Everyone Gets a Trophy

We, as a society, have likely hit our nadir, though there is some chance we have further to fall before some sudden stop marks our complete demise. I have written about the decline in education and capability.

The National Literacy Institute has noted that (il)literacy is tied to "some of today's most pressing concerns." We face teacher shortages, teacher competency issues, and various other secondary education challenges. The Institute notes "21% of adults in the US are illiterate," and "54% of adults have a literacy below a 6th-grade level." Like it or not, this is largely influenced by immigrants: "34% of adults lacking literacy proficiency were born outside the US."

For thoughts on literacy, see Screen Time Wins (February 2026); It's Your Kids! (February 2026). Students are showing up to college, and they lack the basic skills of reading and writing.

The University of Florida reports that "reading for pleasure (is) in free fall." The author of the study says this is not "a small dip—it's a sustained, steady decline of about 3% per year." If you don't do something, practice, you will lose the muscle memory to do it. 

And it is not some systemic change; the drop is steeper among some demographics, which the author attributes to "disparity in reading access and habits." Notably, "women are still more likely to read." Those who exercise skills will better retain them. 

Another dichotomy, perhaps more predictable, is education-based: "People with higher education levels ... are more likely to read." The other good news in the study is that "reading with children did not change over the last 20 years." We may not read for ourselves, but we are at least reading with children. They need us more than ever. 

A Stanford professor is proposing and supporting the "science of reading." She notes that "at least 40 states" have proposed "legislation aimed at reversing the downward trend." There is also interest in teacher preparation, requirements for curricula, and "mandates to use evidence-based screeners to identify students who may need additional support."

There may be some belief that the 20th-century "every kid gets a trophy" has contributed to the decline in competitiveness, refuted by some. Nonetheless, a recent decision by the Los Angeles Marathon to award medals to those who ran 18 miles instead of 26 miles gained headlines. Why 18? Next year 17? 

Will we reach a point where I could get a marathon medal (at the outside, I might do three miles)? Technically speaking, the 18 milers have no more finished a marathon than I have. Where is my medal?

Every kid getting a trophy for finishing the (pick a sport) season is seen by some as rewarding mediocrity. The LA Marathon's decision to award those who did not even finish has been viewed a bit more harshly in some quarters. 

On the other side of the world, the Chinese culture is struggling with the opposite. China announced recently that it would "promote students' physical and mental health" with mandates that limit "excess homework," "reduce academic pressure," and promote "two hours of physical activity ... every school day." 

Might such a move help us with the bane of obesity? Many of our schools do not provide the more moderate recommendation of one hour daily "moderate to vigorous physical activity" now.  

Thus, there is some recognition of the value of exercise and activity. There is the potential of pushing academics too hard. But there is the challenge of illiterate adults and the difficulties that they could present in the world of work and democracy.

In all, there is some need for moderation. Nonetheless, we are societally yielding our futures if we accept "Johnny can't read" as a normal outcome. We can reverse that, but it will require some focus and commitment to teaching, learning, and less screen time, videos, and social media nonsense.  

Thanks for reading this, and for knowing how. 

Reality, Perceptions, Problems

Obesity has graced these pages before. The threat of obesity is among the most challenging in modern society.

See Fat Discrimination (June 2023), Obesity Again (January 2023). See also What's in a Name (August 2020); The BMI Conundrum (August 2022), Comorbidity of Obesity (October 2021), Stool Transplant? (October 2019). Obesity Can Kill Me? What Could Be Worse!? (March 2015), How will Risky Behavior and "Choices" Affect Employment Decisions (April 2013).

For years, Americans have spent incredible sums on health and fitness while obesity rates have recalitrantly soared. According to USA Facts, in the 1960s, the Centers for Disease Control (CDC) categorized 13% of Americans as obese. Using the same definitions, that was over 40% in 2018. There was similar growth in the "severe obesity" and "child obesity" subsets.

To be fair, obesity is simultaneously deceptively simple and incredibly complex. The simple piece is math: calories consumed versus calories burned; burn fewer than you consume, and the body grows. But various hormonal, endocrine, and other contributors impact individuals differently or even uniquely.

Then came the solutions. There have been a variety of easy solutions. Some will remember the miracle of Fen-Phen, a cocktail of fenfluramine and phentermine prescribed in the 1990s. After approval and widespread use, the lawsuits were enough to drive it from the marketplace. It was not alone; there have been various panacea solutions: fad diets, cleanses, stimulants, and worse have been tried over the years.

The 21st century brought GLP-1 drugs for diabetes. These became newsworthy when users reported associated weight loss. That led people to seek them specifically for weight loss. That drove demand, price, and marketplace acceptance. It also led to evolution, and drug makers began marketing GLP-1 drugs specifically for weight loss.

The results are notable. While the GLP category contains various name brands and compounds, some claim it is reasonable to expect 5-10% decrease in body weight in 3 months. For a 5'4 person weighing 174 pounds, that could be an almost 18-pound loss.

