ReAudio: ReAssess Your Workers Comp Toolbox
ReAudio goes beyond policies and regulations to explore the real impact of workers’ compensation. We break down key industry trends, workplace injury data, and best practices while diving into the human side of recovery. Through expert conversations and powerful stories, we uncover the challenges, emotions, and perspectives that shape the experience for employees and employers alike.
Whether you’re an industry professional or just curious about the system behind workplace injuries, this podcast brings you the facts you need and the stories that matter—because workers’ comp isn’t just about processes, it’s about people.
The award-winning ReAudio podcast is presented by your partners at ReEmployAbility. Thanks for listening!
ReAudio: ReAssess Your Workers Comp Toolbox
When Healing Meets Process: The Human Side of Workers' Compensation
Welcome to Season 5 of ReAudio!
When a workplace injury happens, employees are thrown into a system they rarely understand. Dr. Claire Muselman, COO at workerscompensation.com, breaks down the realities of workers’ comp—what it is, what it isn’t, and why expectations often don’t align.
She shares her own experience with workplace injuries, explains why the first 48 hours are critical for recovery, and discusses how delays and miscommunication can impact both physical and emotional healing.
Tune in to learn how organizations can better support injured workers and create a more effective, people-centered claims process.
Visit workerscompensation.com, sign up for their newsletter, or connect with our guest on LinkedIn.
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Speaker 1:You may have been one of the first guests that we had on like three or four years ago when we started this and we so appreciate your always saying yes to hop on and, in a lot of instances, kind of kick off the year for us because insights are so helpful to really help, I think, recenter, everybody as we go into a new year. So obviously you decided not to retire in 2025. You're super, super busy, of course. I noticed you're the COO at workerscompensationcom, assistant professor of practice and co-director of Master of Science and Leadership Program at Drake University, ambassador to the Alliance of Women in Workers' Compensation and you also work with Kids, chance of Iowa, work Complets and the Claim and Litigation Management Alliance. Holy cow, dr Clare, yeah, how'd you get to all that stuff?
Speaker 2:Oh, it's fun. Everything's in alignment. Everything goes into alignment with personal values and professional mission, that's for sure. But so Drake has been amazing. I became a full-time faculty member there in 2023 and became a trying to think about how to best put this. We designed a brand new Master of Science in Leadership program from scratch, which, let me tell you, if we thought our jobs were hard, try and go get accredited and go through those processes of designing every class, every possible structure that could go into something, and then go get it approved like 17 times.
Speaker 2:So very cool, very fun. It's kind of like an encompassing of everything I have done thus far in my career During that time period of becoming a professor like a full professor, full-time professor. I'm a professor of practice, so we stay in industry, which is where my COO role of workerscompensationcom comes in. I've been writing back when workerscompensationcom was run with a different regime. I've been writing there since like 2019. I'm still writing for them. I write for Frank Ferrari he is the head of the media department there but I get to be all the off stuff, kind of behind the scenes of all of the amazing stuff that those great people make sure that the world is aware of what is going on in workers' compensation.
Speaker 2:And this is our 25th anniversary and so we have taken a different lens of kind of what it is. So workerscompensationcom isn't just a media site that everyone thinks that this is where articles get published, but they're actually a compliance tech side that actually helps claims professionals and people who might not be super well-versed in workers' compensation. It's kind of like the encyclopedia of work comp.
Speaker 2:And so this year we have added a couple of different components. We're really like breaking down the basics for employers who might not have any idea about workers' compensation, and then we are also running an emotion series that will turn into a book for people who have been injured, understanding and validating their emotional experience, and then also having the how-to guides for supervisors, for leaders and supportive partners along the process. So we're trying to really build out more of it being people-oriented. Like you and I've been talking about forever where we've done so much focus on the compliance side.
Speaker 2:Now it's time to do more on the people side.
Speaker 1:Yeah, I love bringing in the injured worker into this whole thing as well. I think it's impossible not to look at them as a human being when you incorporate them into this process, especially on workerscompensationcom. My wife is a teacher. She fell off a stool several years ago at school so she was fine. She hit her head, thank goodness.
