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.

State of the States

NWCR 2026!

Day two of the 2026 National Workers' Compensation Review (NWCR) at WCI 2026 begins with the State of the States. A series of posts is listed at the conclusion of this one, providing a roadmap to the entire NWCR 2026 agenda.

State of the States: National Case Law Highlights 2025-2026
Tuesday, August 25, 2026; 8:45-9:45 a.m.
Grand Ballroom 8B

This presentation will be an energetic start to a day packed with content and expertise. Five attorneys from across the country will address the recent rulings and legal challenges that confront the world of workers' compensation.

There are many opportunities to see workers' compensation as state-specific. But in the information age, flaws and cracks in both statutes and historical interpretations (precedent) are exposed and discussed in national forums like the NWCR, social media, and more. What works or fails in a jurisdiction may inspire or confound in another. National trends matter in the information age.

Layered on the decisional aspect are the various legislative changes. Workers' compensation is seemingly always ripe for legislative examination and alteration. In addition, there are the potentials for regulatory change and interpretation regarding how those statutes are interpreted, integrated, and implemented.

This panel discussion will highlight what has changed since we gathered last in August 2025. There have been appellate decisions reaching intriguing outcomes, receding from decades-old precedent, and providing marketplace edification and illumination.

Are these outcomes anomalies? Some may be developing trends. Are these outcomes compelling? Some may have minimal potential for expansion or repetition. Are these outcomes worth study and consideration? That will be a collective analysis with room for audience engagement and questions.

The world of workers' compensation will continue to change and evolve in the years to come. The insight of this panel may well set the stage for us to understand the possibilities and probabilities of how, when, and where.

State of the States: National Case Law Highlights 2025-2026
Tuesday, August 25, 2026; 8:45-9:45 a.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

Moderator: Steve Tipton, Esq., NWCR Advisory Board; Retired, Austin, TX 

Panelists:
Zach W. Jarrett, Holder Padgett Littlejohn & Prickett; Charleston, SC 
Marguerite L. Jonak, Esq., Manning Kass, San Diego, CA

Kristina Jones, Jones & Jones; New York, NY
Sarah Reisner, Manier & Herod; Nashville, TN 
Rusty Watts, Swift Currie, McGhee, & Hiers, LLP; Atlanta, GA 

 

NWCR 2026 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

Stewardship of Truth

NWCR 2026!

The final program of the first day of the 2026 National Workers' Compensation Review (NWCR) at WCI 2026 is Stewardship of Truth. A series of posts is listed at the conclusion of this one, providing a roadmap to the entire NWCR 2026 agenda.

Stewardship of Truth in a World of Intelligent Machines – How Faith-Based Principles Guide the Implementation of AI into the Work Comp System

Monday, August 24, 2026; 2:10 – 3:10 p.m.

Stewardship is a difficult term for some.  Stated simply, it is careful and conscious management. In the end analysis, striving for considered decisions is an admirable goal in any environment that touches human well-being, and there are few environments that are any more intensely human than workers' compensation. 

The Stewardship panel that closes day one of the 2026 NWCR program this August will address the "challenges and perils" of artificial intelligence (AI). The panel will strive to acknowledge the many potentials that AI could include, such as errors, misinterpretations, and simple mistakes. 

These are inevitable. AI is not perfect. It is a platform of imperfect tools designed and built by imperfect people. It is a literalist with a focus on efficiency, predictability, and replicability. And yet, it is a very powerful tool in the hands of a competent, conscious, and careful human, a "steward." 

This panel will stress that AI is not evil, but that it can effectuate inappropriate outcomes as easily and faster than any human can. The discussion will center on retaining the human as an engaged and effective user of these tools in an effort to retain human "judgement, responsibility, and conscience." 

The critical point is for the steward to remain focused on the "human dignity, livelihoods, health, and family wellbeing" of those touched by the workers' compensation systems. The course of progress will be for that steward to actively and intelligently engage innovations and tools like AI in order to deliver these human traits and foci in an efficient and effective way. 

