Deconstructing Comp

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In this episode, we talk to Kirsten Kaiser Kus. She is a defense attorney and an equity owner at Downey & Lenkov LLC, leading their Indiana practice. She brings deep experience from both the plaintiff and defense sides of workers’ compensation. She shares how her involvement with CLM and litigation education shaped her expertise and helped grow her professional network.

We explore the many stakeholders in the workers’ compensation system. Kirsten discusses distinctions between plaintiff-side and defense-side stakeholders and how they interact—or clash—within systems that vary state by state.

On the plaintiff (applicant) side, she highlights challenges such as unrealistic expectations, lack of understanding of legal metrics, and client control issues. Then she systematically breaks down the far more complex defense side, detailing the roles of carriers, TPAs, hearing members, medical providers, mediators, ombudsmen, vendors, brokers, excess carriers, self-insured clients, and even how politics play out in our system.

Throughout our conversation, Kirsten emphasizes one central principle: communication is critical. Where, oh where have we heard that before? Whether navigating expectations, coordinating stakeholders, or managing the risk of expensive cases, clear, proactive, and coordinated communication is what drives effective outcomes.

Stakeholders in the Workers’ Comp Ecosystem:

Injured Worker
The employee who was hurt at work and seeking benefits.

Applicant’s Attorney / Claimant’s Attorney / Plaintiff's Attorney / Petitioner’s Counsel
The lawyer representing the injured worker (term varies by state).

Defense Attorney
The attorney representing the employer or insurance carrier.

Employer
The company where the injured worker is employed; also referred to as "the insured."

Insurance Carrier
The insurance company providing workers’ comp coverage to the employer.

Third-Party Administrator (TPA)
An outside company that manages the administration of claims on behalf of self-insured employers or insurance carriers.

Broker
An insurance advisor who helps employers obtain and manage coverage.

Self-Insured Employer
A company that pays claims out-of-pocket, often with excess insurance coverage.

Excess Carrier
The insurer that covers costs beyond a self-insured employer’s retention layer.

Hearing Member / Judge / Commissioner
The official who hears and rules on workers’ compensation disputes.

Ombudsman
A state-provided guide who assists unrepresented workers.

Mediator
A neutral party who helps both parties involved in a litigated case try to settle the case before trial.

Medical Provider
Doctors and other clinicians who treat the injured worker.

Nurse Case Manager (NCM)
A licensed nurse who helps coordinate medical care and communicate with all stakeholders. NCMs are often called in to help coordinate more complex claims. 

Vendors
Service providers such as interpreters, transportation, Medicare compliance experts, durable medical equipment (DME) suppliers, and home modification specialists.

Subrogation Counsel / Third-Party Recovery
Attorneys or departments pursuing reimbursement when a third party (not the employer) caused the injury.

Family Members
Often involved in influencing the injured worker’s decisions and expectations, an important perspective to keep in mind throughout the recovery process. 

¡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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In this episode, we sit down with industry powerhouse Mollie Kallen to explore the often misunderstood role of case managers* in workers’ compensation. With over 30 years of experience leading one of the largest case management companies in the country, Mollie brings unmatched insight into how effective communication, not just clinical expertise, drives better outcomes for injured employees, employers, and claims professionals alike.

We talk about what makes a great case manager, how communication breakdowns can derail even the best-intentioned care plans, and why advocacy and collaboration are more important than ever. Mollie also shares how her personal health journey reshaped her professional mission and led her to a new chapter of coaching cancer patients and their families with the same compassion and clarity that marked her work in workers' comp.

Whether you're a case manager, claims adjuster, or anyone working in the comp system, this conversation will leave you with a deeper appreciation for the human connection at the heart of recovery.

🎧 Tune in and discover why communication truly is key.

*NOTE: Rafael said "nurse case managers" when he started with his questions. While often, case managers are nurses and have a nursing background, they aren't always nurses, as is the case with Mollie. The reason many nurses become case managers is they have solid clinical backgrounds. So, just know, a case manager isn't always a nurse and people often use these terms interchangeably. Yes, we know! It is confusing. 