Speaker 1:But obviously that was a workers' compensation claim and who would have thought, as a classroom teacher, you'd have to go through that process? And I'm so grateful that I was in this industry because I was able to just kind of explain to her like who is this person calling and what is this company that she's calling from and why are they calling and calling and what is this company that she's calling from and why are they calling. And there was no explanation and it's nobody's fault, it's just you know kind of what we were a little bit talking about before we started recording. Like we, we live this on a daily basis.
Speaker 1:People that get injured do not, and so it would like be somebody throwing me into a backhoe and say, okay, dig a ditch right. I would have no idea the first thing to do. And it's the same thing for for people trying to manage the workers compensation world when they're injured. So it's so nice that you guys are bringing that in and I like the foundational stuff and that kind of comes to those articles that you had written at the beginning of January of this year with regards to managing red flags and high risk claims, as well as the communication aspect with claims adjusters, and they were written back to back.
Speaker 1:I kind of wanted to talk to him in reverse order, though it seems like kind of the managing high risk really leads into the better communication aspect, Did you so? You mentioned all the different kind of audiences with workerscompensationcom. Now did you write those articles with different audiences in mind or were they generally for anybody that's interested in leaning in and learning more?
Speaker 2:So a lot of the writing I do is very general, generalized, generally based. There are a couple of ones, so these are part of a roadmap series is what we developed. We had enough employers that I have been talking to and working with just in my captive environment, and we've got the global insurance accelerator going on here in Des Moines right now, and there's a lot of times that people just don't know what they don't know, and so I thought that there would be an element that we could really break it down and simplify the process, because, to your point, people don't know who's calling. They don't know why people are calling who do you need to have information ready for? What information do you need to have? And I think this is such an advantageous group of people to begin with that it's very hard to navigate if you don't have a person like you with your wife in your corner, and so we wanted to break this down and really simplify the process of what happens at what point, and so these two articles that you're referencing are pieces of, okay, what happens once the claims occurred, and so we've broken it out into three different areas where it's like what to have, what to be ready for before a claim ever happens, because ideally that's where we've done most of our work.
Speaker 2:Most organizations don't do that. We wait until something happens. It's just kind of human nature, it's our human behavior. Until there's an issue, we don't fix something. So we've got that pre. Then we have what happens when a claim happens, and a lot of times we see the employer side go a little bit more on that. Well, it's his fault. Safety should have done this. Why didn't this happen? And we go in the finger pointing instead of the claim happened. Who cares? Now it's trying to get this person back to work, back to life and when we look at it from that landscape, all right, if we just take all of the ick out of the way and just focus on here's the claim. What do we need to do for this person to get them back to work, back to life and move on?
Speaker 2:let's just put that energy there instead of in all the other kind of bullshit places yeah and then we've got like the post claim that is running right now, or okay, so a claims happened, we've got them back to work. Now what? Because just getting them back to work in a modified capacity isn't necessarily the end of the claim. But if you're on the employer side, you're not going to give very much more thought to it if they're back in the workplace so then what happens?
Speaker 2:and then our last series is what happens if a claim is deemed non-compensable. What is your roadmap to that? Because there is a roadmap. We just get really bad when that one happens.
Speaker 1:Right For sure, looking at these two particular articles and I certainly would love to move Maybe we can talk about this in another episode as we do kind of go along this process because they're all so, so important Looking at like it looks like. Obviously, communication is key in every part of this, but we can communicate and talk about two totally different things as an end result, and we could have great communication but we could be each be talking about totally different things right.
Speaker 1:So, in the overall perspective, if you look at a claims adjuster, if you look at a risk manager, if you look at all the people involved in a claim, how often do you see that their end goal is not necessarily always getting that injured worker back to work right, like they have different end goals, can you? Talk a little bit about those various end goals and maybe some of your experience on how to better focus everybody's goal on the right thing.
Speaker 2:So I think there's a common misconception in workers' compensation to start out with. When someone gets injured, our goal as an industry is to get them back to work period. It isn't about restoring the livelihood of this individual to their full functioning capabilities prior to injury. The work comp system is literally to get them back to work. So I'll give myself an example. So I used to run marathons. I've run seven of them and I had a hip injury and a knee injury that were both deemed workers' compensation that I can't run marathons anymore. I probably could make it the effort, but my surgeons have advised against it if I would like to keep my body parts. So work comp isn't going to try and restore me back to marathon status. What work comp did was make sure I could get back to my sedentary job duties because, I've always been, you know being in the work comp space.
