about two to three percent annually. That has now shifted to five to seven percent growth across multiple categories. That kind of synchronized increase is what makes this trend more concerning.

Medical Costs Are Leading the Story

Medical payments remain the largest component of total claim cost, and they are the primary driver of the current increase. Radeva pointed out that medical payments have been growing at about six percent per year in recent periods. But what is driving that growth is different from what we have seen in the past. Utilization has remained relatively stable. The number of services per claim is not increasing dramatically.

Instead, the growth is coming from two main areas:

• Rising prices for medical services
• An increase in high-cost cases

That second point is especially important.

A Small Percentage of Claims Is Driving a Large Share of Costs

One of the most striking data points from the session was this. High-cost claims represent about six percent of claims in the median state. But they account for roughly forty percent of total medical payments. In some states, that number is even higher. That means even small increases in the number or severity of these claims can have a significant impact on overall system costs.

Radeva explained that certain factors dramatically increase the likelihood of a claim becoming high-cost. Injuries such as fractures between the ankle and hip are far more likely to escalate compared to something like carpal tunnel. Comorbidities also play a major role. About one in five injured workers has a degenerative condition, and those claims are at least thirty percent more likely to become high-cost. This ties directly into the Employer Panel discussion, where the same pattern emerged. Claims are not just becoming more expensive; they are becoming more complex.

Complexity Is Driving More Than Just Medical Costs

What makes high-cost claims particularly impactful is that their effects extend beyond medical payments.

They also drive:

• Longer disability durations
• More intensive care coordination
• Higher litigation and administrative costs

Radeva noted that claims receiving resource-intensive care beyond twelve months are up to thirty-five times more likely to become high-cost. Additionally, claims involving multiple providers early in the process are significantly more likely to escalate. This reinforces a pattern we are seeing more clearly across the system. Complexity early in a claim often leads to cost escalation later.

Indemnity Costs Are Being Driven by Duration, Not Just Wages

Indemnity benefits are also increasing, but the drivers have shifted. Historically, indemnity growth closely followed wage growth. If wages increased by two percent, indemnity benefits followed at roughly the same rate. That relationship still exists, but it is no longer the full story.

Wages increased significantly during the pandemic recovery period, reaching five to six percent growth annually before moderating back down to three to four percent. But even as wage growth has slowed, indemnity costs continue to rise. The reason is duration. Workers are staying on temporary disability longer.

The average duration has increased from about 12 weeks to 13.5 weeks. That may not seem significant at first glance, but across thousands of claims, it adds substantial cost to the system.

Why Disability Duration Is Increasing

Less experienced workers are one key driver. Employees with less than two years of tenure account for about half of claims and tend to have slower recovery patterns. Comorbidities are another factor. Workers with underlying health conditions often require more treatment and take longer to return to work. Behavioral health conditions also play a role. Issues like depression and anxiety can complicate recovery and extend time away from work.

And then there is a factor that often gets overlooked. Return-to-work availability.

In many cases, workers may be medically cleared to return with restrictions, but if no modified duty is available, disability benefits continue. That makes duration not just a medical issue, but an operational one.

The Cost of Managing Claims Is Also Rising

The third component of rising costs is benefit delivery expenses, which include litigation and medical cost containment. These costs have also been increasing steadily. Litigation expenses per claim are growing at about six percent annually, driven by higher payments to defense attorneys and increased use of medical-legal services. Medical cost-containment expenses are also rising, particularly as claims become more complex and require greater oversight.

Radeva made an important point here. This is not a result of inefficiency alone. It reflects the growing complexity of claims. More complex claims require more coordination, more evaluation, and more resources to manage effectively.

The Bigger Picture: A Shift in the Cost Structure

When you step back and look at the full picture, the trend becomes clear.

Since 2022, workers’ comp has entered a new phase where:

• Medical prices are rising
• High-cost claims are playing a larger role
• Disability durations are increasing
• Administrative and litigation costs are climbing

And all of this is happening at the same time. That combination is what is driving the six percent annual increase in total cost per claim.

What This Means for Employers

What stood out to me most from this session is that cost control in workers’ comp is becoming less about any single lever. It is no longer just about reducing utilization. It is no longer just about managing indemnity. And it is no longer just about negotiating medical costs. Instead, it is about managing complexity.

