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Deconstructing Comp

Deconstructing Comp

著者： Yvonne Guibert & Rafael Gonzalez
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Now in Season 6! We are still breaking down complex workers' compensation issues into bite-sized nuggets, one conversation at a time, with one slight twist. We are finally doing what we set out to do when we started: discuss the nuances of our fascinating system in "Cliff Notes" style summaries.


Yvonne Guibert and Rafael Gonzalez approach workers' comp conversations from different backgrounds. Still, they share many things in common, such as their love for family and friends, a passion for Latin culture, and good old-fashioned belly laughs. Join them as they chat with industry friends and colleagues, learn more about their roles, laugh, and have fun along the way. You might learn something along the way! See you soon! ¡Hasta pronto!

© 2026 Deconstructing Comp 出世 就職活動 経済学
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  • Herbert Van Patten: The Art of Followership

    Herbert Van Patten: The Art of Followership
    2026/10/05
    Send us Fan MailGUEST BIOHerbert Van Patten | Senior Vice President and Chief Sales Officer, ISYS Solutions and Career Smart Learning35+ years in workers' compensation, starting as a Spanish-speaking vocational counselor and transitioning to leadership and sales rolesSenior Vice President and Chief Sales Officer overseeing nurse case management services (on-site and telephonic across western states) and healthcare training/recertification for medical professionalsMentor to college students and young professionals, focused on developing self-leadership skills and helping emerging talent find meaningful purpose in their insurance careersWHAT IS FOLLOWERSHIP?Merriam-Webster defines followership as: "the capacity or willingness to follow a leader." In our episode, you'll hear what Herbert Van Patten says about the importance of followership, especially for younger generations. EPISODE SUMMARYWhat happens when we look at workers' compensation not as a system to navigate, but as an opportunity to change the trajectory of injured workers' lives?In this episode, Herbert Van Patten walks us through his unconventional entrance into workers' comp. Completed military service. The job market was soft in 1991. Fluent in Spanish. Hired as a Vocational Counselor. He shares his philosophy on leadership development. He also talks about a new concept we don't often discuss: followership. He makes a case for seeing nurse case managers as the "hub of the wheel." Central coordinators. The connectors who get everyone aligned around a shared mission. But here's what matters. He's not just talking about better claims management. He's sharing a vision for our entire industry. What if we rallied around one unified mission: to use a workers' compensation claim as an opportunity to change an injured worker's life trajectory for the better?Herbert also challenges how we think about vulnerability in leadership. Have you ever had imposter syndrome? Most of us see it as a problem. He sees it differently. It's a signal for self-examination. A prompt to look at yourself honestly. Leaders don't need to have all the answers. What they actually need is the courage to build trust through honesty, consistency, and transparency. As Herbert puts it: "If we can rally around that unified mission as an industry, how much more effective would we be in the work we do?"The conversation goes deeper too. Language barriers. Cultural competence. How the younger generation wants to be led differently than we did (Boomers and Gen Xers). And the real stories. Injured workers who, after catastrophic injuries, went back to school. Who completely transformed their lives. Who changed their families' futures.KEY THEMESWorkers' Comp: A Noble ProfessionStop thinking about workers' compensation claims as something to close. Start seeing them as opportunities to change someone's life trajectory. That's the reframe worth considering. And it's a noble profession. Doubt Can Lead to Self-LeadershipImposter syndrome isn't a failure. It's a signal. Use it as a prompt for self-examination. Leaders don't need to have all the answers. They need the courage to find them by working with the people they lead.Followership As a SkillWe talk constantly about what it takes to be a good leader. We almost never talk about followership. But most of us are following someone. The younger generations relate to followership differently than Baby Boomers or Gen X. Understanding that shift is where real leadership development starts.Language and Trust Are InseparableSpeaking to injured workers in their own language isn't just about communication. It's about connection. It's about breaking through the suspicion built into the system. When you connect in someone's native language, you open a door to trust. That's harder to open any other way.RESOURCES & CONNECTIONSISYS Solutions: Nurse case management services across western states and telephonic services nationwide.Career Smart Learning: Healthcare training and recertification for case managers, nurses, social workers, and other medical professionals.Institutes of Health (IOH): Intensive outpatient programs for traumatic brain injury, PTSD, and complex chronic pain.¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp
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    45 分
  • Gia Sawko: Deucing Every Point

    Gia Sawko: Deucing Every Point
    2026/09/18

    Send us Fan Mail

    Guest Bio

    • Gia Sawko | Chief Claims Officer at Signal Mutual
    • Decades of claims experience in workers' compensation
    • Instrumental in navigating how AI reshapes the adjuster's role
    • Focused on preserving and amplifying human judgment in claims work

    The Conversation

    Yvonne, Rafael, and Gia get into what's happening in claims work right now. The job is harder than ever. The tools haven't caught up. And there's a path forward if we're willing to think differently about training, technology, and what we ask of the people doing this kind of work.

    Key Discussion Points

    The Claims Desk Hasn't Been Redesigned in 20+ Years

    The claims adjuster's job has become exponentially more complex. Medical knowledge requirements have expanded. Regulatory demands keep multiplying, and they're harder than ever to navigate. Case management now demands synthesis across medical history, pharmacy data, functional capacity, and emerging compensability questions. But the actual desk, the systems, and the workflows look almost identical to what they did two decades ago. The infrastructure hasn't kept pace with our industry's complexity.

    Why Don't We Train Claims Adjusters Like Apprentices?