There will be ample time for discussion of the "challenges and perils." The pitfalls faced by the new AI user are many, and unfortunately, the user warnings are few. The uninitiated may be led into incorrect or even fake legal interpretations, misapplication of legal principles or requirements, inappropriate expectations, or ineffectual suggestions and recommendations. 

Everyone in the workers' compensation process will eventually use tools that involve AI. Each will be presented with the output that others in the process have generated with AI. The entire community will be challenged to adjust to the new world that is touched, enhanced, or polluted by output that was poorly curated, misstated, or misconstrued. 

None of that will necessarily equate to evil or even bad intent, though that potential also exists. Nonetheless, most of the challenges and tribulations will come from unskilled application, inexperienced engagement, and naive, unconscious trust. 

The contention of this panel is that workers' compensation professionals will be confronted with the output and effects of these tools. They will be challenged by the patient who has striven to research, the pro-se litigant who is mis-relying, or the occasional professional who has forgotten their human role, the steward role, in maintaining the presence and prominence of human responsibility, compassion, and humanity in this difficult process. 

Stewardship of Truth in a World of Intelligent Machines – How Faith-Based Principles Guide the Implementation of AI into the Work Comp System
Monday, August 24, 2026; 2:10 – 3:10 p.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

 

Moderator: Bill Pipkin, NWCR Co-Chair; Partner, Austill, Lewis, Pipkin & Maddox, Mobile, AL 

Panelists:
Connor Atchison, WiseDocs, Toronto, Ont.

Dr. Chris Brigham, Brigham and Associates, Hilton Head Island, SC 
Desiree Tolbert Render, Sedgwick, Orlando, FL

NWCR 2026 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

Evidence, Perspectives, and More

Another federal judge in the news, this time for an alleged altercation. The America Online (AOL) reports that surveillance video is involved. The story was later picked up by other media, including the New York Times and the San Francisco Chronicle.

I have been persistent in warning about the ubiquity of video cameras in modern America. See Optics and Options (September 30, 2025) and all the posts noted there. With the emphasis on security and the minimal chances of real investigation of property crimes. See Drive Carefully (May 2026); cameras will continue to proliferate.

Even when there is a video, there is perhaps room for different perceptions. That might mean that someone disagrees with what the video depicts, the authenticity vel non of the video ("it's a deepfake"), what it depicts ("that is not me"), or what may have occurred other than what was captured. This is the realm of evidence, argument, interpretation, and credibility. These are the crux of litigated disputes.

In this story, there are allegations of battery, and a disagreement over parking appears to have played a role. A Ninth Circuit Court of Appeals judge in Idaho was parked "askew" when another man parked and "allegedly verbally criticized the judge's parking twice." The criticizing driver allegedly suggested the judge "learn how to park," and then there was a conversation.

To be fair, we have all parked askew at some point. And America's parking lots have long been a potentially unruly place. Recent examples include Indianapolis, Memphis, and Florida. In fairness, there are likely multiple such events daily in every state, but they do not make the news. Parking and driving somehow seem to bring out conflict.

The Idaho judge then allegedly "grabbed the man's glasses off his head and threw them across the parking lot." According to the video, the judge then referred to the man as "crazy" and as a more derogatory adjective. The video then "appears" to show the judge running to "stomp on (the) glasses."

Apparently, the judge admitted to "knocking" the man's glasses but "stated he did not touch him." The judge's attorney commented that the "judge will address the charges through (the) judicial system." And it is imperative that we remain ever-conscious that everyone in America is innocent until proven guilty. Allegations are simply that, allegations. And the presence of video evidence or clamor does not change that, for anyone.

Nonetheless, an organization called "Fix the Court" has announced that it filed a complaint regarding the Idaho Judge. It cites Canon 1 of the Code of Conduct for U.S. Judges, and notes a desire for more "expeditious disclosure of incidents involving the federal judiciary."

