Rapid Fire Hot Topics

NWCR 2026!

The afternoon of day two of the 2026 National Workers' Compensation Review (NWCR) at WCI 2026 begins with Six-Shooter Session – Rapid Fire Discussion of Important/Hot/Topics. A series of posts is listed at the conclusion of this one, providing a roadmap to the entire NWCR 2026 agenda.

Six lawyers and a brave moderator will strive to deliver the tribulations of fifty states in sixty minutes. The program will be

Tuesday, August 26, 2026; 1:00-2:00 p.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

I have served on this panel in the past, and it is an exhilarating experience. Each of the participants will have interesting examples to share from particular states. You can well imagine that some states present more fodder than others, but if it happened in the last 12 months, it is likely to merit mention here.

There are topics that universally challenge. For the last two decades, medical access has been a predominant issue across the country. The supply of physicians is simply not keeping pace with patient demand for a variety of reasons. One is that people like me are getting older in greater numbers, and we are demanding more care. Some of it is the rapidly evolving new treatments and the demand for specialists in that care.

Workers' compensation suffers in this challenge for various reasons. There are physicians who perceive the financial constraints of these systems to be too onerous. Some physicians do not appreciate the volume of paperwork, permission seeking, and documentation that workers' compensation requires. There is a perception that other payment systems, like group insurance, pay more reasonable rates for care, and that draws physicians to treat those patients before workers' compensation. In any event, there is room for improvement in our supply and provision of care and treatment.

Complexity seems to be increasing. The decisions in workers' compensation on issues like causation (see the Monday afternoon program Causation Analysis). States are perceived as more strenuously adhering to the purpose of workers' compensation, e.g., caring for work injuries, and striving to differentiate and exclude injuries that are merely coincidental with work or only minimally related to the work performed. There is some contention that the result is complex burdens of proof regarding causation and compensability.

Presumptions are always a hot topic. States have habitually added special treatment opportunities for specific occupations. These often operate within workers' compensation statutes, but can also be semi-independent parallel statutes. There are therefore potentials for conflicting statutes, difficult interpretations, and questions regarding which party has the burden in a particular instance and how difficult that burden may be.

These challenges and more are the burden of claims and risk professionals striving to make sound decisions. They confound or frustrate litigation counsel who sometimes perceive the foundations shifting beneath their feet. In the midst of it all is the allegedly injured person, their employer, and all of the perceptions and beliefs that they bring to the situation (see Empathy).

Rapid-fire it will be; dull it will not. This program is always informative, and the hour is always too short.

Six-Shooter Session – Rapid Fire Discussion of Important/Hot/Topics
Tuesday, August 26, 2026; 1:00-2:00 p.m. (Room TBA)

Moderator: Bobby Stokes, Esq., Retired, Austin, TX 

Panelists:
Stuart Colburn, Esq., Defense attorney; Gun Barrel City, TX

Mike Doyle, Esq., Claimant’s attorney, Los Lunas, NM

Jeff Napolitano, Esq., Defense attorney; New Orleans, LA

Annemarie Pantazis, Esq., Claimant’s attorney, Charlotte, NC

Phyllis Phillips, Esq., Mediator; Williston, VT
Hon. Cathy Surbeck, Judge, Philadelphia, PA

Monday, August 24, 2026
     1:00-2:00 NWCR 2026 and Litigation Management
     2:10-3:10 Causation Analysis
     3:15-4:15 Stewardship of Truth

Tuesday, August 25, 2026
     8:45-9:45 State of the States
     9:55-10:55 Actuarial Insight and Mysterious Underwriting
     11:00-12:00 Empathy
     1:00-2:00 Rapid Fire Hot Topics
     2:10-3:10 Beyond Exclusive Remedy
     3:15-4:15 Strategies to Thrive in Times of Change

Nullius in verba

A recent article reminded of the importance of evidence and what the author calls "The Evidence Revolution." This is a book review and may drive demand for Helen Pearson's Beyond Belief: How Evidence Shows What Really Works. This is an indictment of the anecdotal, the emotional, and the perils of groupthink that have driven so much in policy and "conventional wisdom."