Speaker 2:On the insurance side, our jobs are seated, sedentary for the most part. So when we look at what the intention behind the industry is, it's to get that person back into functional work abilities, not necessarily restore what their life was like previously. And I want to caveat that and state that blatantly, because it's a very common misconception on the injured worker side. Like we want to go back to like I want to go back to running again. I mean it was great, I loved it, it was in really good shape, that was a huge thing for me. But that's not the way the laws are designed and so having that highlighted up front is really, really, really important. But I don't know anyone that talks about that at all until we're at like settlement time. So I think that's one to just clarify on the front. On the get-go, I wrote an article this past year called when Are All the Injured Workers' Yachts? Because you know people think that people are out here to game the system and try and get this.
Speaker 2:But work comp gives you indemnity benefits and medical benefits. There's no yachts. But people get really upset when they can't get back to their pre-life status. So when we start looking at the end goal of an adjuster, adjusters want to close the claims, like our goal as adjusters is to move these claims through their process so that they get closed, and so ideally for that is getting the injured worker to the best medical position that they can be. Get them to that maximum medical improvement. If there's any type of impairment that needs to be issued, get that done, paid and close the claim.
Speaker 2:Risk manager is also probably is going to be wanting to see that claim closed.
Speaker 2:Employer representative wants that person back in the office and then once that person's back into an office or into their work environment whether it's a construction site, it's an office dynamic, it's on the floor restaurant, you name it they're not going to pay as much attention to the ongoing maybe physical therapy or getting that person to MMI.
Speaker 2:So each person has like a different benchmark of what they're looking for, to the ongoing maybe physical therapy or getting that person to MMI. So each person has like a different benchmark of what they're looking for, because I even thought about that as we're in this third roadmap. It says post-claim strategies. Well, the claim is still going on, but from an employer standpoint, the claim is done on their mind because their person is back in the office and so, even like us talking about it, I'm like I probably should have renamed that something different, or like post-return to work, and called it something different, because it is going to mean different things to different people that are navigating this situation and so having the different end goal, like we've always looked at it back to work, back to life but as a twofold First we get you back to work and then we're going to try and help you adjust to what your life is like, and then the claim closes.
Speaker 2:And so that's always been my claims philosophy, whether I was on the employer as the risk manager or I've been managing the insurance company or running a claims team. That's always been ours, because it's not just the return to work, it's what happens to their life now and that's, I think, where we see a big misconception between what the adjuster's goal is versus, like the employer, risk manager side.
Speaker 1:How involved is an adjuster after that injured worker goes back to work? Because my I mean, you blew away my assumption right there, thinking about, once we get somebody back to work if they're, you know, released to their full duty, right, I understand that if they're in modified duty, there's ongoing process to get them back to full duty, if that's possible. But once an injured worker is released to full duty, what is the claims adjuster's responsibility after that? Because, essentially right, that claim is closed.
Speaker 2:Yeah, they give usually okay if there's no any type of benefits that are going to be issued long term. So any type of permanency, because maybe they're not at their full functioning ability. About 30 days. People usually give it about 30 days. Make sure the rest of the medical bills come in and those get processed. Maybe there would be a straggler, but outside of that it's about another 30 days and then we're going to go ahead and close your claim file. What else needs to be filed with the state and people move on so that's really so.
Speaker 1:Then it's on the employer really to make sure that that, if there's any, everything continues to go well psychological, um, mental issues that have to be worked through. If they're, if they fully, you know, if they've returned to their regular role and they're able to complete it right, because I'm sure sometimes we return people to their regular role and they're able to complete it right, because I'm sure sometimes we return people to their regular role and it's really maybe not quite time to do that or there's a reason why they're not able to fully function where they should be. So it's on that risk manager or on that direct manager, that employee, to keep an eye out for those types of things, right, and we're kind of going off the beaten path of these particular articles, but I think that's really important for people to understand, especially on the employer side. Like you said, it's not over when that claim is closed, right.