National Public Radio (NPR) reported the incident as part of a broader discussion. It noted the recent filing of two impeachment articles regarding an Atlanta judge whose behavior was widely reported. See Lessons from Poor Behavior (May 2026). It also noted a Michigan judge accused of violating probation related to a DUI case (alleged; remember the innocent until proven guilty mentioned above). See Super Drunk (June 2026). 

NPR cited a former judge who noted that "When judges act badly, even in their private lives, it reflects badly on everyone else." That is likely a fair statement. The news is the news. The news notes that the Chief Judge of the Ninth Circuit only recently learned of the sunglass-throwing allegations and has instigated an investigation.

As is our habit, there will be due process. The accused will have the opportunity to confront the accuser. Evidence will be evaluated by a finder of fact (judge, jury, or Congress). Decisions will be made. The processes, outcomes, and perceptions will be imperfect. We are all imperfect humans, and all that we create will likewise be imperfect. But we will strive for objectivity, fair process, and transparent outcomes. 

The overarching sentiment of all this news coverage and commentary is critical. Notably, some criticism is focused on transparency. In an ideal world, those who make missteps would self-evaluate and even self-report. I have praised those who do so. See Yes, Virginia, Mitch was Right (June 2026), and I have been less complimentary of those who shirk responsibility or try to hide errors. See Just Delete It? (October 2025).

In an increasingly cynical and suspicious world stoked with clickbait headlines and social media virality, there are challenges aplenty. No unnecessary fuel should be shoveled to the flames, nor should fanning (unforced errors) be engaged by those who make errors and mistakes. 

Causation Analysis

NWCR 2026!

The 2026 National Workers' Compensation Review (NWCR) will be presented at WCI 2026. The second program will be Causation Analysis. A series of posts is listed at the conclusion of this one, providing a roadmap to the entire NWCR 2026 agenda.

Causation Analysis: AI as a Tool for Structured, Defensive Medical Reasoning
Monday, August 24, 2026; 2:10 – 3:10 p.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

The core of workers' compensation is medical. Medicine, it is often said, drives the analysis in these challenging personal injury situations. It is the physician who must answer so many of the difficult questions that the legal world has foisted upon them. While these include sticky subjects like maximum medical improvement, work restrictions, and impairment, the first task is often determining whether some outcome or complaint is or is not related to the insult or injury that has been alleged. Stated more simply, did that accident cause this malady?

Any casual observer of workers' compensation would be quick to realize that many documents are generated. These include the state-required reporting forms, financial records, and more. But we have also evolved to producing a vast amount of documentation regarding medicine. This includes patient-generated questionnaire answers, nurse or other paraprofessional interaction records, physician office notes, radiology and other diagnostic results, consulting physician reports, hospital status notes, and ultimately physician reports.

In the typical analysis process, this volume challenge is exacerbated by the inclusion of too many duplicates and repetitions. That is driven by the litigation process, the desire for completeness, and the fear of missing something important. Accuracy matters. Completeness matters. And time is most often at a premium.

In the 21st century, we have been presented with an opportunity to engage artificial intelligence (AI) in the collation, organization, and summary of these various documents. AI large language models (LLMs) are proficient at identifying duplications, ordering documents chronologically, and summarizing content competently. To be sure, these LLMs are not perfect and are as capable of making mistakes as any human is. But, they are powerful tools that may take the edge of that time premium mentioned above.

The 2026 NWCR will address frameworks, including the Bradford Hill criteria, for analyzing causation. The "Causation Analysis" panel will be

Causation Analysis: AI as a Tool for Structured, Defensive Medical Reasoning

Monday, August 24, 2026; 2:10 – 3:10 p.m. (Room TBA)

The panel will discuss tools available for synthesizing the causation analysis, the application of frameworks for decision-making, and reaching causation conclusions that are based on the presented evidence. The goal is a process that leads to the appropriate conclusion as opposed to beginning with some conclusion that requires some justification or support.