The perils that she unveils are beyond inconvenience or even injustice. There are examples of acute harm driven by the unsupported and unsupportable consensus of the expert community. The first example is Dr. Spock, and no, not the Star Trek (DesiLu, 1967) master of overcoming emotion in the pursuit of logic and reason.

This Dr. Spock was an American pediatrician who "authored The Common Sense Book of Baby and Child Care in 1946." According to Connecticut History, he became "the world’s most famous pediatrician," and according to The Evidence Revolution, he "revised his book in 1958 to say parents should place their infants face down to sleep to avoid choking."

The only problem with this proactive advice from the "most famous pediatrician" is that children died. The Evidence Revolution says that "Sudden Infant Death Syndrome (SIDS) increased" following his public endorsement. As time passed, "evidence accumulated that face-down sleeping correlated with a much higher risk of SIDS."

Evidence and dead children accumulated. Thirty-two years later, "a 1990 study showed that SIDS infants were nearly nine times more likely to have been sleeping face-down." A late-century "public health campaign" pushed to avoid face-down sleeping. The frequency of "SIDS deaths dropped nearly 70 percent." Science debunked eminent opinion. 

Experts may be qualified by their education, experience, or training. Anyone can be an expert in something, and there are a multitude of evidence codes and published opinions that both provide guidance and standards.

But expert opinions may be more difficult. Particularly when someone brings fame and acclaim with their expertise. It may be difficult to believe that someone who has become larger than life may not have the best or most conclusive opinion. How can we vet and differentiate opinion, choose between experts?

The Evidence Revolution explains that these kinds of outcomes are what drove the reasonably recent "rise of evidence-based medicine." With randomized trials, carefully designed studies, and careful consideration of contrary study results, science is capable of both individual and societal progress and improvement.

Nonetheless, there is evidence that too often science fails us. There are shortcomings, and the efforts of a few may be responsible for our safety. Reading that, I was pulled back to Roman poet Juvenal and his inquiry "Quis custodiet ipsos custodes?" ("Who watches the watchmen?"). So, in parallel, who studies the studiers?

The Evidence Revolution describes non-profits that strive to "conduct systematic, standardized reviews of the data from research on various health questions." With this focus, the intent "is to provide clear, objective overviews of all the relevant evidence."

There is some skepticism as to who pays for research. What happens when a funded study fails to support the sponsor's hypothesis? Who watches this? Are negative outcomes buried? Despite the verification and review efforts, The Evidence Revolution says a scant majority of Western healthcare, even today, "is in line with evidence-based clinical guidelines."

The author proceeds to cite other examples of regulatory or other systemic adoption of hypotheses without empirical proof. There is a discussion of examples of such missteps in economic policy, education, and general management. These are each troubling, demonstrating inordinate reliance on the reputation and volume of some advocate while ignoring the empirical evidence, or at least questioning the absence of it. 

The article on The Evidence Revolution begins with "the official motto of ... the Royal Society of London: 'Nullius in verba' ('Take nobody's word for it')." Perhaps we can learn much from Dr. Spock (the pediatrician) and the other examples of groupthink, authority bias, and more that can distract from the real credibility foundations:

The trier of fact (judge or jury) is often faced with competing expert conclusions. What supports the conclusions? What are the signs or symptoms? What empirical evidence exists to support or refute a conclusion? What objective indicia exist, and how does it fit with the hypothesis or conclusion? 

But, most importantly, how effective is the expert's explanation of the constellation of evidence, the process they used for examination and evaluation, and the logical path to their opinion? In the end, the finder of fact will not be an expert. They will nonetheless have to be effective at evaluating and comprehending the expert's process, analysis, and opinion(s). 