    Gia makes a good point: we should treat claims adjuster development like other industries treat apprenticeships, such as skilled trades. New adjusters need structured mentorship, graduated complexity, and time to build judgment alongside technical knowledge. Right now, they often get thrown into the deep end. If we reimagined onboarding the way apprenticeship programs do, with clear progression and accountability, we'd build stronger professionals. People who feel accomplished master their craft and stay in the industry.

    AI as Support, Not Replacement

    The highest-value use of AI in claims isn't automation; it's augmenting what adjusters already do. AI can flag high-risk claims and surface comorbidities. It can summarize documents. But the adjuster owns the relationship with the claimant and the critical judgment calls. The combination between the person and the algorithm is where we'll get the best outcomes.

    Implementation Challenges Are Real

    You can't pause operations to implement AI. Decision fatigue is a risk when adjusters get too many warnings. And AI is only as good as the question asked. We need to teach adjusters how to ask better questions and build trust through testing. This is the "how" nobody's really solved yet.

    AI Literacy Is Non-Negotiable

    Every adjuster needs to become proficient in AI language now. Start small, test on easy tasks, validate against what you already know. Those who build this proficiency will be positioned better than those who don't. The window is now.

    Deucing Every Point

    Gia is a serious tennis player! Ask her about a match where she lost 6-0, 6-0—and she'll tell you about the deuces, the rallies that mattered, the quality of every point. Lean in to hear what the court might teach us about adjuster mastery.

    ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

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    56 分
  • Dr. Robert Hall: What Our Rx Data Reveals

    Dr. Robert Hall: What Our Rx Data Reveals
    2026/09/04
    Send us Fan MailGuest Bio Dr. Robert Hall | Medical Director, Optum Workers' Comp and Auto No-Fault12 years leading medical direction and formulary oversight at OptumPhysical medicine and rehabilitation (PM&R) specialist maintaining active clinical practice one day per week with injured workersStrategic voice on PBM industry trends, emerging drug therapies, and AI's role in claims prioritizationOur Conversation We explore pharmacy spending trends, compensability questions around new medications like GLP-1s and migraine medications, and how AI can help claims professionals prioritize without replacing judgment. Our conversation builds on CompPharma's 20th Annual Survey released earlier this year. Dr. Hall provided context from his unique PBM perspective.See the CompPharma 2025 Prescription Drug Management in Workers' Compensation SurveyKey Discussion PointsScript Volume Down, Per-Script Costs Up Prescriptions filled decreased 4%, yet per-script costs rose over 4%. Fewer generic opioids are available, causing providers to transition patients to more expensive alternatives. When lower-cost options aren't working, switching to higher-cost versions becomes the default.Opioid Decline Slowing Opioid spend dropped 7%—slower than the 13% annual declines of prior years. While fewer people are on opioids overall, those taking them can face additional complications such as opioid-induced hyperalgesia, where the pain medication itself makes pain worse. Providers unknowingly increase doses thinking pain is worsening, creating a spiral that drives costs and complexity.Efficiency Remains the Industry's Biggest Gap According to Dr. Hall, despite much progress, feedback from injured workers and treating providers is consistent: speed remains a big issue. Authorization turnarounds, surgery approvals, and medication approvals all lag. Efficiency directly impacts outcomes.GLP-1s: Compensability Questions Without Clear Answers GLP-1 medications (weight loss drugs) are appropriate when weight loss is necessary for surgery or when catastrophic injuries cause weight gain. But with 30-40% of adults overweight or obese, there's a strong incentive to route these expensive drugs through workers' comp claims instead of out-of-pocket. The core tension: just because a drug is medically effective doesn't make it work-related. Clear frameworks are needed to distinguish compensable uses from general health expenses.A parallel exists with migraine medications—highly effective for a common condition (10% of the population), creating similar pressure to tie them to workers' comp when they may not be compensable.Important caveat: GLP-1s carry real risks. Severe nausea, vomiting, diarrhea, pancreatitis, and hospitalizations have occurred. When complications arise, they become part of the claim, adding complexity and cost.PBMs Score Highest on Customer Service PBMs earned their strongest-ever customer service grades in this year's CompPharma survey. Relationships matter as much as technology. Speed, communication, and partnership mindset drive loyalty.AI Adoption Rising—But De-skilling Risk Is Real About one-third of respondents now use AI tools. The cautionary tale: radiologists improved cancer detection with AI, but their standalone diagnostic ability declined after using it. For workers' comp, AI's highest value is prioritization—flagging the 2 catastrophic claims out of 100 that need immediate attention. The goal is to free human judgment for complex decisions, not replace it. We need to keep using and challenging our brains. Early Identification of Catastrophic Claims AI could synthesize accident type, injury location, physician findings, diagnostic studies, and functional capacity to identify claims spiraling toward permanent total or catastrophic status before they explode in cost. Early intervention changes trajectory.The risk: "creeping catastrophic" claims. Injuries that seem manageable but don't close gradually become complex and expensive. Opioid dosing spirals, high-cost alternatives accumulate, and routine claims become catastrophic without anyone realizing when the shift happened.State Variations as a Learning OpportunityFor folks newer to workers' comp, Dr. Hall suggests the 50 different state regulatory frameworks aren't just learning obstacles—they're live experiments in how to approach injury treatment. Professionals entering the industry should embrace this complexity and diversity to build deeper medical and operational knowledge.The Motorcycle Pivot Dr. Hall learned to ride a motorcycle last year after walking away from the idea a decade ago (when a bike cost as much as new kitchen cabinets). He's now ridden 1,000 miles on quiet Sunday afternoons. ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp
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    51 分
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