There will be a discussion of how experts can appropriately delegate tasks in the causation analysis process, applying constraints and processes so that the outcome is produced efficiently and effectively without losing the primacy of the physician expert's scientific knowledge, analysis, and experience.

The ultimate goal remains the same today as it has always been. The parties all want the correct answer to difficult questions, such as causation. They need principled and replicable processes for analysis, synthesis, and rendition of expert opinions that are ethical, unbiased, and defensible.

In pursuit of those goals, balancing the capabilities and efficiencies of AI, the confluence of these tools and the causation analysis process is inevitable. The Causation Analysis panel will address the engagement of these tools in making a challenging process more efficient and effective.

Causation Analysis: AI as a Tool for Structured, Defensive Medical Reasoning
Monday, August 24, 2026; 2:10 – 3:10 p.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8)

Moderator:

Christopher Brigham, MD, NWCR Advisory Board; President, Brigham and Associates, Inc., Hilton Head Island, SC 

Panelists:
Alex Alamazon, Esq., Almazan Law, Miami, FL

Mark Melhorn, MD, Mid-America Orthopedics, Wichita, KS
Heidi Sellers, Acrisure, Bradenton, FL

NWCR 2026 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

Aligning Litigation Strategy

NWCR 2026!

The National Workers' Compensation Review (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. It begins Monday afternoon and extends throughout the day Tuesday. 

The premier, "session ONE," will be a Litigation Management Panel featuring claims, legal, and medical perspectives. The moderator is Nicole DuShane of Summit Insurance. This will be:

Aligning Litigation Strategy, Defense Counsel, and Employer Outcomes
Monday August 24, 2026;1:00-2:00 p.m.
Grand Ballroom 8B (Entrance through corridor Grand Ballrooms 7 & 8).

The world is awash in financial incentives. These can be obvious and rudimentary, such as comparing the price of gasoline among various stations. But incentives can be less apparent when they are intertwined in large, integrated systems. Workers' compensation obviously fits that bill. There have been various efforts over decades to either incentivize or disincentivize actions or reactions in the delivery of these benefits. Each of them had an intended consequence but too often precipitated other unintended behaviors. 

The panel will also discuss the challenges of confidentiality of client information. While this is not an artificial intelligence or cybersecurity panel, the implications of each are readily apparent and may perhaps be the 800-pound gorilla in the room. The claims process will always involve sensitive, private, and even confidential information. How, when, and why it is disseminated is a critical part of the litigation practice, from the perspective of those who seek recovery and those who defend it. 

One of the great challenges of the workers' compensation system is the intimate relationship that exists long before an injury occurs. The employer and employee are well acquainted. They have past experiences of trust, performance, and reliability. They come to any dispute with pre-existing perceptions that may be fact, opinion, or a combination. These may be recognized or lurking in the shadows of inherent predisposition that the NWCR exposed in 2025. How the expectations of employers, employees, and the workplace figure into the management of litigation is complex and worthy of discussion. 

Part of that complexity is the relationship between defense counsel and their two clients. Too often, it is forgotten that the one attorney represents both the employer and the carrier or servicing agent. These two clients may sing in harmony, but there are ample opportunities for their interests to diverge. Who selects defense counsel? Who directs their actions and makes the ultimate decisions? What is the process for reaching the conclusion points to afford counsel their marching orders? It is a myriad of potentials and challenges. 

Counsel's relationships with the management, claims, risk, and financial professionals may be complex and may differ from claim to claim. Expectations are a given. Recognizing them, defining them, and addressing them will lead to greater harmony, predictability, and concert.  

Aligning Litigation Strategy, Defense Counsel, and Employer Outcomes
Monday August 24, 2026; 1:00 – 2:00 p.m.