The finder of fact and the advocates for the parties would do well to think critically and adopt the Royal Society advice, "Take nobody's word for it."

Ralph Humphries Retires

August 7, 2026, marks a bittersweet moment, one I know will be repeated. Tomorrow is the last workday of Hon. Ralph Joyner Humphries. He desires to depart without hoopla or celebration. I have respected that generally (no party, no cake), but I could not resist a blog post.

Judge Humphries is a Florida Gator, graduating from law school there in 1977. He worked briefly in criminal law in Jacksonville and then began practicing insurance defense, which included workers' compensation.

I met Judge Humphries very early in my career at a convention produced by the Florida Defense Lawyers Association (FDLA). I met a great many lawyers at that Amelia Island gathering, and as I reflect, the experience was somewhat overwhelming. Young lawyers—do not get overwhelmed. This is a very welcoming community you have joined. Embrace it, become involved and active in it. 

While FDLA was an association I belonged to for several years, there was also a local Jacksonville equivalent: the Jacksonville Association of Defense Counsel (JADC). Judge Humphries was a leader in that group, and it hosted annual programming even when the FDLA opportunities involved significant travel and expense that my employers did not favor or persistently facilitate for young lawyers. 

Employers, find a way to facilitate such experiences for your young lawyers. It is important. It is more important today than ever before. Lawyers have to have opportunities for interaction and growth. 

That economic reality related to travel led me to focus on JADC opportunities, and as a result, I worked there with Judge Humphries and a variety of excellent Jacksonville attorneys. I proudly became an organizer and eventualy president of JADC. 

When I met Judge Humphries, he was a partner at a prestigious firm. I recall when he departed and formed a partnership with two other well-known local defense attorneys: Schutte, Humphries, and Becker. His example in that likely contributed to my analysis when I opened my own firm in 1997. 

Nonetheless, throughout my time practicing in Jacksonville, I had ongoing contact with Judge Humphries and his firm through the JADC, some multi-employer litigation, and mediating with his partner Mark Becker.

In one memorable multi-employer case, I represented a company whose employee was injured hanging drywall in Jacksonville. There were thorny coverage issues because my client was a Texas company with only Texas coverage. Looking for a "general" contractor, another entity was represented by Judge Humphries, and yet another by the newly retired Judge Rhodes Gay.

I learned a lot in that case. To make it more interesting, one of the potential "contract" employers was the building owner. Coincidentally, that owner was then negotiating to build out a space for the Jacksonville OJCC office to occupy. That layered some interesting potential recusal issues into the mix, raised by Judge Wilbur Anderson at a hearing at the old OJCC office in the Fuller Warren Building at the base of the Hart Bridge Expressway. Somehow, I recall that hearing after all these years. 

That litigation and my involvement with JADC allowed me many opportunities for education and growth. Stated simply, Judge Humphries was engaged in the community, an experienced and engaging practitioner, and a willing mentor. I look back fondly on those Jacksonville days.

After taking the bench, I had a few opportunities to preside in cases in which Judge Humphries was counsel. One of those was complex and challenging enough that I remember details to this day. Suffice it to say that over the course of years, lawyers and judges are exposed to a lot of disputes. In my experience, only a very few stick in the memory. Nonetheless, I still recall that one of Judge Humphries's and his patient resolve with a difficult situation and opponent.

Judge Humphries was appointed to the OJCC bench in 2010 and is retiring just short of 16 years here. I struggle with that somewhat because it seems more like yesterday. As they say, time flies when you are having fun.

Thus concludes August 7, 2026, a storied career spanning almost 50 years and almost 16 years on the bench. I lament his departure and what that will mean for the OJCC in Jacksonville. Simultaneously, I celebrate that he is taking the time to spend on fishing, family, and travel. There comes a moment for us all when the long-earned reward of retirement is the right move.

I promised Judge Humphries no party and no cake, but I do love cake. So, here is your cake; the message is apropos—so much conflict and challenge is "not your problem anymore." Thank you for making the resolution of so many conflicts, disputes, and cases your problem for so long. 