High-cost claims, comorbidities, delayed recovery, and operational gaps like a lack of transitional duty are all intersecting. That means employers need to think more holistically. This ties closely to what I covered in the other WCRI session on access to care and system complexity. The trends are connected. Rising costs are not happening in isolation. They are the result of multiple system pressures converging at once.

What to Watch Going Forward

The session ended with several open questions that are worth paying attention to.

Will medical price growth continue at the current pace?

Will the frequency of high-cost claims increase further?

Will disability duration continue to extend?

And how will labor market conditions influence these trends moving forward?

Those are not small questions. But they point to something important. The future of workers’ comp cost management is going to depend less on reacting to claims and more on understanding the drivers behind them. Because right now, those drivers are becoming more complex, more connected, and more impactful than ever.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post WCRI Notes and Takeaways: Why Workers’ Comp Claim Costs Are Rising Again appeared first on Amaxx Workers Comp Blog.

The panel included Paul Tauriello, Director of the Colorado Division of Workers’ Compensation, Dr. Cora Roelofs from the Center for Construction Research and Training, Neil DeBlock from Zurich North America, and Frank Rivera from the Massachusetts Port Authority. Each came at the system from a different angle: regulatory, labor, insurance, and employer operations. And while the topics ranged from AI to mental health to climate risk, the underlying theme was consistent.

Workers’ compensation is becoming more complex, not less. And the old ways of managing that complexity are starting to break down.

AI Is Moving Fast, but Trust Is Lagging Behind

The panel opened with a discussion on artificial intelligence, and what stood out immediately was the lack of alignment on what AI should actually do in workers’ comp. Paul Tauriello framed it in a way that stuck with me. He described AI in the industry as “overtalked and under-resolved on risk.” That tension showed up throughout the discussion. From a regulatory standpoint, the concern is not just efficiency. It is fairness. Tauriello pointed to new legislation in Colorado focused on preventing AI-driven discrimination and requiring that healthcare decisions include individualized data and human oversight. The concern is that without guardrails, AI could repeat historical patterns of bias in ways that are harder to detect.

From the labor perspective, Dr. Roelofs made a different but equally important point. The issue is not resistance to technology. It is a lack of transparency. She described AI as a “black box,” especially in safety applications, where workers are being monitored without a clear understanding of how the data is used or whether it actually improves outcomes. Her point was simple. Workers will accept change when there is clear evidence that it makes them safer. Without that, trust breaks down.

On the insurance side, Neil DeBlock took a more practical view. He sees AI primarily as a tool for efficiency, particularly in claims handling. He gave the example of summarizing large medical record files in complex claims, freeing up time for adjusters to focus on more meaningful parts of the claim. But even there, he emphasized the importance of keeping human judgment in place. That contrast was one of the more interesting dynamics of the session. Everyone sees the potential of AI. But there is no shared agreement yet on how far it should go, or where the limits should be.

Access to Care Is Also an Administrative Problem

From a previous session, I wrote about how access to care is becoming more operational and less about simple provider availability. This panel reinforced that idea, but added another layer that I think is often overlooked.

Paul Tauriello made the point that access to care is not just about whether providers exist or how close they are. It is also about whether the system allows care to happen. He described administrative barriers as one of the biggest issues. Delays caused by authorization processes, unclear denials, and extended investigations can slow down care even when the provider is available and the treatment is appropriate. At one point, he noted that even when guidelines clearly support a treatment, delays still occur. His focus has been on tightening timelines and closing those gaps so that care is not stalled by the system itself.

That is an important distinction. In many cases, the barrier may not be geography, it could be process.

The Aging Workforce Is Changing How Claims Develop

Another major theme was the aging workforce, but the discussion went deeper than the usual talking points.

Frank Rivera shared a perspective that I think reflects what many claims professionals experience over time. Early in his career, he approached claims narrowly, focusing on the specific injury. But over time, that approach breaks down. As he put it, you might start with a back injury, but quickly realize “everything’s wrong,” and the claim becomes much more complex. That shift matters. Older workers often bring comorbidities, longer recovery timelines, and more complicated return-to-work scenarios. Managing those claims requires a broader view, not just of the injury, but of the entire health and work context. At the same time, there is another side to the aging workforce that does not get enough attention.

From a system perspective, Paul Tauriello noted that experienced workers are often less likely to get injured. But when they do, the severity tends to be higher. That dynamic is changing both frequency and severity trends across the system. And then there is the workforce behind the system itself.