Moderator: Nichole DuShane – Summit Ins., Lakeland, FL

Panelists:
Becky Hillhouse, Sr. VP & Head of WC Claims, Ascot Ins. Group, Madison, MS
Alan Pierce, Esq., Pierce, Pierce, and Napolitano, Salem, MA
Melissa Spurlock, Select Medical, Mechanicsburg, PA


 NWCR 2026 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

Mental/Mental at Home?

CBS News reported recently that remote work may pose risks for some workers: "Research shows it hurts their mental health." Remote work is wildly popular with some. Employers have reported struggles with finding and retaining in-office workers in a workforce acquainted with the slippers and sweats world of virtuality.

The mental health concerns are centered on "alone time" and the absence or minimization of human contact. This is characterized as the absence of "idle chitchat," speaking to a coworker, or even a "smile from a passerby." The quoted study noted that most workers have not "compensate(d) by socializing more outside of work hours."

The study also raises some questions. The conclusions are based, in part, on frequency of mental health provider visits and prevalence of psychiatric prescriptions. Some will argue that the data and premise are arguably not scientific proof of causation but of coincidence. See Consensus in the Absence of Proof (January 2021); Tootsie Pops Make you Think (August 2021);

There is a stark difference between coincidence or correlation (the presence of two findings) and causation (the conclusion that one resulted in the other). See Work Hours are Deadly? (June 2021); Disparity and Evolution (August 2024).

Nonetheless, some may conclude that there are mental health risks to isolation. During SARS-CoV-2, I once instructed a remote worker, simply, "go outside." Asked what they should do, I replied that it did not matter, but their persistent isolation indoors needed to end. I still think that was good advice. But I have never heard of an AI suggesting it. See Ya Jonesing Man? (March 2025). To be clear, I have no mental health counselor training, but everyone benefits from a break and some fresh air. 

Workers' compensation systems across America take very different approaches to emotional complaints and allegations of injury. Some states, like Florida, require most employees to suffer a physical injury as a predicate for compensability of emotional injury. This is commonly referred to as a "physical mental" state. We had a great discussion of these intricacies at the SAWCA annual convention last week, comparing and contrasting four state perspectives. 

There are states in which an emotional injury alone can be compensable, commonly labeled "mental/mental" states. These distinctions are discussed in The Debate of Mental Mental and PTSD (January 2017); More Rust (October 2022), and other posts noted there.

I have also noted the challenges of emotional health periodically and have made some suggestions that there are particular challenges to mental health in the modern world. See Mental Health News (September 2020); Emotional Health (October 2022); and AI and Mental Health (October 2023).

The overarching point is that there can be stress in the workplace. In physical/mental states, that stress will not generally be sufficient alone as a workers' compensation injury. Nonetheless, in states in which "mental/mental" injuries are compensable, the emotions of an employee may be a sufficient foundation for a workers' compensation claim.

How prevalent is this mental/mental? Researchers have struggled with quantifying because the various state requirements, definitions, presumptions, and burdens are quite different. Nonetheless, some research concludes that "mental-to-mental injury, an injury involving purely mental stimuli, may be eligible for compensation in 40 states." 

That is not to say to all employees in those states. Several laws treat various occupations with different and disparate laws. Occupations with proficient lobbies and through extensive efforts have carved out special treatment for themselves. Those are policy decisions that intentionally treat workers differently. 

So, we conclude with the risk of isolation. Being alone persistently may present significant risk of mental health effects. One might begin having conversations with inanimate objects like volleyballs, see Tom Hanks in Castaway (20th Century Fox, 2000). In fairness, many of us mutter to ourselves in the office. 

Nonetheless, the work-at-home paradigm may increase that risk, particularly if the worker does not consciously strive for human contact elsewhere in their non-work time. And, as to the point in workers' compensation, the resulting emotional condition(s) may be compensable under some workers' compensation laws.