Congratulations, Ralph, that your moment is now. You will be missed, valued, and remembered here for your demeanor, work ethic, impartiality, and commitment. I join many in wishing you well in the next chapter!

Help Me to Help You

NWCR 2026!

Day two of the 2026 National Workers' Compensation Review (NWCR) at WCI 2026 continues in its second hour with:

Actuarial Insight and the Mysterious Process of Underwriting and Reserving – What You Don’t Know Can Help You or Cost You Big
Tuesday August 19, 2026; 9:55 – 10:55 a.m.

A series of posts is listed at the conclusion of this one, providing a roadmap to the entire NWCR 2026 agenda.

I spent years of my legal career striving to understand the mysterious and distant "actuaries." Their influence over claims was periodically raised and discussed in the confines of claims reviews. They were never named, merely the collective: "the actuaries" say ....

The misunderstood persona and purpose of the actuary will be addressed in a blue-ribbon panel this August at the National Workers' Compensation Review program of the Workers' Compensation Institute. There is apparently an inherent conflict in the world of claims prediction and reserves, pitting the mathematical science of actuaries against the broader community of hands-on claims professionals.

Hearing this discussed, I am often reminded of a great salesperson I knew long ago. He was focused on putting together economically advantageous exchanges for his company. He was not paid by commission, but there was, nevertheless, an "Art of War" flavor to many discussions.

I vividly recall this person's observations about lawyers. It was a persistent and negative "Lawyers are just there to screw up the deal." Don Henley's counter observation was "lawyers clean up all details" (End of the Innocence, A&M, 1989). They had, clearly, perspective differences. That is likely as true for the claims professional and the actuary. There are perspectives, interests, and foci, and they can honestly disagree. 

William Zachry is on the National Workers' Compensation Review (NWCR) committee. The NWCR presents a two-day program each August at the WCI. The NWCR program will be informative this year, and the breadth of topics is notable. Mr. Zachry was a proponent of the actuary discussion this year. This will be:

Actuarial Insight and the Mysterious Process of Underwriting and Reserving – What You Don’t Know Can Help You or Cost You Big

Tuesday August 25, 2026; 9:55 – 10:55 a.m.

Hearing the planning committee discuss the actuary program, I was instantly reminded of a humorous exchange on the sitcom Scrubs (Touchstone, 2001-2010). It was so powerful that it became a meme on interaction. In it, one professional, a bit unprofessionally, badgers another to "help me to help you." It is an admonition about communication and works in this context.

The actuary brings something to the table that many claims professionals lack: science. That said, there are many who express doubt and disdain for actuarial science. It is a mathematical endeavor, and math is a science. Math tends to be highly predictable and replicable. We all come, in time, to faithfully believe that 2+2 = 4. Well, perhaps not always.

Mr. Zachry, in his paper Actuarial Axioms for Claims Handlers and Risk Managers, notes that "No actuarial calculation is ever entirely accurate." This is because the actuary's role is not purely mathematical. They also employ statistics, predictions, and even assumptions. Mr. Zachry also adds to this complexity the fact that the actuarial analysis allows "expected patterns," but expectations may become elusive. 

It is in these variables that critics find the flaw(s) with actuarial science. If the predictions or assumptions are incorrect, then the best math in the world cannot produce accurate and reliable results and predictions.

Whether you are beyond bored with the term "artificial intelligence" (AI) or not, this program will likely reference it. The data, probabilities, and predictions of today are being influenced by the claims experience of yesterday. And that analysis is largely being delegated to large language models to organize, collate, and summarize. 

The AI are generating information that humans used to collect and organize. Mr. Zachry stresses that the best tool the claims professional has is the "consistent, timely, and accurate information" about claims. If this is communicated effectively to the actuary, they can employ their best efforts to provide predictability and facilitate planning. 