Neil DeBlock raised a concern that has been an issue in our industry for a number of years.. A significant portion of the workers’ comp claims workforce is nearing retirement, and there is not a strong pipeline of new talent coming in. His point was direct. “No one grows up and says they want to be in insurance.” That creates a long-term challenge that technology alone is not going to solve.

Mental Health Requires More Than a Program

The discussion on mental health was one of the more grounded parts of the panel. Dr. Roelofs emphasized that while peer support programs and navigation tools are helpful, they do not address the root causes. Issues like unpredictable schedules, lack of paid time off, and unsafe work environments are still driving mental health challenges. In other words, the system is often responding to the symptoms, not the source.

Neil DeBlock added another layer by bringing the conversation back to the claims process. He pointed out that human interaction is critical in identifying warning signs that technology may miss. His suggestion was that claims management may need to evolve beyond traditional roles, potentially incorporating more support-oriented functions to help injured workers navigate both recovery and life disruption. That idea aligns with something I have seen repeatedly. When injured workers feel isolated or uncertain, outcomes tend to get worse. Addressing that requires more than just medical management.

The Bigger Picture: A System Under Pressure

If I had to summarize this panel in one takeaway, it would be this. The workers’ compensation system is being pulled in multiple directions at once.

Technology is advancing faster than regulation, and trust can keep up. Workforce demographics are shifting. Access to care is becoming more complex. And mental health is becoming more visible.

What struck me is that none of these issues exist in isolation. They all connect back to how the system functions as a whole. And that may be the real challenge going forward. It is not just about solving individual problems. It is about adapting the system to handle a higher level of complexity without losing the human element that ultimately drives outcomes. That was the thread running through this entire discussion. And it is something I expect we will be hearing a lot more about in the years ahead.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post WCRI Notes and Takeaways: AI, Risk, and the Expanding Complexity of Workers’ Comp appeared first on Amaxx Workers Comp Blog.

Was the injury legitimate?
Was the claim denied?
Was the employee exaggerating?

But those questions miss a much more important truth:

Most workers don’t hire attorneys because of the claim.
They hire attorneys because of fear — specifically, financial fear.

At the center of that fear is what we can call the Breadwinner Effect.

The Moment Everything Changes

When an employee gets injured, their world doesn’t just pause—it becomes uncertain. For many workers, especially those in hourly or physically demanding roles, income is not optional. It is immediate, necessary, and often already allocated before it even arrives. Rent, groceries, utilities, and family expenses depend on it.

So when that income is suddenly interrupted, the injured worker isn’t thinking about claims strategy or legal process.

They’re thinking:

“How am I going to pay my bills?”
“Who is going to cover these medical costs?”
“Why hasn’t anyone told me what’s happening?”

These are not legal concerns. They are survival concerns.

What Injured Workers Actually Experience

From the plaintiff attorney perspective, one of the most common triggers for attorney involvement is surprisingly simple:

No one contacted the injured worker.

Two weeks go by, and the employee still doesn’t know:

• How they will get paid
• Whether the claim is accepted
• Who is handling their case
• What happens next

In that silence, uncertainty grows. And uncertainty quickly turns into assumption.

The worker begins to believe the worst:

• The claim must have been denied
• The employer doesn’t care
• They might lose their job

At that point, hiring an attorney feels less like escalation—and more like protection.

It’s Not Just the Worker — It’s the Role They Carry

One of the most powerful insights from the discussion was the recognition that many injured workers see themselves not just as employees, but as providers. They are the ones responsible for keeping everything running at home. Whether it’s supporting a spouse, raising children, or simply maintaining financial stability, their identity is tied to their ability to earn. When that ability is threatened, the pressure intensifies.

This is especially true in households where there is a single primary income. When that income becomes uncertain, the entire household feels it immediately. Conversations at home shift from routine to urgent:

“What are we going to do for money?”
“How long will this last?”
“Are we going to be okay?”

That pressure doesn’t wait for the claims process to catch up.

Why Financial Fear Turns Into Litigation

Litigation is often a reaction to uncertainty—not conflict.

When injured workers don’t understand how the system works, they try to create certainty wherever they can. And an attorney provides exactly that:

• Someone who will explain the process
• Someone who will advocate for payment
• Someone who appears to bring control back to the situation

From the worker’s perspective, hiring an attorney is not about fighting the employer. It’s about stabilizing their financial situation. Unfortunately, once that step is taken, the claim changes. Communication becomes more formal. Costs increase. Timelines extend. And what could have been a cooperative process becomes adversarial.