Speaker 2:No, and usually this tends to fall to HR then, where if somebody has an issue but remember, hr wears a lot of hats of trying to keep an organization moving forward and so it's interesting like we created this roadmap series so that people don't fall through the cracks and if you have these one-off claims that you know what to do, okay, so I still need to follow up with this person.
Speaker 2:Okay, claim is closed, but on the employer side, still checking in every few weeks and just saying, hey, I just want to make sure you're still doing okay, can make a huge difference, because what you don't know can and will hurt you. You don't know can and will hurt you Because if something does go wrong and you, as the employer, are not notified about it or you don't know what's going on, who do you think they're going to go talk to? And this is where we try to look at what goes on from a legal standpoint, and a lot of times we hear my employer doesn't care about me. So this is where we're trying to put the power back into our scope of control. Each of us has a scope of control in this industry and in this claim system type mentality that we can then take our scope of control to help mitigate the risk that is coming or has already manifested from these injuries.
Speaker 1:And we talk about being proactive a lot from all different aspects of the claim process and efficiency comes into that as well. Right, by being proactive it makes the whole process be a little bit more efficient. Do you ever run into issues where perhaps, like a claims adjuster or even on the employer side, a risk manager, somebody wants to be more proactive with an injured worker but, for whatever reason, higher-ups are kind of stifling that ability to take that extra step and maybe go beyond just checking the box to make sure that they are doing the right thing for that injured worker? And if you do run into those I'm sure you have what are some ways for those individuals to be able to overcome that resistance that maybe they're getting from higher ups?
Speaker 2:Sure.
Speaker 2:So I think this goes twofold. So we continue to hear. You know, the best claim is a claim that doesn't happen or the best claim is a closed claim. As a behavioral scientist at Drake University that is currently researching neuroscience and claims, let me just tell everyone people are going to get injured. It happens. That's like literally sending your toddler outside and hoping that they don't skin their knee. We're humans being and this stuff's going to happen.
Speaker 2:So I think when we start to see people that want to be more proactive, the first thing that higher-ups tend to get nervous about is what is this going to do for our liability? Liability and this is again an educational thing on the workers' compensation side, because you don't get faults thrown at you from a legal standpoint by doing what is in the best interest of your injured human, your injured employee. And a lot of times when someone gets injured, they get shipped off to the island of misfit toys, kind of, and we put them on this island where they're still your employee. They were good enough for you to hire into your culture to begin with. What do you think is happening now? And so, when I've seen the people that want to take that extra step usually the first path of resistance is okay. Well, if we go above and beyond for this person, what happens to the next or whatnot? And I want to reiterate that each case is so individually specific that in working with, if you're the risk manager, in working with those direct supervisors, showing how this care, compassion, concern, maybe going a little bit above and beyond, ends up having a better ROI, not only from a claim standpoint but also from an organizational culture standpoint. Because what do you think that injured worker is going to go tell all their colleagues or their friends?
Speaker 2:Because a lot of times we focus on the easy metrics to track where we're like how many days has somebody been off work, how much have we spent, what has been like the lost time, and we focus on these metrics.
Speaker 2:What we don't track are what happens to that supervisor when this person goes out. And now they have to add on their stress of that workload, of figuring out how to redisperse it. Or what about the unintended nature of overtime? Because you're not going to hire somebody to come fill this person's job if they're only going to be out a couple of weeks. So then you've got overtime for employees, you've got added duties, you've got added stress on this team that's happening. So for a risk manager to say, hey, I want to go above and beyond to help this employee so we can get them back integrated with this team that's going to do so much from the employee morale standpoint and what's going on within that team, like we don't quantify what's going on with the supervisor and the other employees. But if you start to look at that dollar for dollar from an inefficiency and productivity standpoint, you can't tell me that's not going to pay for itself but we don't track that.
Speaker 2:So we can't specify what kind of. Roi that's actually delivering. But, I mean again, we're not hiring people to come fill this person's job, to train them, if they're only going to be out three, six, eight weeks. Yeah, yeah, it's difficult I think that's the argument you make.