With this Actuarial Insight program in your arsenal, the claims manager, examiner, or adjuster will be better equipped to understand both the actuary's conclusions and process. Rather than conflict, this understanding can be used to build collaboration and consensus. Positive interaction can adjust, correct, or challenge assumptions and predictions.

Mr. Zachry is quick to provide anecdotal support. He challenged his actuary to identify specifics. He asked what claims were driving expenses and reserves significantly. He phrased this as "which are driving up your projections," and thus the necessity of reserves/collateral. He then knew which claims he could focus on closing in order to maximize the financial impact of his team's efforts. 

In the same spirit, the actuary can use this Actuarial Insight presentation to better understand criticalities. Examples are how little the actuary role and work are understood or appreciated. They make an indispensable product but rarely speak to their target market and consumers. The actuary can better understand variables, assumptions, and market forces that are not empirical but based on long experience in actual claims.

In the end, the Actuarial Insight program will foster interaction, collegiality, and communication. Each side may have its plea ("help me to help you") answered with better process, communication, and output. The resulting collaborative results may drive enhanced outcomes for all involved as the walls that separate are breached.

Actuarial Insight and the Mysterious Process of Underwriting and Reserving – What You Don’t Know Can Help You or Cost You Big
Tuesday, August 19, 2026; 9:55 – 10:55 a.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

Moderator: Suzy Braden, NWCR Advisory Board;  

Panelists:
NWCR 2026

James Marshall

Pete Rasmussen

Program Overview:

Monday, August 24, 2026
     1:00-2:00 NWCR 2026 and Litigation Management
     2:10-3:10 Causation Analysis
     3:15-4:15 Stewardship of Truth

Tuesday, August 25, 2026
     8:45-9:45 State of the States
     9:55-10:55 Actuarial Insight and Mysterious Underwriting
     11:00-12:00 Empathy
     1:00-2:00 Rapid Fire Hot Topics
     2:10-3:10 Beyond Exclusive Remedy
     3:15-4:15 Strategies to Thrive in Times of Change

GLP-1 Costs Increasing

I noted previously that off-label medication use was a fiscal challenge; see Whoa Nelly (June 2025). That centered on some insurance company decisions not to "cover GLP-1s for weight loss." The impact of these potentially life-saving medications is difficult to dispute, but their cost continues to draw attention. In the interest of full disclosure, I have some investment in one of the producers, Lily. 

In May 2026, NewsNation echoed a Wall Street Journal report regarding municipal governments perceiving untoward medication impacts on their budgets. Described as "sticker shock," one New England town of 15,000 residents had to rework its budget to accommodate its employees' near-million-dollar GLP-1 habit. Its conclusion was "it was nearly broke."

Some reaction was directed to "how do we pay for this," but some was also directed at "how do we stop paying for this?" There are issues associated with the financial impact on the employer, but also on the employees who desire the medication but now face increased financial responsibility. 

At the outset of any discussion, obesity is an American epidemic. There have been plenty of discussions of that: Reality, Perceptions, Problems (February 2026); Obesity - a Better Definition? (June 2024); Obesity yet Again (January 2023); What is in a Name? (August 2020); Gluttony in America (August 2018); Obesity Can Kill Me? What Could Be Worse!? (March 2015); I am what I am (July 2013); Get me a Huge Soda Please (April 2013).

Obesity may have a direct impact on people's employment and lives. Disparity and Evolution (August 2024); Obesity Death (June 2024); Fat Discrimination (June 2023); Monetary Costs of Obesity (December 2021); How will Risky Behavior and "Choices" Affect Employment Decisions (April 2013).

And there may be impacts on treatment and care. Dosage Discrimination (October 2023); The BMI Conundrum (August 2022); Comorbidity of Obesity (October 2021); Stool Transplant? (October 2019).