Recently, a 28-year-old "opened up about her addiction" in a "vulnerable moment." The headline stopped me because it included "GLP-1," featured last year in Whoa Nelly! (June 2025); and Connecticut Price Fixing (July 2025). I know people who are taking these drugs, and have read much about them. 

Nonetheless, I had not heard the word "addiction" associated with them. I had presumed those who undertook the therapy would use GLP-1s chronically. There are multiple references to addiction. 

Scientific American noted that an AMA analysis concluded " the vast majority of people quit taking these drugs within two years," about 85% overall, with a larger drop "among those without type 2 diabetes." The study included "more than 120,000 people, with and without type 2 diabetes."

The immediate question is therefore "how sustainable" the drugs are in terms of effect. In other words, will the weight loss persist post-drugs? The Scientific American article notes that

"when a person who had been taking one of these medications stops, the hunger cues it had suppressed often come raging back, which causes the weight to return."

Admittedly, the study did not investigate results of cessation, but, relying on other investigations, the conclusion is that "regaining weight is almost inevitable." There is also a discussion that we are each preset to "a specific weight range their body naturally tries to maintain." Thus, when the drug-induced inhibitions disappear, we are inclined to regain weight, to return to our preset weight or range.

Back to the 28-year-old with the "vulnerable moment." She is a model, and "has been open about her use of GLP-1." She says she is an on-and-off user; she "fluctuates." She uses the word "addiction," but there is little in the article to support that word. An addiction is

"a compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects,"

According to Merriam-Webster. Nonetheless, the implication is that some people seek these drugs, abandon them after a time, and feel a need or desire to return to GLP-1. This may lead to questions about source and control issues. These are prescription drugs, but the internet abounds with sources and suppliers who offer access without those pesky doctor visits or other hurdles.

Thus, there is some indication that these diabetes drugs are regularly used by non-diabetics. And, it is practical that they are used by those who are not obese. Beyond the health risks of obesity, there is some feeling that weight loss and body image are important on a general level.

There was a time when compulsive weight loss received ample news coverage. The psychiatric diagnoses of anorexia and bulimia were newsworthy. Then came an era of "body positivity," when some believe the "self-love" and excuse led to increased fat-forgiveness and unhealthy lifestyle choices. Whose business is obesity, eating disorders, and drug use?

Earlier this year, as a movie franchise edition loomed, some questioned the appearance of one movie star. They noted that people were "talking about her body," and perceived a marked weight loss in recent years. The celebrity responded, essentially suggesting that people mind their own business, "I think we should be gentler and less comfortable commenting on people’s bodies, no matter what."

She suggested that we should, societally, 

"dismantle fatphobia, and to slowly but surely push us toward a world where the size and shape of our bodies don’t function as indicators of our value." 

That may seem a noble goal, but the American public loves body image. We spend almost $33 billion on diets and weight loss and $72 billion on GLP-1s each year. The whole of "fatphobia" and body image is big business. And there are causative or coincidental effects noted. The "vulnerable moment" model above says her business and income increased notably while on GLP-1.

In fairness, weight loss is tied to caloric consumption in some degree. Thus, if you elect to lick the donuts instead of actually eating them, weight loss may be inevitable. And, perhaps people will believe you are advocating against juvenile obesity. Others may believe you are disingenuous, which is mentioned in some reactions in that CNN article.

Thousands and Thousands

There are many opportunities in life to pause and reflect. There are milestones we may note, though they have meaning only to ourselves. Today, I do so once again.

Earlier in 2025, I delivered my 2,000th professional lecture. That has been a long road that includes almost seventy semester classes taught across three institutions. I have striven to track attendees, but I have taught thousands of students and seminar attendees. I have been privileged to have that opportunity before national audiences in Arkansas, California, Colorado, Florida, Georgia, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Nevada, New York, Tennessee, Texas, Virginia, and West Virginia. 

For years, I changed my intro biography, used at various seminars. First, striving for brevity but also trying to keep up with an approximate number of lectures and blog posts. Now, I can just say "has delivered thousands of lectures." That has a nice ring.

I passed a notable mark in 2022 and celebrated a decade of writing this blog. You find many blogs on the internet, but few that persist for a decade. Many websites include a blog, and yet the posts are old and dated. I am proud of that persistence.

Today, I celebrate another milestone—my bio can now similarly abbreviate with "has written thousands of blog posts." This one marks 2,000. Not exactly Barry Bonds' 73 home runs or Alex Ovechkin's 895th goal to beat Gretzky. But, nonetheless, it gives me pause. It is a life moment. 

The posts are mostly here (1939). But I have written posts for other blogs. My WorkCompCentral posts are preserved in another section, the Off-Site Archives (25). Posts about the challenges and evolution of electronic filing are in eJCC Software (36). Some might count the many other short posts in categories like Regulatory News (85) and Announcements (122). But those are less substantive. I have long elected not to include them in any count. 

