In this episode, co-hosts Yvonne Guibert and Rafael Gonzalez talk with expert defense attorney and educator Jeff Adelson in a candid conversation about two often-overlooked forces in workers’ compensation: ethics and empathy. Together, they explore how small shifts in behavior, perspective, and communication can create better outcomes for injured workers and claims professionals alike.
From managing ethical gray zones to acknowledging the human side of every claim, Jeff brings decades of insight, humor, and heart to the conversation. This episode challenges us to rethink the role of compassion in claims management and reminds us that doing the right thing and doing good business are not mutually exclusive.
💡 Highlights for Newer Professionals in Workers’ Comp
✔️ Know the Rules on Represented Parties
Jeff shares an important story about being asked to communicate directly with a represented worker. This is a legal and ethical no-go: always respect representation boundaries; communicating without counsel is prohibited and can jeopardize a case.
✔️ Doing the Right Thing Isn’t Always Easy
In a pivotal moment, Jeff explains how his firm gave up a significant contract rather than compromise its ethics. It's a lesson for anyone new to the industry: ethics must come before convenience or profit.
✔️ Ethical Issues Aren’t Always Black and White
The episode touches on how clerical issues or unclear situations, like a temporarily inactive attorney, require careful, thoughtful handling. Consulting with ethics counsel and taking the high road is always a sound strategy.
📘 Terms to Know (Episode Reference)
Ethics (in Workers’ Compensation)
The moral principles that guide behavior and decision-making within the workers’ comp system, including how injured employees are treated, how claims are handled, and the integrity of legal, medical, and administrative actions.
Empathy
The ability to understand and share the feelings of another. In claims management, empathy can foster trust, improve communication, and lead to better outcomes by acknowledging the human side of the injury.
Moral Hazard
A situation in which one party is more likely to take risks or act unethically because they do not bear the full consequences of their actions — often discussed in the context of fraudulent claims or system abuse.
Conflict of Interest
A situation where a person or entity involved in the claims process (e.g., provider, attorney, or claims adjuster) has competing interests that could improperly influence decisions or outcomes.
Good Faith Handling
The expectation that claims administrators and insurers will act fairly, honestly, and in the best interest of all parties — especially the injured worker — throughout the claims process.
Compassion Fatigue
Emotional exhaustion can affect professionals who regularly deal with others’ trauma or suffering. Often experienced by adjusters, nurse case managers, or clinicians, it may lead to detachment or burnout.
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