The Real Reason Workers’ Comp Claims Go Off the Rails — And How to Fix It

When a workers’ compensation claim spirals into a costly, prolonged, or litigated nightmare, most people instinctively look for a technical failure: late paperwork, a coverage issue, or a misstep by the claims adjuster. While these certainly matter, they’re rarely the root cause.

The real reason many workers’ comp claims go off the rails?

Poor communication, unmet expectations, and a lack of trust.

These human elements — often overlooked in the technical noise — are the key drivers of claims that become unnecessarily expensive or adversarial. But the good news is this: with intentional, systematized communication, they’re also some of the easiest problems to fix.

The Cost of Getting It Wrong

Let’s start with what happens when communication and trust break down. According to research by the Workers Compensation Research Institute (WCRI), claims are far more likely to escalate into litigation when workers:

• Fear being fired

• Don’t understand what’s happening with their claim

• Perceive their employer doesn’t believe them

• Feel ignored or left in the dark

In fact, WCRI found that fear of being fired was the single most predictive factor in whether an employee hired an attorney. And guess what? In many of these cases, the claim wasn’t even denied — the worker just didn’t know what was happening. The silence was misinterpreted as rejection.

This mistrust can easily add tens of thousands of dollars to the cost of a claim and months (or even years) to its duration.

Why Technical Excellence Isn’t Enough

It’s easy for employers and claims teams to get buried in the logistics: reporting lag times, nurse case managers, OSHA compliance, forms and follow-ups. These are all important — but they’re not what injured employees care about most in the moment.

Here’s what they are thinking about:

• Am I going to get paid?

• Can I afford my medical care?

• Will I lose my job?

• Does anyone at work even care that I got hurt?

If those questions aren’t answered proactively — and with empathy — the worker starts to draw their own conclusions. That’s when frustration sets in, attorneys get involved, and your claims go off the rails.

Fixing the Problem: It Starts with Empathetic, Systematic Communication

You don’t need a complex overhaul or new software to fix this. You just need consistent, proactive communication strategies built into your workers’ comp program. Here are four high-impact ways to start:

1. First-Day Phone Call: The Empathy Sandwich

The first 24 hours after an injury are the most critical. A simple phone call from a supervisor or claims coordinator can completely shift the trajectory of the claim.

Use the “Empathy Sandwich” approach:

• Start with empathy: “We’re really sorry you got hurt — how are you feeling?”

• Cover the technical: “Here’s what to expect next: we’ll be coordinating your care, and you should hear from your adjuster soon.”

• End with encouragement: “We look forward to having you back on the team and supporting you however we can.”

This 10-minute call reduces confusion, builds trust, and gives the worker a roadmap.

2. Get Well Cards: Small Gesture, Big Impact

A handwritten card may seem old-fashioned, but it carries enormous weight. It shows the employee they’re not just a line on a report — they’re part of a team that cares.

Many employees who end up litigating do so because they felt like no one cared. A simple card can keep that perception from ever forming.

3. Set Clear Expectations with an Employee Brochure

Don’t assume workers understand how workers’ comp works. Most don’t — and uncertainty breeds fear. A clear, easy-to-read brochure that explains:

• How to get medical treatment

• How and when they’ll be paid

• What their rights and responsibilities are

• What your company will do to support them

…can replace fear with clarity.

Distribute this brochure at hire and again after an injury.

4. Weekly Check-Ins: Keep the Lines Open

Injured workers who are left alone often spiral into frustration and disengagement. A quick weekly call can:

• Monitor their recovery

• Reinforce your support

• Identify concerns before they escalate

These check-ins are also a great time to discuss return-to-work possibilities, helping shorten claim duration and maintain morale.

Bonus: Prevent Litigation Before It Starts

According to WCRI, most litigated claims didn’t need to be litigated. In many cases:

• The injured worker thought the claim was denied (when it wasn’t)

• The employee wasn’t sure what to expect

• There was no communication from the employer after the injury

Systematic communication solves all three. When you check in regularly, answer questions, and show empathy, you dramatically lower the odds that a lawyer will enter the picture — and drive your costs up with them.

Final Thought: You Don’t Need Buy-In from Everyone to Start

One of the most powerful insights from workers’ comp mastery training is this: you don’t need company-wide buy-in to begin implementing these systems.

If you’re a risk manager, HR leader, claims coordinator, or safety director, you can:

• Send get well cards

• Make first-day calls

• Print brochures for your team

• Schedule weekly check-ins

These small, low-cost changes can completely change how your employees experience an injury — and how your claims resolve.

Conclusion: Take Back Control with Communication

Workers’ comp claims don’t go off the rails because of paperwork errors. They go off the rails when injured employees feel scared, confused, or abandoned.

Empathy, expectations, and consistent communication aren’t fluffy extras — they’re the core drivers of claim outcomes. And they’re completely within your control.

Fix the human side of workers’ comp, and the rest of the system runs a whole lot smoother.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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