There have been some memorable posts for me. One of my earliest suggested, in 2015, that we should be worried about Social Security. See Time for that Bake Sale (August 2015). That is likely still my most read. A decade later, that is a growing concern. I have personally worried about the solvency of that for almost 50 years after some reading in the early 1980s. Some of our challenges are not that unpredicted or unpredictable. 

Likely my most frequent topic was SARS-CoV-2 and the impacts on our world, community, and practice. I keep a list of those, and the second most frequent - AI. Other recurrent topics here are opioids, obesity, and the Code of Judicial Conduct. I am admittedly somewhat predictable.

I get some feedback about topics. Many have questioned, "What does this have to do with workers' compensation?" Usually, that question is misplaced by someone not looking deeply enough. Other times, these posts are clearly beyond the "workers' compensation" title. Nonetheless, my posts are consistently about the law, judging, medicine, and the connections to the workers' compensation community are clear enough. 

It is gratifying to mark the "thousands" milestones. While any of those "thousands" (students/attendees, readers, posts, presentations) might be seen in a positive light, I also see the opposite. With each passing day, we each draw closer to our eventual end. Every achievement, personal and professional, from beginning to end, moves us forward. We will likely each remember a parade of our firsts.

And yet, there will be a commensurate parade also of "lasts." In between, there will be a multitude of this and that, these and those. The day-to-day brings motivation, energy, ennui, and even exhaustion. The world of work can become repetitive, monotonous, and transactional. I have often reflected on how my time in retail, delivery, and food service all became transactional and even blasé.

As I reflect on the brief moment I have spent in Florida workers' compensation, I recall moments of all of that. I reflect on an introspective moment over a decade ago, when I concluded There's No Other Place I Wanna Be (September 2014). That post remains one of my favorites among "thousands."

Over the decades here, I recall many calm days, punctuated with various challenges, stressors, and adventures. I have seen the recurrence of issues, and periodically, there have been legal questions that were downright perplexing in their complexity and analysis. 

I am drawn back to astronomer Carl Sagan (1934-1996). In my youth, he was an oft-cited authority opining on deep topics, including the potential for life on other planets. He wrote, lectured, and changed our world. No, I find no comparison with myself. But I have striven to share some thoughts. 

Sagan became famous for the phrase "billions and billions," a reference to the stars. But he decried the reference. He corrected people and claimed he never said it: "I said 'billion' many times on the Cosmos television series, which was seen by a great many people. But I never said 'billions and billions.'” He noted:

“I’m told that Sherlock Holmes never said, “Elementary, my dear Watson” (at least in the Arthur Conan Doyle books) Jimmy Cagney never said, “You dirty rat”; and Humphrey Bogart never said, “Play it again, Sam.” But they might as well have, because these apocrypha have firmly insinuated themselves into popular culture.”

Of note, he issued this denial in a book called Billions & Billions: Thoughts on Life & Death at the Brink of the Millennium. Intriguing and perhaps poetic. In that, I relate to Sagan. I have had this blog quoted to me over the years. Periodically, those references have been less than accurate reflections of what I actually said here.

I have heard of those who quote this blog in legal proceedings. I have witnessed it in oral arguments. There is self-consciousness and unease when that occurs. This blog is not an authority but perhaps a source at the beginning of one's own analysis. Nonetheless, citation to a blog is dangerous ground. Some years ago, I changed my writer profile to discourage citation as a legal authority: 

This blog is not legal authority and should not be cited in pleadings or arguments.

That has perhaps helped. But to help, it would have to be read. 

I particularly enjoy hearing from folks about posts. I get the sporadic compliment or mention. That is gracious and even heartwarming. That said, I have always written these posts primarily for my own growth, understanding, and reflection. To the extent the entries aid and inform others, so much the better.

Thousands and Thousands. No Carl Sagan, no Cosmos, and yet today I reflect on some thoughts I have left behind. Perhaps they will evaporate should Google ever diminish or disappear (they say the internet is forever, but that is a long time indeed). Perhaps they will merely fade into the obscurity of an ever-growing volume of content. And yet, maybe someone will run across some of this in a hundred years and find some use in the source, reflection, or perspective.

The end is not mine to predict, but the journey is mine to chart. The years here, the pages here, the reflection back - all worthy of a moment. Thousands and Thousands and Thousands today and onward to the next milestones. I hope that each reader likewise has their own milestones and moments worthy of recollection and reflection. Thanks for reading. 

What is a Donor?

What is a donor? What is the meaning of any word?

Is it all in the definitions? We have been there before, in the discussion of obesity in America. Some have suggested that the solution to the escalating volume of obese Americans would be to simply change the definitions. See Zen and the Art of Trial (November 2023) and What's in a Name (August 2020).