Undoubtedly, there are both personal and societal costs from obesity. We long ago decided to socialize American medicine in the name of compassion and fairness. Whether someone has the ability to pay for their care or not, we generally provide care. Arguments can be had regarding the extent, convenience, and efficacy of such care, but we provide some quantity nonetheless. See First Thing We Do (April 2026) and Socialized Medicine in the News (May 2026).

One of the ways we socialize medicine is through the contract of insurance. Long ago, the drive to health benefits became a rallying cry of organized labor and then an underlying cost element of various goods and services we all consume. The expense a business pays to provide employee health coverage is part of the business's calculation of how it charges for its resulting goods or services.

Is a city (or small New England town) any different? NewsNation notes that the cost of GLP-1 medication can be "upward of $1,000 a month for people who do not have insurance coverage." There are paths around, under, and over the cost obstacles, but the meds are expensive in any event. 

Municipalities are seeing competition for their budgets and will have to choose a path. They may decrease spending on other needs. A Buffalo, New York, council member noted this:

“We have crumbling infrastructure. We need new streetlights. We have parks that need investment. We need new sanitation trucks. We need more equipment for police and fire.”

The implication is that a million dollars might be spent providing GLP-1s for city employees, or the money could be used for these other perceived priorities. Despite that, the acceptance of GLP-1s seems to be expanding. France recently announced that it would proudly be the "first country in Europe to cover" these medications. That said, their plan is to cover 65% of the cost. 

At a state level, "only 13 states cover GLP-1 medications for obesity," according to Medical News Today. The coverage that does exist "depends on your plan, your health conditions, and which GLP-1 is prescribed." The tenor of that article suggests coverage can be sparse and challenging. 

The impacts are potentially the same for workers' compensation (WC) budgets. Many view workers' compensation responsibility as limited to workplace exposures or accidents. Nonetheless, it is common for such programs to treat co-morbidities and interrelated health challenges that impact the work injury recovery. GLP-1 are likely being provided in some state WC systems for weight loss and diabetes. Thus, the cost challenges are likely there as well. 

The equation is not different for the employees. They perceive a personal need for weight loss and all the benefits that it provides. Having lost a great deal of weight in my golden years, I personally attest to the benefits in fitness, energy, and well-being.

An employee quoted in the NewsNation article was shocked when her insurance plan changed. She noted that she had been responsible for a $30-per-month copay for her GLP-1, but she lost her coverage for this medication. She now finds herself, seemingly, faced with the reality of paying $300 per month for another version. That change will stretch a family budget. Like cities, every family has competing interests to fund: food, shelter, etc.

Notably, there is no mention in the NewsNation article of the alternatives to GLP-1. The simple fact is that when we consume fewer calories than we burn, weight loss follows. I know this as I have done it. The equation is simple. To accomplish the feat, one may eat less while maintaining activity. Or, one may eat the same while increasing activity. Or, for the real results, one can increase activity while decreasing caloric intake. 

Eating less costs less (budget-friendly). Exercise need not involve a membership or even much equipment; I walked my weight off with some $40.00 per pair. close-out, running shoes. I go through about two pairs per year. They are not pretty, but they offer the support I need. Since reaching my goal weight, I walk two miles every morning, rain or shine.

I watch my step counter, and with my other daily activities and periodic walks, I average more like 3.5 miles daily. I take the stairs every day, each way. Little changes can make a big difference, and at little to no financial cost. 

Could employers be as creative? Do employers provide opportunities for activity? I know people who walk twice a day with their coworkers. They (1) socialize, (2) often discuss work challenges, (3) clear their minds, and (4) get almost a mile of steps each morning and afternoon. The employer may see that as 30 minutes of lost productivity daily. But they might as readily see it as promoting health, team, and well-being.

There are no easy answers. I struggled with weight for decades without the success or even motivation for it. Lives are busy, and there is a draw to the easy answer of a pill. But in the end, the success comes from lifestyle change. The equation between calories consumed and burned will remain, whether a decrease in consumption is motivational or pharmaceutical.

And there are budget considerations for everyone involved.