This could be an important point, the "some." It is practical for a worker to have potential entitlement in the state where a work accident happened (the home), where hired (might have made an acceptance by telephone from almost anywhere), where the employee lives, or even where the employer is located. An employer might face multiple potential exposures in one employee. 

Might an employer find themself on the hook for compensating the employee for that non-work time spent socializing? If the mental health provider prescribes an evening out to socialize, a bowling league, or walks in the park, will the mental/mental states treat that differently than an orthopedic ordering physical therapy? Maybe the work-at-homer can get a script for a night or two on the town as "treatment?" Or maybe a trip to Aruba?

A final note is that workers' compensation laws tend to embrace events within a particular state, noted above. So do many workers' compensation insurance policies. Is that New Jersey employer covered for a mental health claim from its Illinois remote worker? Might the potential exist for a coverage dispute by a carrier purportedly unaware of what company payroll represents work in remote states?

It is a fair question to consider when explaining to the broker or issuer that you need coverage in the state where the employee is located. A company in Iowa with a work-at-homer in California may well face liability under the California workers' compensation law. 

How Could You Not Know Now

Early in my legal career, there was excitement when the Florida Legislature changed the law slightly, and the result was the potential for cigarette companies to be successfully sued. The legislation was not the end by any means; there have since followed a whole raft of lawsuits. Some say there have been thousands; others say that it is many more. 

I remember many conversations about the litigation. The plaintiffs, thereafter, in the 1990s, often alleged that they did not know of the dangers of smoking. Had they known, they posited, they would never have taken up such a dangerous distraction, habit, or addiction. Or, at least, they would have striven harder to quit. If only someone had told them. 

There was much discussion among lawyers about the federally-mandated warning on cigarettes that was established in 1966 (for those struggling with math, that was 28 years before the start of Florida lawsuits following the 1994 statutory enabling change. 

Certainly, some folks may have started smoking before 1966, but even so, there had been a great deal of time in which to quit. As certainly, the initial warning was somewhat milktoast: ""CAUTION: Cigarette Smoking May Be Hazardous to Your Health." It was later enhanced with the requirements of graphics, but not until 2009. 

Was there bad action by "big tobacco?" I doubt there is anyone who would argue that there was not any. It is generally accepted that the cigarette companies hid internal research data about dangers and diseases. 

There is little doubt that nicotine addiction was manipulated, children were targeted, misdirected research was allegedly bought and paid for, and the whole "low-tar" campaign could be a lesson all its own. There is some seeming consensus that various companies acted inappropriately from time to time. Google "Gladys Kessler Philip Morris RJ Reynolds, corrective statements." 

I personally harbored some skepticism about the "I didn't know" arguments in the 1990s as I watched Florida tobacco litigation expand and accelerate. How was it possible for smokers to not know of the dangers? I got the warnings as a youth, echoed by every adult smoker I knew (many), repeated later in high school, they were printed on the packages, and also on stickers on the vending machines where many bought cigarettes (machines did not discriminate on age).

Nonetheless, I had some serious discussions in the 1990s about starting a cigarette company. We were going to call our product "Death" and the proposed logo prominently featured a skull and crossbones. We planned to eschew the federally mandated:

"Caution: Cigarette smoking may be hazardous to your health."

We planned, instead, to have a warning on one side panel that said simply:

"Strictly a novelty, do not open, consume, or light under any circumstance."

On the other side panel, we planned a more stern and direct warning:

"These cigarettes will undoubtedly destroy your mouth, esophagus, lungs and will kill you. Do not smoke."

Our critics said we would not sell any. But we had a feeling that those who wanted to smoke would light up no matter what the package said. We also suspected that the "real" tough person crowd would smoke them simply because they were "Death." The "manly" man in that era was associated with one particular brand; some even quibbled over which package of that brand was the most manly.