Now there may be some arguments for rethinking who is "obese." The National Institute of Health points out that there may be valid considerations of Eurocentrism regarding the body mass index (BMI) and our preconceptions regarding body habitus. That said, changing such a definition should come through introspection and science. 

These thoughts returned to me with the recent New York Times publication of a guest essay, "Donor Organs Are Too Rare. We Need a New Definition of Death." That piece, written by three physicians, is behind a pay wall.

Other publications have picked up the piece, affording access to the rest of us. The essential point is that there are two definitions of death recognized by medicine:

1. "Either the heart has stopped, or"
2. "The brain has ceased to function, even if the heart is still beating."

The author notes that "most donor organs today are obtained after brain death." This is complete cessation of function, "devastation of the whole brain." The complaint is that "brain death is rare," and there is a high demand for donor organs. The problem, from the author's perspective, is that too few are dying in a donation-friendly manner. 

The prevalence of "circulatory death" is said to be much higher, but with the cessation of circulation, "organs from people who die this way are often damaged and unsuited for transplantation." The authors therefore advocate that we "broaden the definition of death" to allow earlier harvest of donor organs.

BioEthics.com poses some intriguing questions about the use of tools to prolong circulation in an effort to preserve organs. The idea of restoring circulation to preserve organs is broadly interesting. It might also have some implications for advance directives and do-not-resuscitate (DNR) documents that are signed by many. 

Others contend that the proposal published in the N.Y. Times is advocating change "to allow patients to be killed for their organs." It is fair to say that there are some vehemently opposed to changing the definition of "dead." Who should make such a decision? Would it be subject to various state laws, and thus depend on where the patient is when a decision on death is to be made?

The questions here are difficult. There is some potential for expanding the availability of donor organs. But, there is also some potential for donors to be less-than-enamored with the effort to change the definition of "dead." Would the state law where the donor made the donor agreement matter more than the law in the state where the donor is at the time of deciding whether they are dead?

Might such a change result in fewer donor volunteers? If the definition were changed, would all those previously executed donor agreements remain effective? Are these contracts in the truest sense of the word? Likely not, as there is no quid pro quo, no "consideration" received by the "donor," a word that itself means:

one that gives, donates, or presents something

The donor agreement is far more likely a gift than a contract, and as such, one that could be validly revoked. 

Dave's Picks for WCI 2025

This is your one-stop for my recommendations of sessions at the WCI 2025. Below is my day-by-day, hour-by-hour list of recommendations. Now, if you are a judge, you should be in the judiciary college learning to be a better judge (every class). Regulators, well, the regulator college (same—every class). But, if you are in any other career path, the recommendations below are my best advice.

One of the great challenges of attending the annual WCI event each August is the vast assortment of available programs at any given moment. There are large and small rooms, broad and narrow topics, and many outstanding speakers. These are all organized in the ”big book” that has been published for decades, and which provides more information than I could include here. That is all available in the familiar format as a PDF, also. Or, if you are one of the hip and tech-savvy, "there is an app for that," called Whova.

So, here are my “Breakout” recommendations, with a first, second, and third (In the order listed) for each time slot. If you would understand the broadest issues and foundations in workers’ compensation, these would be the programs you would grace with your presence, intellect, and engagement. Tell 'em Dave sent you. 

Sunday, August 17, 2025 9:00-5:00 

        9:00-5:00, Grand Ballroom 8B

The mediation program is open to anyone. Its breakouts on Sunday have no competing programming. Want to be a better adjuster, case manager, risk manager, attorney, or mediator? There is no better spot to spend your time understanding how disputes are discussed, negotiated, and resolved. This is a diamond in the rough, too often overlooked and too valuable to be ignored. 

Sunday, August 17, 2025 5:00-6:00 

5:00 PM - 6:00 PM The OJCC meet and greet in the Anaheim, Atlanta and Boston rooms (Hall of Cities) will be a great time to (1) meet our team, (2) put names with faces, (3) see old friends, and (4) kick off your WCI 2025 experience. 

Monday, August 18, 2025 7:00-8:30

7:00 AM – 8:30 AM  Prayer Breakfast; Pastor Ron Simmons, DWAY Praise Team; Crystal Ballroom H.

Separate registration and fee required 

Why- a great way to get the brain working and to start the day with energy and community.

Monday, August 18, 2025 10:00-11:00 (Not a breakout)

9:55 AM – 10:55 AM Industry Keynote Address – Speed, Complexity, and Noise: Navigating the Chaos of Modern Risk Management, Kimberly George, Mark Walls, Palms Ballroom, Canary.

Why- there are many issues percolating in this community throughout the year. If you consider yourself scholarly about workers' compensation writ large, this would be the update you would find time for annually.

Monday, August 18, 2025 1:00-2:00

1:00 PM – 2:00 PM Controversial Medical Issues; Teresa Bartlett, Robert Hall, Michael Lacroix, Paul Meli; Grand Ballroom 8A.