Resources mentioned in this episode: 

ReEmployability: https://www.reemployability.com/

Cancer Coach Connection: https://www.cancercoachconnection.com/

¡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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In this engaging and insightful episode, co-hosts Yvonne Guibert and Rafael Gonzalez sit down with legendary industry leader Bill Zachry for a deep-dive into the realities shaping today’s California workers’ compensation system, and other state systems around the country. 

We explore rising WC costs, why it makes sense to manage and treat psychosocial barriers to recovery early on in the claim — or risk higher costs down the road, and other tips and observances he's made along the way. 

Bill shares powerful stories from his career, including how he entered the system as an injured worker, his role as a "baby claims adjuster," how he has helped shape public policy, the role of organized fraud in the Los Angeles basin and more. He also discusses his coined term, “sisterhood of the traveling body parts,” to describe recycled injury narratives.

Our discussion also touches on prevention, prescription patterns, several issues related to public policy, and the cultural and systemic gaps that keep workers’ comp stuck in a reactive posture.

This episode is equal parts candid, educational, and entertaining — and is a must-listen for any workers' compensation professional, regardless of tenure. 

Resources:

Rising Medical Solutions Annual Benchmarking Study

¡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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Melissa Steger returns to walk us through the building blocks of the unique Texas UT System workers' compensation program. While the program is self-insured, they use a third-party administrator (TPA) in a hybrid system where the TPA staff sit on-site with the UT System staff who oversee the program. 

Covering 160,000 employees and over 250,000 students, UT System uses a variable rating system and has set up a culture where the individual institutions within the system compete against one another to achieve superior outcomes. The results? Truly innovative and remarkable. 

During Melissa's tenure with the WC program, and through a system of healthy competition, they initially saw program costs of eighty cents per $100 dollars of payroll. When Melissa retired last year, it had fallen to 8.5 cents per $100 dollars of payroll. 

How did this happen? Melissa talks about some of the nuances of their program including an annual retreat, where the hybrid staff come together to improve communications, get focused on core program goals and learn how they could continuously improve their results. 

Join us as we talk to Melissa and learn how UT System achieved such amazing results.

Melissa also talks about flunking out of retirement. She is now VP of Business Development at WorkCompCollege.com 

¡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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In this episode, Yvonne Guibert catches up with Nelson Gonzalez, Executive Director - Florida, Rehab Without Walls® NeuroSolutions, and they talk about Return to Work. 

In the workers' compensation system, a return-to-work (RTW) policy or program helps injured or ill employees safely and efficiently return to work. The goal or purpose is to minimize downtime, reduce costs, and maintain employee skills and productivity. 

Join the conversation to hear Nelson's perspective on why RTW programs are so essential, why some RTW programs fall short, what a good RTW program should include, and more. 

Companies and resources mentioned during this episode include: 

Rehab Without Walls® - https://www.rehabwithoutwalls.com/

ReEmployability - https://www.reemployability.com/

Bag of Happies - https://bagofhappies.com/

¡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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In this episode, Yvonne and Rafael chat with Joseph Sousa, Workers' Compensation Program Manager for the City of San Diego. In our conversation, we learn from the perspective of a self-insured, self-administered workers' compensation program administrator, and what is important to that stakeholder perspective. 

One thing that stands out is the numerous benefits of operating a self-insured, self-administered program for both the employer and employees. The employer gains total control over various aspects, especially compared to purchasing an insurance policy from an external insurer. Since all employees work for the same entity, there is a strong sense of pride and compassion when it comes to supporting colleagues.

The City of San Diego is regarded as a gold standard in workers' compensation programs. Some key elements of San Diego's program include:

- An established culture of wellness and safety

- Early intervention

- Peer support and compassion for fellow employees

- Effective communication

- Self-efficacy, where injured employees take ownership of their recovery

- Quality partnerships with medical providers

Join us as we delve deeper into Joseph's insights and learn more about the City of San Diego's workers' compensation program.