Where Employers Get It Wrong

Most litigation that stems from financial fear is preventable. But employers often underestimate how quickly fear builds when there is no communication. They assume the system is working because the claim is being processed internally. Meanwhile, the injured worker is sitting at home with no information and mounting anxiety. Even small gaps create big problems.

A delayed phone call.
A missing explanation.
A bill that arrives before reassurance does.

Each one reinforces the idea that the worker is on their own.

How to Defuse the Breadwinner Effect Early

The solution is not complex, but it does require intention. The most effective employers act immediately to remove financial uncertainty. They reach out early—often within the first 24 hours—not with technical language, but with clarity and reassurance. They explain what the injured worker can expect: how wage replacement works, how medical bills are handled, and who will be guiding the process. Even if all the answers are not available yet, simply acknowledging the situation makes a significant difference.

Equally important is reinforcing that the employee is valued and that the goal is recovery and return to work. This directly addresses the fear of job loss, which is one of the most powerful drivers of attorney involvement. Simple tools can support this effort. A clearly written employee brochure outlining the process helps eliminate confusion. A handwritten get-well card from a supervisor can shift perception in a way that policies never will. Ongoing follow-up ensures that initial reassurance doesn’t fade into silence.

These actions may seem small, but to an injured worker facing financial uncertainty, they carry enormous weight.

A Different Way to Look at Litigation

The biggest shift employers can make is this:

Stop viewing litigation as a legal problem.
Start viewing it as a human response to financial insecurity.

When workers feel informed, supported, and confident that their needs will be addressed, they rarely feel the need to involve an attorney. But when they feel uncertain—especially about money—they act quickly to protect themselves.

The Bottom Line

Most injured workers are not looking for a fight. They are looking for stability. They want to know that their bills will be paid, their income will continue, and their job is secure. When those needs are met early, trust is built and litigation is avoided. When they are not, even a straightforward claim can escalate quickly. Understanding the Breadwinner Effect allows employers to see what is really driving behavior—and to respond in a way that keeps claims on track, costs down, and relationships intact.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post The Breadwinner Effect: Why Financial Fear Drives Workers’ Comp Litigation appeared first on Amaxx Workers Comp Blog.

At this conference, one of the most timely discussions I attended focused on a challenge that continues to affect nearly every corner of workers’ compensation: access to care.

This panel took a different angle than the Employer Panel earlier in the conference. While the employer discussion focused more on operational challenges inside organizations, this session explored the broader system level barriers that make it difficult for injured workers to actually get treatment.

The panel brought together perspectives from regulators, insurers, and employers, which made the discussion especially valuable. Instead of staying theoretical, the conversation focused on what access problems actually look like in the field and what organizations are doing right now to address them.

What stood out to me most is that access to care is no longer just a provider network issue. It is a workforce issue, a communication issue, a systems issue, and in many cases, a community infrastructure issue.

The barriers are not limited to one geography or one type of employer. They appear in rural towns, in major cities, in panel states, in employee choice states, and even in markets where provider directories look full on paper but functionally offer very few real options.

One thing became very clear during the discussion: in workers’ compensation, delays in care are not just inconvenient. They directly affect recovery, return to work, trust in the system, and ultimately claim outcomes.

Issues Employers Face With Access to Care

One of the most useful parts of the conversation was how honestly the panel described the reality on the ground. Jessica Moyers of Hershey shared an example that illustrates how dramatically access to care can vary depending on location.

Most people associate Hershey with Pennsylvania, but the company operates facilities across multiple states and environments. In some locations, access to care is relatively easy. In others, it is anything but.

Moyers described a facility in Bluffton, Indiana, a town with fewer than ten thousand residents. The community has only one physician, a small hospital without an emergency department, and limited specialty services. When an injury requires specialized care, the solution is often simple but logistically challenging.

“We drive,” Moyers explained when discussing how they get employees access to treatment when local options do not exist.

That example highlights an important reality. Access to care is not an abstract policy issue. It becomes very real when an injured worker needs a specialist, when there is no local provider for a dental or eye injury, or when the nearest appropriate care requires transportation planning just to make treatment possible.

The panel also discussed a growing phenomenon sometimes referred to as “ghost listings.”