Why- the world of workers’ compensation revolves around the diagnosis, treatment, and remediation of medical conditions. This is a foundational challenge that is at the root of everything in workers’ compensation.

1:00 PM – 2:00 PM Aligning Metrics with Risk Strategy; Mark Byers, Michael Fountain, Lesley Zielinski, Laura Noble, Grand Ballroom 7A.

Why – every professional in workers’ compensation is contributing to a singular goal of injury treatment, remediation, and return to function. All of those decisions will be increasingly driven by metrics in the age of AI. Know how the metrics are perceived, and you may be better able to see your future.

1:00 PM – 2:00 PM What is Workers’ Comp? How it All Began; Stuart Colburn, Mark Pew, Timothy Conner, Roberte Mille, Robert Wilson, Magnolia Ballrooms 7-10.

Why- The panel will be intriguing, engaging, and anything but subdued. The history of this community, process, and system is studied and appreciated too little. Bob Wilson will moderate this, and he is one of the few left here who remember when workers’ compensation started at the end of the 19^th century - a rare opportunity to engage with a true historical hysterical luminary.

Monday, August 18, 2025 2:00-3:00

2:30 PM – 4:30 PM National Regulators Roundtable; Regulators from multiple states and Melodie Belcher, Crystal Ballroom G1. 

Why- these are the regulators at 30,000 feet. They see and hear much, watch horizons, and are challenged with your issues. Hear what they see and where this is all going.

2:10 PM – 3:10 PM Preventing Burnout in Healthcare; Ashley Catapano, Josh Schuette, Howard Weiss, Gia Sawko, David Jennings, Grand Ballrooms 13–14.

Why- the medical care is at the root of all that is workers’ compensation. How is the medical team to do their best? Two of the most fanatically energetic people I have ever known are on this panel. See if you can figure out which two.

1:50 PM – 2:40 PM Injured Workers Are Humans Too; Debra Livingston, Gloria Fagan, Melissa Jorgenson, Denise Evans, Taurus Glass, Magnolia Rooms 1–3.

Why- A reminder of the human elements, for both injured workers and their employers, is an admirable topic that is worthy of our time. If Debra Livingston has not encountered it, it is likely not in workers' compensation. 

 

Monday, August 18, 2025 3:00-4:00

2:30 PM – 4:30 PM National Regulators Roundtable; Regulators from multiple states and Melodie Belcher, Crystal Ballroom G1.

Why- these are the regulators at 30,000 feet. They see and hear much, watch horizons, and are challenged with your issues. Hear what they see and where this is all going. If you make it through the first hour, this second hour is your chance to see them all struggle with more issues. 

3:15 PM – 4:15 PM Building Trust in the Claims Process; Felicia Snead, Beth Koller, Amy Wilds, Vera Hill, Magnolia Ballrooms 4–6.

Why- the work injury and recovery is a journey with many guides. Trust is a critical component for every professional involved. And, you get to hear from Vera Hill, an OJCC Certified Scholar!

3:15 PM – 4:15 PM Mitigating Psychosocial Barriers Through Work; Adam Seidner, Bryan Conner, Drew Cashatt, David Hoyle, Grand Ballrooms 13–14.

Why- everyone has psychosocial factors that affect them. Understanding is the beginning of meeting those needs.

Tuesday, August 19, 2025 9:00-10:00

8:45 AM – 9:45 AM Mental Health Risks in the Workplace; Thomas Aune, Jennifer Dean, Danielle Hill-Lamoureau, Bill Brueckner, Greg McKenna, Crystal Ballroom J1.

Why- the human element will be the one that persistently requires our attention, management, and focus. This will impact every workplace and, therefore, every workers’ compensation professional.

8:45 AM – 9:45 AM From Team to Impact: Driving Financial Success with RTW; Omar Perez, Eddie Martinez, Patti Colwell, Shandra Burkhardt, Zachary Rosenthal, Crystal Ballroom H.

Why- the ultimate goal following any work injury is remediation, recovery, and return to work. Maintaining our focus on these goals is a critical part of workers’ compensation.

 

 Tuesday, August 19, 2025 10:00-11:00

9:55 AM – 10:55 AM The Perils of Misperception: Separating Objective Facts from Subject Emotion, Les Kertay, Geralyn Datz, David Langham, Grand Ballroom 8B.

Why- predisposition is impacting every perception, reaction, and conclusion you make. These are inherent, and your knowledge of them is critical to success.

9:55 AM – 10:55 AM Organizational Evolution & AI; Janet Tucker-Coffey, Kimberly Vaughn, Tim Benson, Joe Powell, Crystal Ballroom J1.

Why- artificial intelligence is here. There will be changes in duties, functions, and even workplace structures. Everyone should be interested and concerned.

9:55 AM – 10:55 AM Time is Not on Our Side, Rivera, Gillock, Joyce Weimer Taysha Carmody, Magnolia Ballrooms 4–6.