More about City of San Diego: https://www.sandiego.gov/

Council of Self-Insured Public Agencies (COSIPA): https://cosipa.org/

Public Agency Risk Management Association (PARMA): https://parma.com/

¡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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In this episode, Yvonne and Rafael talk to Amy Cooper, Vice President Sales, Carrier Practice at Gallagher Bassett, and founder of Rise®, an amazing insurance community dedicated to empowering early-career professionals, attracting new talent, fostering networking opportunities, and providing access to invaluable resources, as described on the Rise® website. 

We are so excited to have Amy as our guest. We've been watching the tremendous growth of the Rise® community and the annual Rise® Leadership Summit that happens every June. 

So listen as we chat with Amy about the annual event, speed mentoring, fun pop-up events, and more! 

To learn more about the Rise® Annual Leadership Summit, please visit them at https://riseprofessionals.com/

Use code "COMP100" to save $100 on registration for this year's event.

2025 Rise® Leadership Summit June 16-18 
Marriott Harbor Beach Resort and Spa
Ft. Lauderdale, Florida

¡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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Recently, Yvonne and Rafael attended the 2025 Florida Bar and WCCP Workers' Compensation Forum, April 9-11, in Orlando, Florida. 

Unfortunately, there was no wi-fi available to do live streaming, which is what we planned to do, but we did talk to several folks and conducted short interviews to capture their excitement and thoughts about the conference. 

Conference interviews include: 

Judge David Langham, Florida Deputy Chief Judge of Compensation Claims
Stacy Hossman, Executive Director of WCCP
Oneill Martinez, FL Mediator
Yvonne and Rafael take time to catch up
Holly Akers, Claimant Attorney - Jacksonville, FL
Ya'Sheaka Williams, Defense Attorney - Tampa, FL
Adam Levy, Defense Attorney - Tampa, FL

We hope you enjoy this "bonus" episode of on-the-spot interviews at one of our top Florida conferences. 

The conference takes place again in 2026 at the same location at the Omni® ChampionsGate Resort in Orlando, FL, and you can check here for information about that and other events by WCCP: https://www.wccp.org/

¡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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After much anticipation since we started this podcast, Stuart Colburn joins us for a special episode focused on Texas! 

Stuart, a shareholder at Downs & Stanford, P.C., has over 25 years of experience in workers' compensation. He shares his journey into our industry and expertly navigates the evolution of the Texas Workers' Compensation system since the 1980s. Throughout the conversation, he highlights the unique aspects that make Texas' approach distinctly different from those of other states.

Stuart is board certified in Workers' Compensation Law by the Texas Board of Legal Specialization and was the founder and first Chair of the State Bar of Texas Workers' Compensation Section. He co-authors the Texas Workers' Compensation Handbook published by LexisNexis and, as a certified lobbyist and frequent Division of Workers' Compensation conference representative, brings valuable policy perspective to the conversation.

(Correction: Stuart mentions 2011 as the year Wikipedia and iTunes emerged; however, the correct year is 2001.)

NOTE: Stuart shares a slide deck during this episode, which you can see in the video version on our YouTube channel. 

Resources mentioned in this episode:

Texas Workers' Compensation Handbook 2025 Edition

Texas Department of Insurance - Workers' Compensation 

Texas Subsequent Injury Fund

American Medical Association (AMA) Guides

Official Disability Guidelines ODG by MCG 

National Comp Conference

Stuart Colburn bio

¡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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We like to have fun with our episode titles when we can, hence "Alphabet Soup." Still, despite the fun name, this is an informative episode, particularly for those newer to the workers' compensation industry. 

Our guest is Jennifer Wolf, president and CEO of MWCIA in Minneapolis, MN. 

Jennifer expertly navigates through many of the common terms and acronyms we use. This is certainly not meant to be an exhaustive list of terms, so we have included several links for a more complete list for the nerdy folks like us: 

California Department of Industrial Relations Glossary

Tennessee Department of Labor and Workforce Development Glossary of Acronyms

Florida Senate 440 Statutes Workers' Compensation Definitions

Pie Insurance Workers' Comp 101 Glossary

Texas Department of Insurance Workers' Comp Insurance Glossary

We hope you enjoy it. If we missed a term or acronym you think should have been included, let us know! We may need to do a "Part 2" on terms and vocabulary! 

¡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