Maria Capelli-Schellpfeffer of Liberty Mutual described the issue this way: providers may appear in directories as participating physicians, but when someone attempts to schedule an appointment, they discover the provider is no longer accepting workers’ compensation patients.

As she explained, “You look at the list, and the providers are there, but when you reach out, they’re not seeing workers’ comp patients.” This disconnect between listed providers and actual availability is becoming an increasingly common challenge nationwide.

Why This Matters More in Workers’ Comp

Waiting weeks for a routine appointment is frustrating in group health. In workers’ compensation, the consequences can be much greater.

Capelli-Schellpfeffer emphasized that delays in treatment directly affect recovery potential and return to work.

“If scheduling a surgery takes weeks or months, that delay has a direct impact on the injured worker’s ability to recover,” she noted.

When injured workers cannot access care quickly, several things begin to happen. Recovery slows. Employee frustration grows. Trust in the system declines. And once trust erodes, the claim becomes harder to manage at every step.

The panel repeatedly returned to this point. Access to care is not just about provider convenience. It shapes the injured worker’s entire experience with the workers’ compensation system.

Practical Solutions Employers Are Using

What I appreciated about this session was that it did not pretend there is one universal solution. Instead, the panel highlighted practical interventions organizations are already using. One approach is building relationships with providers before injuries occur.

Employers are increasingly inviting physicians and therapists into their facilities to better understand the work environment and the physical demands of the job.

Another solution discussed was transportation planning for rural locations. When care options are limited locally, simply ensuring the injured worker can travel to appropriate providers can remove a major barrier.

Technology is also playing a growing role. Several panelists highlighted the value of 24/7 nurse triage programs combined with telemedicine, which allow injured workers to immediately speak with a clinician who can guide them to the appropriate next step. These tools can be particularly valuable in rural areas or for mobile workforces.

The discussion also touched on direct contracting, an approach becoming more common as organizations seek to fill gaps where traditional networks are no longer sufficient. Rather than relying solely on PPO networks, employers are increasingly forming direct relationships with specific providers to guarantee access when it matters most.

On-Site Clinics and the Culture of Care

The conversation also included a candid discussion about on site clinics. Moyers explained that Hershey operates many facilities with on-site nurses and medical resources. Interestingly, she noted that the financial return on investment from a workers’ comp perspective is not always clear.

However, the cultural impact is significant. Employees know there is someone on site who understands their work environment and can help immediately if something goes wrong. That kind of support sends a powerful message. It reinforces that the company cares about employee health and safety, not just claim administration. In many cases, the most valuable benefit of these programs is not cost savings. It is the trust they create.

My Biggest Takeaway: Communication Is Still the Foundation

By the end of the session, my biggest takeaway was surprisingly simple. For all the discussion around networks, telemedicine, rural healthcare funding, and provider shortages, the most consistent answer to the question of what needs to improve was communication.

Jessica Moyers emphasized that employees need clear guidance on what to do after an injury.

“Communication as a whole,” she said, “would help a thousandfold.”

That communication includes how injuries are reported, where employees should go for treatment, how information flows between providers and employers, and what steps happen next in the claim process. The panel also emphasized the importance of communication between system stakeholders.

Jeff Nelson, Commissioner of Workers’ Compensation at the Texas Department of Insurance, encouraged industry participants to speak up when regulatory barriers create problems.

“We want a system that works for everybody,” Nelson said. “If there are things we can improve, we need to know about them.”

That kind of collaboration between employers, regulators, and providers will be critical if the industry hopes to close the growing access gaps.

What Matters Going Forward

This session did not offer a single silver bullet, but it did offer something better: a realistic picture of the challenge and a practical sense of where progress can happen. Access to care in workers’ compensation is becoming more localized, more operational, and more dependent on real collaboration. Provider directories alone will not solve it. Networks alone will not solve it. Technology alone will not solve it.

What will move the needle is a more connected approach that combines communication, creative care access strategies, stronger employer-provider relationships, and better data about where the true gaps actually exist.

If the Employer Panel earlier in the conference highlighted how organizations are redesigning their internal claims programs, this session reinforced that solving access to care will require changes across the entire workers’ compensation ecosystem.

Access to care is not a side issue. It is one of the core factors shaping recovery, claim performance, and trust in the system itself.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%.  He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors.  IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2025 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The post WCRI Notes and Takeaways: Access to Care Issues and Potential Solutions appeared first on Amaxx Workers Comp Blog.