Why- the how, and the why are critical to good outcomes and return to function. But the “when” can be a challenge in a busy world.

 

Tuesday, August 19, 2025 11:00-12:00

11:00 AM-12:00 PM Discover Innovative Strategies to Engage Injured Worker; Tara Acton, Tracey Davenport, Benedict Nawachukwu, Teresa Bartlett, Grand Ballroom 8A.

Why– the injured worker, their remediation, recovery, and return to work are the meaning of workers’ compensation. How to best engage and involve them is critical.

11:00 AM – 12:00 PM The 3 D’s and Their Impact on RTW Success; Rosa Royo, Les Kertay, Brittney Parr, Debra Livingston, Crystal Ballroom H.

Why- The remediation and recovery mindset. What is frustrating worker recovery?

Tuesday, August 19, 2025 1:00-2:00

1:00 PM-2:00 PM Work Comp Immunity Waived: What Happens When We Lose Exclusive Remedy, David Greene, Michele Maffei, Melissa Spurlock, Steve Figliuolo, Grand Ballroom 7A.

Why- with a variety of potentials for civil liability, and the challenges of tort litigation, including some opt-out proposals, this is a topic for consideration.

1:00 PM-2:00 PM Live Oral Argument; Florida First District Court, Palms Ballroom-Canary.

Why- everyone in the workers’ compensation world should strive to understand the role that appellate decisions play in day-to-day decision making.

Tuesday, August 19, 2025 2:00-3:00

2:10 PM – 3:10 PM Credibility: The Currency of Success in Workers’ Compensation; Sheila Reecer, Chris Siderio, Suzy Braden, Grand Ballroom 8A.

Why- Because credibility and trust are critical elements of every relationship in the workers’ compensation community. The presence or lack of credibility drives many reactions and decisions.

2:10 PM – 3:10 PM Preparing Your Risk Management Program for 2026 and Beyond; Kelly Cyler, Joan Vincent, Max Koontz, Grand Ballroom 7A.

Why- The Risk Managers make decisions that impact the entire claims process, every professional involved, and the ultimate recovery/remediation of the worker. Their perspectives on today, tomorrow, and beyond will touch every aspect of this community.

2:10 PM – 3:10 PM Faking Good or Faking Bad – Identifying Illness Exaggeration with Confidence; Mark Glencross, John Dsumy, Greg Iannuzzi, Michael Bunte, Crystal Ballroom C.

Why- This perspective on the subjective and the potential to influence recommendations or decisions is tied inexorably to the human mind, credibility decisions, and inherent predispositions.

 

Tuesday, August 19, 2025 3:00-4:00

3:15 PM – 4:15 PM What Got You Here, Won’t Get You There: Lloyd Brown, Evelyn Eure, Steve Figliuolo, Kurt Leisure, Deedee Gasch, Caryn Siebert, Jennifer Morris Jones, Grand Ballroom 8A.

Why- Because everyone needs to grow and learn. Building skills and setting goals is healthy, engaging, and important. Every professional should have some degree of focus on their personal development.

3:15 PM – 4:15 PM Transforming Lives – A Powerful Story of Recovery Through Early Intervention; Jack Richmond, Jan Saunders, Teddy Gonzalez, Crystal Ballroom C.

Why- because the human element must be remembered and celebrated. The concerns of the injured and their employers must play a pivotal role, and stories of success are inspiring and motivational

 

Wednesday, August 20, 2025 9:00-10:00

8:45 AM – 9:45 PM Elevate your negotiation skills and transform your approach to securing what you deserve, Elizabeth Constantin, Crystal Ballroom C.

Why- Leadership and growth come through negotiation, investment, and engagement. The Alliance of Women in Workers’ Compensation bring keys to negotiation to the fore in this hour.

9:00 AM – 9:55 PM AI Jeopardy: AI’s Star Power in Workers’ Comp! Rao Tadepalli, Stan Smith, Nathan Taekema, James Benham, Grand Ballroom 10-12.

Why- AI is here, and what we don’t know is how much we don’t know. The implications for workers, employers, and workers’ compensation are patent to some, but will impact all.

8:45 AM – 9:45 PM Barriers to Implementing Effective Mental Health Solutions in Workers’ Compensation; Les Kertay, Marcos Iglesias, Adam Seidner, David Hoyle, Chris Cunninham, Crystal Ballroom C.

Why- Because the panel is stellar. But more so, because the human mind engages every decision, analysis, and challenge. Mental health matters in planning, safety, treatment, recovery, and return to work. It is ultimately foundational.

 

Wednesday, August 20, 2025 10:00-11:00

9:50 AM – 10:50 AM Restoring Confidence in Scientific Research; Mark Williams, Melina Griss, Rafael Silva, Crystal Ballroom J1.

Why- Medicine and science are at the root of workers’ compensation. There are significant challenges to the credibility of some science and scientists. Negative perceptions may discourage workers and employers alike.