Speaker 1:Yeah, you can't, you can't. There's a lot of things that are not trackable. There's a lot of things that you know in in every aspect of business that sometimes we try to assign some kind of trackability to. That's just, it's it, and you're right, those things absolutely fall away. So let's say we're in a situation where we have a claim and I'm sure you would agree with me that the majority of claims move pretty smoothly. I mean, my wife was. I mean there was no issues, she went right back to work. Thank goodness she was okay. Right, it was a claim, it was handled, it was settled, done right, and that's the majority correct 80% of claims we don't talk about.
Speaker 1:We don't talk about it's the red car theory, the success. I don't talk about that. I want to be a red car.
Speaker 2:I'm going to talk about fraud. Oh, let's talk about those people.
Speaker 1:Right. So now let's look at the one article you wrote was about identifying some red flags. So we want to try to make 90 to 100 percent of them go smoothly, right, and so there's definitely indicators as a claim is created that maybe would be an alert to not only an adjuster but to a employer as well, right? So kind of morphing these two articles together. Talk a little bit about some of those red flags and how does communication come into play when those things are identified between employer and adjuster?
Speaker 2:Sure. So I think the number one thing to talk about is lag time. The lag time in reporting, from the moment that the injury happens to when it gets reported to a supervisor, is crucial, and then from that employee representative, that supervisor, HR, whoever it is to the claims team is really important. So we've seen a lot of data recently, especially in this past year, about that zero to 48-hour window and we've talked about this in the industry forever. But now medical professionals are helping us put our money where our mouth is on how important it is we get people to the right facilities, the right specialists within 48 hours of the injury.
Speaker 2:And so what we see when we start to see these red flags from a lag time perspective, I look at it twofold. One, did somebody drop the ball and this is like an organizational culture thing of not getting people notified the way we're supposed to, or is it? Two, do people just have no idea what the expectations are? And I say that because when I was the chief risk officer of an industrial services company, the number one phone call I would get off hours is so-and-so got injured. What do we do? So? This is where what plan do you have in place for your people to know who to contact, and then where's the phone number? Where is the information that they actually need to make sure that they know what to do?
Speaker 2:Again, we don't want to deal with this until it's actually happened, but we've got to get people moving quickly and when we start to see a delay, like Todd, think about it from the standpoint from your wife. Your wife falls off the stool, hits her head. Let's say nobody talks to her for like the next five days, because that's what I'm seeing for lag time right now with a couple of groups I'm working with. It's like five days. Can you imagine no one talking to your wife about this for?
Speaker 1:five days she hit her head yeah. Like come on, yeah, well, and a lot can happen in five days, right, you know, you could be fine that first day and then two days later start to see stars. I mean yeah.
Speaker 2:So that is an issue. Some of the times we tend to assimilate lag time with somebody faking an injury. But again, did they know where they were supposed to go? Was it at least reported? And the difference that comes with a lot of these is people get fearful of filing claims on the employer side because they're worried about what it's going to do to their mod.
Speaker 2:You know, every claims program is set up differently, but where we start to see the sticky get really icky is where there's this lag time and the employer's like, well, maybe I'll just try and send Joe to the doctor's office myself. And then it starts to become something. So let's just say it was your wife, she fell off the stool, she hit her head and we're like, well, we'll just go ahead and cover that doctor's appointment. But let's say it gets bad again. Two days later she's starting to see stars, she needs an MRI. And this is where it starts to get bad.
Speaker 2:But that's not on the injured worker, that's on you having a bad process as an employer. And this is where we have thrown a lot of heat towards injured workers saying, well, they didn't tell us, did they? Or did they not have a right process in place so that they knew what they were supposed to do. And this is where we see triage lines being really helpful. But a lot of times it's fear of the unknown. People don't know what to do because we've never had this happen before. So you know, all right, she said she bumped her head, all right. And the supervisor makes a note on their desk and a week later the note is still on the desk. Nobody's been told. And again, I don't know about you, but if that's my partner, like, I'm going to be really angry and I think about when we start to put it in terms of people that we care about our loved ones, our children, our parents, like you name it.
Speaker 2:We would never want that for them. So if we take a step back and start to seek to understand what's going on, that can make a big difference. And when we have these delays in reporting, then if we want to go talk to witnesses well, I don't remember what happened a week ago we're off to a whole different project and we're trying to go back to witnesses saying, hey, we wanted to get more information around this and that doesn't. It doesn't work like that. So not only is this timely reporting so imperative, but it sets the tone for everything else, so that you can get a good investigation. Now I also want to caveat this into the point where people need to know what they need to do when they get injured and they need to know what information they are supposed to provide.