Imagine an ad that opens with a group shooting pool and sipping suds. A buff gentleman unrolls his sleeve (yes, this was a real thing, people kept cigarette boxes in their shirt sleeve) to reveal a pack of "Death," which he gallantly offers a vivacious young lady who intones, "Death for us all!" and the commercial fades to black with the skull and crossbones logo and our "these will kill you" warning. The voiceover is "some fear death, others flee it, but some even smoke it!"

Unfortunately or not, we got distracted by some other opportunities and never got "Death" launched. Any time I would lament the foregone opportunity, I was readily assured that "Death" would never have succeeded. Too much was known about the dangers. Smoking was "over." I rarely met anyone who thought such a venture could succeed. 

The premises-banning began in the 1990s, also. The Centers for Disease Control credit California with leading the way. There were prohibitions on smoking in various venues like bars, restaurants, and more. I will never forget the incredulous look I got from a California restaurant hostess when I asked for a "non-smoking" section in the 1990s. Time reported that trend continued through the beginning of the 21st century.

That followed the ban on domestic airline flights that started in 1988 and which soon cascaded into a near-universal ban on aircraft. Some foreign-flagged carriers continued through the 1990s with "smoking sections." I once flew on one where the smoking section was the seats on one side of the aisle, and the non-smoking were inches away on the other side.  

George Carlin questioned in that era 

“Isn’t making a smoking section in a restaurant like making a peeing section in a swimming pool?”

Crass, but memorable. By the second decade of the 21st century, those indoor smoking bans had spread to even the area around entrances to certain buildings. 

It has now been 60 years since the mandatory warning became the norm. Gallup reports that smoking is at an "80-year low," but 11% of American adults smoke. The Census Bureau says there are 258.3 million American adults, so that is 28 million customers still in the market for "Death." Some contend that the biggest winner is, in fact, the taxman. Some argue that government makes more from each sale than the producer does. 

That is intriguing. It is more intriguing that smoking is more prevalent in Europe ("Roughly 1 in 4 Europeans smoke compared to about 1 in 7 Americans"). And you can buy from machines there without identification, though there are warning stickers. This is despite a Harvard analysis that the cost and taxation in Europe are more pervasive, as are smoking regulations.

By this point, the reader probably has questions. Primarily, likely, what does this have to do with anything? Fair criticism. Well, the New York Post recently reported that cigarettes are cool again!

There were trays of them, "at the Vanity Fair Oscar's Party." And, as important, a random cool woman recently appeared on the cover of that magazine puffing away. There are, again, cameos in films and television. The paper concludes, "Smoking is well and truly back," despite those pesky government warnings.

Those who enjoy some nicotine include some otherwise health-conscious folks. They are nonetheless interested in "an occasional indulgence." Cigarettes are said to be "a great way to network" and a "good way to meet people." They are a "rejection of wellness culture."

Reason argued in 2026 that the American indoor smoking bans are too restrictive, arguing for the inconsistency that Japan has adopted. In their flexibility, one might see freedom of choice or chaos. The answer in Japan to whether smoking is acceptable is likely always "it depends." Whether right or wrong, the point is that advocates are seeking to re-establish smoking in public places. 

I said it in the 90s, and sadly, I was right. People will smoke regardless of the science, the warnings, and the dangers. There is a draw, social and societal, and all the cool kids seem to be doing it. Some of the cool kids are advocating for its return to acceptance or at least some nightclub deregulation. It is possible that some of them are even being paid for their advocacy or public use. 

I am not a fan. Nonetheless, how someone chooses to use the life they have been given is for them to decide. Nonetheless, I don't buy the "second-hand smoke can't hurt you" routine. I prefer that you keep your death to yourself. But it is also somewhat up to me to be willing to avoid the spaces in which people do smoke or vape. 

In the coming years, will those who have used these products in the 21st century be compensated for their conditions or diseases? Will there come a point where the world is comfortable concluding that everyone who consumed these products knew and accepted the risks? Despite all that is now known, will young people keep adopting this habit?