9:50 AM – 10:50 AM GLP-1 Medications in Claims; Julie Black, Danielle Quinn, Gerry Stanley, Adam Seidner, Teddy Gonzalez, Crystal Ballroom C.

Why- obesity is a major concern in both pre- and co-morbidity. The supply and cost of GLP-1 will be of concern to patients and payers alike, as both obesity and diabetes influence treatment.

9:50 AM – 10:50 AM Premium Fraud Schemes; Dominic Dugo, Jay Bobrowsky, Chris Welch, Shaddi Kamiabipour, Joe Benevides, Thomas Donahue, Crystal Ballroom G1.

Why- fraud is a persistent challenge to the workers’ compensation system. Some understanding of the breadth of potential challenges provides a foundational understanding of systems and actions.

None of these is guaranteed to deliver (well, most are not; Tuesday at 9:55, the panel with Datz and Kertay will undoubtedly rock). Nonetheless, these are the broad topics that bear study and consideration. There is much to learn and so little time. See you in Orlando!

 

Connecticut Price Fixing

The class of medication referred to as GLP-1s is back in the news. The focus of these is primarily diabetes, but the drugs have become popular for the ancillary purpose of drug-induced weight loss. See Whoa Nelly (June 2025). The rapidly expanding use of these drugs and their market costs have created impacts on state budgets.

Various federal legislation includes Medicare negotiation of some medication prices (the Inflation Reduction Act). The same legislation more specifically impacts insulin costs in terms of patient cost sharing. Eligibility for Medicare and Medicaid may be affected by the One Big Beautiful law recently signed, and various states may make changes in their administration of these programs.

The discussion in Whoa Nelly provides some illustration of the cost of medication in our world generally. Those who are familiar with the world of workers' compensation will readily recognize that obesity is a potential comorbidity that requires attention in the process of treating a work injury. See Obesity yet Again (January 2023), and the posts it cites.

In response to the price of obesity drugs, various states have sought solutions, according to the Associated Press. There have been efforts to constrain patient populations, restricting the use of this diabetes medicine to diabetes patients. That is the approved use, but many seek this for the ancillary weight control benefits.

Then came the idea of simply taking the medication, using a process similar to the government taking of real property, called eminent domain. Some have perceived an increase in the breadth of eminent domain with the U.S. Supreme Court decision in Kelo v. New London, 545 U.S. 469 (2005). This is a complex topic that pits the interests of private landowners against the interests of government.

Essentially, Kelo concluded that a government can seize private property and transfer it to a private person if there is a financial benefit to the government. Until 2005, the common use of eminent domain was to seize real estate for clear government purposes such as post offices, highways, courthouses, and similar.

A corollary to eminent domain is now being pursued by Connecticut (coincidentally the state in which Ms. Kelo lost her real property). According to Yahoo, a bill signed by Governor Lamont in July will direct attention at reducing the state's cost for "GLP-1 drugs, similar to Novo Nordisk's (NVO) Ozempic and Wegovy and Eli Lilly's (LLY) Mounjaro." Though this is being led by Connecticut, the implications are broader.

The Connecticut bill will result in the state "petition(ing) the US Health and Human Services Department (HHS)" to essentially seize the property rights of medication manufacturers. While this is similar to eminent domain, it is statutory, "a section in the US Patent Code, 28 US 1498."

The effect would be for the federal government to "claim ownership of the patent(s)" for various medications. This would allow the government to determine and control the price of what it consumes. Instead of paying a "market price" to obtain these medications, or negotiating its own price, it would dictate the price charged by manufacturers.

If the current owners of those patents elect not to produce at the established price(s), then the government would "contract with generic manufacturers to produce a version of the drugs in exchange for royalties" that the government deems fair.

The implications of this are broad. In one perspective, the cost of medications might be broadly impacted. This example of significant medication cost might lead to similar government involvement in a broader spectrum of medication. Those who invest in the research and development of remedies may be less inclined if they perceive a greater potential for government seizure and moderated profits.

In another perspective, the financial impact of GLP-1s might decrease markedly. The budgetary relief on government might be mirrored for health insurers and other consumers, affording less sacrifice in other spending.

Some may see the potential for less focus on healthy diet and exercise if the GLP-1s become inexpensively available. In short, why eat right and care for the body when a cheap, simple, pharmaceutical path is available?

What of the potential for liability? GLP-1s have been researched and developed since 1984. The first Food and Drug Administration approvals came in 2005, and yet the popularity has been more recent still. As broader populations use these substances, is there potential for as yet undiscovered side-effects or other detriments?

Some will see this employment of section 1498 as a government overreach. Others will see it as a necessity. The discussions and perspectives will be intriguing as the coming months bring broader debate of the Connecticut proposal.

Whoa Nelly!

