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Predictions for workers’ comp in 2019 – part 2

Continuing my predictions for workers’ comp in 2019, the first five were Wednesday.

But before I do, you may want to read this on the fallacy of so-called “experts” – I occasionally think I am one. (thanks To Tom Lynch of Lynch-Ryan for the link)

6.  The “advocacy” claims model will gain a lot more traction, as more employers, insurers, and TPAs embrace treating “claimants” as actual real people with medical and disability problems.

The problem is – how do we track this? That’s my challenge, but I hope you will let me know of payers embracing the model!

7.  “Opt-Out” will not gain traction.

Allowing employers to “opt out” of workers compensation is a solution in search of a problem – overall work comp is working pretty well, costs are under control, employers don’t see it as an issue, most patients recover and get back to work.

Most importantly, there is no significant political constituency that cares enough about it to make it happen.

Promoted by ARAWC and a few stakeholders invested in managing opt-out business, this isn’t going anywhere. Change does not happen unless there is a problem that needs fixing, and work comp’s problems are tiny in comparison to other issues confronting state legislatures…taxes, school funding, gerrymandering, Medicaid expansion, rural hospital funding, industrial and economic development, natural disaster preparation and recovery…

(Good friend and IAIABC Executive Director Jennifer Wolf Horesjh has a slightly different perspective…you can listen to Jennifer’s podcast here.) . She notes the advocates are working diligently to promote Opt-Out/Non-subscription.

8.   Service companies that deliver best-in-class customer service – and build that into their branding messaging – will win. 

In a commoditized business (which is how most buyers view most work comp services) customer service is critical to success – but most companies in commoditized businesses don’t understand this.

I’d go a step further – because workers comp is a declining, industry, being known for delivering great service is essential to survival.

Yet many businesses just don’t understand this, or if they do,

  • they haven’t figured out how to deliver great service,
  • or if they do deliver great service they fail to build that into their branding efforts
  • if they even have anything that remotely resembles “branding.”

We will be doing some interesting research on this later this year which should help determine a) if my prediction is accurate, and b) what works.

9. More success in reducing long-term opioid usage by more payers.

We’ve learned that diligent, persistent, intelligent and caring approaches to managing chronic pain and long-term opioid usage produce results. The State Funds of California, Ohio, and Washington along with Sedgwick are a few of the payers achieving remarkable success in helping patients handle their chronic pain while reducing their opioid usage.

Vendors including Carisk are also delivering solutions to this knottiest – and most problematic – of work comp problems.

10. Payers will implement business models and processes using Artificial Intelligence  

These will include some or all of these:

  • claims intake and triage;
  • fraud/waste/abuse triggering and assessment;
  • patient and provider communication;
  • clinical assessment, including utilization review;
  • policyholder communication;
  • and more I can’t think of.

That’s it for this year’s predictions. So, what say you?

5 thoughts on “Predictions for workers’ comp in 2019 – part 2”

  1. I’m not that knowledgeable about WC but my experience in the broader insurance industry confirms prediction #10 about AI use. You can not overstate the rate of adoption expected for the use cases you list, limited only by the availability of data management specialists , which will cause many payers to partner with expert professional services firms.

  2. The absolutely best advocacy model I’ve seen is that run by the Miami-Dade School Board. They will return injured workers back to work within restrictions as soon as possible and of course pay close attention to incoming claims. The thing that qualifies them for best advocacy model is the willingness to go great lengths to restore the injured worker to being as whole as possible. If this requires providing service not strictly related to the injury, they do it. They are willing to use innovative treatment methods. They are proactive and have instituted a program called Rebuilding Me. This program offers at risk workers the opportunity to participate in physical conditioning programs free of charge with significant rewards for the workers’ efforts. To see some of the activity, go to Instagram “RebuildingMe”. This is truly a model for others especially considering the cost savings that have already been realized and will continue to accumulate.

  3. Joe,

    Your friend Jennifer is correct. The Koch Brothers and the companies behind ARAWC are free-market, libertarians who don’t want government social insurance programs like work comp. You are probably correct that it won’t happen, but that won’t stop them from trying.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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