Speaker 2:If we can give that up front to people like, okay, if you get injured, this is what, like, you call MedCorps advisors, you call MedCorps, you call, like, any of these triage lines, or maybe Cedric's Nurse Triage, whatever it is, and this is the information you need to have readily available, because that then helps everybody else that's going to go through this process to help that investigation, help establish those facts and resolve any discrepancies, because we were prepared to make that initial phone call and if you've got all this information up front, that's only going to strengthen the communication with everybody else, to align expectations, because by the time the adjuster gets assigned now, she or he has a good amount of information that they need to be able to move forward, versus having these blank spaces where they have to try and piece together information and now this person's at the ER and well, we could call them then because we have 24 hours to make our phone call.
Speaker 2:But do you think that they're going to be in a headspace that is able to retain information while cortisol and adrenaline are pumping through their body? Probably not.
Speaker 2:But, we don't pay attention to those elements, even though they're crucial for the understanding of what is going on throughout this process.
Speaker 1:Yeah, there's so much fear involved on both sides, right, I mean, as an employee, I might be fearful to make even say that I got hurt, right, because I don't know what this is going to lead to. I got to keep working, I don't want to be out of work. Hey, I'm tough. I mean, listen, I've hurt myself before.
Speaker 2:What's a little blood, right, I thought both of mine that when I was an adult were when I was a director of work comp and the other was a VP of work comp. Let me tell you how stupid I felt. I mean like I need I need to report a work comp claim and like witnesses were around for all of them. I mean it wasn't, but you feel like there's a sense of shame that comes with it, especially even being through the being from the system and knowing how it works. That doesn't change things. I mean you're still injured and there's all these emotions that come with an injury to your body, and so I'm very excited that workerscompensationcom is going to unpack all of that and then help people Like it's okay, here is validation for an injured worker, here is validation for an employer.
Speaker 2:This is how you do that, because a lot of times we feel these things in a silo and then we're like is this okay? Of times, we feel these things in a silo and then we're like is this okay, is it not? And that impacts the healing process because of stress, anxiety, the different neurotransmitters, the different hormones that get released as a result, and it impacts that healing process. And again, so much of this steers to your point from the fear of the unknown.
Speaker 1:Yeah, we have only scratched the surface of I know what's on workers compensation dot com, especially now with the kind of the new direction and the. I guess the the organization's goal now of really embracing all aspects of the workers compensation world, including the injured worker, which is amazing. So workers compensation dot com is obviously. Anybody can go there and browse around. I believe I got this through an email, yeah.
Speaker 2:Yeah.
Speaker 1:So if you yeah, tell me, tell everybody if they want to look into workerscompensationcom a little bit more, what they can find there and how to proceed.
Speaker 2:Yeah, you can go to workerscompensationcom. We do have a weekly newsletter that kind of recaps what our top articles have been. You can follow us on LinkedIn. There's a newsletter that is released every morning and then we highlight some of the articles. It focuses on cases that are going around throughout the United States anything work comp related that you should know about. Sometimes we get the really crazy awesome cases, the one-offs, that are fascinating and interesting, and other times it's updates based on jurisdictional law. You know we just hit a new year, so here comes all of the regulation updates the maximum and minimums for states, mileage, you name it, and this is your one-stop shop for all things compliance.
Speaker 1:Awesome, dr Claire. I'm so glad that you're there now and looking forward to everything that's going to be coming out, and thank you so much for your time with us. Will you come back again this year? We should do this like quarterly or something.
Speaker 2:Yeah, I would love that. It'd be great.
Speaker 1:Awesome. Thank you so much, Dr Claire Musselman. We appreciate your time.
Speaker 2:Thank you, Todd.
Speaker 1:Claire Musselman. We appreciate your time. Thank you, todd. Thanks for listening to REA Audio. I hope we opened up your brain a bit and helped you be better at what you do. Please follow us on Spotify, apple Podcasts, stitcher, amazon Music or wherever you get your podcasts. If you have input or suggestions, email Todd at reemployabilitycom. Be grateful and have a fantastic rest of your week.
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