"Whoa Nelly" is an exclamation often used as a "say what?" "Hold on," or "back the truck up" expression. It is of unknown origin, but was apparently made famous by some fellow who announced football games for several decades. Pick your exclamation, there is some potential approaching for reigning in.

But, the "whoa" is a command to stop. The word has found new protagonists in the financial field. Blue Cross Blue Shield of Massachusetts announced in April that it will no longer "cover GLP-1s for weight loss." The price of medications, according to CBS News "have skyrocketed" and are "crippling budgets in the public and private sector."

California's "revised budget" predicts a $12-billion deficit, according to Family Doctors. One solution being discussed is to "end ... coverage for GLP-1 medications used for weight loss starting January 1, 2026." That would reportedly include Medicaid patients, according to Becker's Payer Issues.

Nonetheless, we have some significant challenges.

1. Too many people are overweight or obese.
2. Too many of us like our comfort foods (to the point of being uncomfortable)
3. We Americans like simple solutions that do not involve personal sacrifice (eating less, exercising).

The upshot is worthy of discussion.

The National Library of Medicine republished a Washington Post article in 2020. It concluded:

"74% of adults in the U.S. are overweight."

"43% who are considered obese."

10% of them "don't perceive themselves to be overweight."

There are many obese Americans. What would it cost to treat them all for Diabetes? The question is posed that way because GLP-1s are approved by the Food and Drug Administration to treat Diabetes. "Diabetes is a disease." And, there are those who think obesity is a disease also. Nonetheless, the Centers for Disease Control (CDC) reminds that:

"Obesity is influenced by many factors, including health behaviors, stress, and medical conditions."

Before one puts too much emphasis on that, the same might be said of Cancer, heart disease, and a raft of other conditions.

Nonetheless, what is the cost?

The Peterson KFF Health System Tracker reports that the costs of one month's prescription of the popular GLP-1s, annualized, are:

For some reason, the cost here is about five to ten times more expensive "than in other large, wealthy countries." That comparison seems troubling. Why are these medications so much more expensive in the United States, and how could that be ameliorated?

That GLP-1 cost is comparable to the average people pay for health insurance, which is "$8,951 for single coverage and $25,572 for family coverage," according to Kaiser Family Foundation.

The adult population of the United States is 347,045,613 (74%). The "overweight" is therefore likely about 256,813,755 and the "obese" is 149,229,614 (43%). To treat the "obese" with these drugs would cost:

Yes, that is $1.6 trillion to $2.4 trillion to treat all of the "obese" with GLP-1 medication for their obesity. The U.S. federal budget in 2024 was $6.9 trillion total. To treat all the "obese" with GLP-1 at retail price would require 24% to 35% of the total federal budget.

What would it take to treat the "overweight" population with these medications? That would be between $2.8 trillion (42% of the budget) to $4.2 trillion (60% of the budget).

These figures are, of course, at retail. The great myth is that someone is paying retail. They are not, well, not very often. Nonetheless, the cost of this solution to obesity seems significant, and likely explains the current proposals to cease providing these Diabetes medications for obesity.

Nonetheless, there are applications in the works for FDA approval of various GLP-1 for the specific purpose of obesity. Novo Nordisk has submitted an oral form, and Eli Lilly is similarly on track for an application.

It seems likely that debate will persist regarding the treatment of obesity. There will be questions of comparing the cost of treating obesity with "one pill," or preventing it with another (White Rabbit, Jefferson Airplane, RCA, 1967):

"One pill makes you larger

And one pill makes you small

And the ones that mother gives you

Don't do anything at all

Go ask Alice

When she's ten feet tall"

What, though, is the cost of treating all the ailments that are complicated by obesity? The CDC says these include:

"Coronary heart disease.Type 2 diabetes.

Cancers (endometrial, breast, and colon).

High blood pressure.

Lipid disorders (for example, high total cholesterol or high levels of triglycerides).

Stroke.

Liver and gallbladder disease.

Sleep apnea and respiratory problems.

Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint).

Gynecological problems (abnormal periods, infertility)"

In other words, having made the decision to socialize medicine and abandon personal responsibility, which cost is more palatable? Do we pay to treat obesity, or do we pay to treat implicated diseases? Is one a better solution, generally, a more economic decision overall, or a more logical choice?

There seems to be some potential that we are at a point of inflection. Decisions of great import may lie ahead regarding the persistence and perniciousness of "obesity," the societal inclination away from diet and exercise, and all that the implications and tangents that entail. 

The truly socialist medical systems have aptly demonstrated that supply and demand cannot be eradicated. Market forces persist. An editorial from Britain reminds that socialism means rationing care. The decisions are not made economically, but politically, and yet are supply/demand decisions nonetheless. There, the obese are being denied surgery, relief, and remediation. 

Scarcity is an economic fact. 

Or, again, perhaps we just redefine obesity? See What's in a Name (August 2020). That might make decisions for us, but will it make anyone healthier? Or, is it just rearranging the deck chairs? 

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