Deconstructing Comp

Yvonne Guibert & Rafael Gonzalez
  • 5.0(7개의 평가)
  • 직업
  • 격주 업데이트

Now in Season 5! We are still breaking down complex issues of workers' compensation into bite-sized nuggets, one conversation at a time, with one slight twist. We are finally doing what we set out to do when we started: discuss the nuances of our fascinating system in "Cliff Notes" style summaries.  Yvonne Guibert and Rafael Gonzalez approach workers' comp conversations from different backgrounds. Still, they share many similar things, such as their love for family and friends, a passion for Latin culture, and good old-fashioned belly laughs. Join them as they chat with their industry friends and colleagues, learn more about their roles, laugh, and have fun on the journey. You might learn something along the way! See you soon! ¡Hasta pronto!

  1. 8월 29일

    Robert Rassp: Basics of WC Benefits

    Send us a text Disclaimer: The views expressed in this episode are Judge Robert Rassp’s personal opinions and do not reflect the official position of the State of California, Department of Industrial Relations, Division of Workers’ Compensation (DWC), or the Workers’ Compensation Appeals Board (WCAB). In this episode of Deconstructing Comp, Yvonne and Rafael are joined by Judge Robert Rassp for a straightforward discussion about the fundamental benefits of workers’ compensation and why they are important. Judge Rassp walks us through the foundation of the system, from medical treatment to temporary and permanent disability benefits, and explains how these core protections are designed to support injured employees while balancing employer responsibilities. The conversation also explores how utilization review, independent medical review, and evolving case law influence the delivery of these benefits. Judge Rassp emphasizes the importance of fairness, education, and due process in ensuring that both injured employees and employers understand the system and can navigate it effectively. According to Rassp: “Temporary disability keeps food on the table during recovery. Permanent disability recognizes when someone’s life has been permanently changed by an injury.” Please join us for this informative episode with one of our industry's most experienced and esteemed educators. Judge Rassp is also an adjunct professor at Pepperdine University's Caruso School of Law, where he teaches workers' compensation law, and he's a founding member of the CC&R Band, a parody band that performs classic rock and roll hits at many Southern California industry events.   Key Terms from the Episode: Medical Treatment – Care provided to cure or relieve the effects of a work-related injury or illness.Temporary Disability (TD) – Wage replacement benefits provided to an injured employee while recovering and unable to work.Permanent Disability (PD) – Benefits awarded when an injured employee has lasting impairment that affects their ability to earn wages.Causation – the link establishing that an injury or illness arose out of and in the course of employment, or more simply put, that the injured employee's work contributed to their injury or illness. This is also referred to as AOE/COE.WCAB (Workers’ Compensation Appeals Board) – The judicial body that adjudicates disputes in California’s workers’ compensation system.Utilization Review (UR) – The process by which an employer or insurer evaluates a medical treatment request for appropriateness and necessity.Independent Medical Review (IMR) – The appeal process when a treatment request is denied through UR, conducted by an independent physician reviewer.Case Law – Published court or WCAB decisions that interpret statutes and guide future workers’ compensation cases.¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    47분

  2. 8월 11일

    Dr. Marcos Iglesias: Cultivating A Recovery Mindset

    Send us a text In this episode, Yvonne and Rafael talk to Dr. Marcos Iglesias, Chief Medical Officer at AF Group. Dr. Iglesias shares his journey from occupational medicine to the executive level and the lessons he’s learned about helping injured workers recover faster and more fully. Drawing on decades of experience, Dr. Iglesias offers candid, practical advice for younger clinicians entering the workers’ compensation space, emphasizing the importance of looking beyond symptoms to understand why a patient isn’t improving. He explains how focusing on what an injured worker truly needs to feel supported can reduce frustration for clinicians, improve communication with claims and employer teams, and create better outcomes for all parties. From breaking down barriers to recovery to fostering stronger provider relationships, Dr. Iglesias underscores that when clinicians approach care with curiosity, empathy, and collaboration, everybody wins. Listeners will leave with actionable insights into how new medical professionals can navigate the complexities of workers’ comp, make a meaningful impact on injured workers’ lives, and help shape a system that works better for everyone. Key Terms and Definitions in this episode:  Biopsychosocial Model of Care – A holistic approach to healthcare that addresses the biological, psychological, and social factors influencing an injured worker’s recovery, promoting comprehensive and individualized treatment plans. Chief Medical Officer (CMO) – Senior medical leader responsible for developing and overseeing clinical strategies, ensuring medical best practices, and aligning care delivery with business goals. Claims Operations – The department or function responsible for managing claims from the first report of injury through closure, including investigation, evaluation, and settlement. Early Intervention – Identifying and addressing potential issues in a claim as soon as possible to prevent delays in recovery and reduce claim duration and costs. Employer Engagement – Active participation of the employer in the claims process, including communication with the injured worker, accommodations for return-to-work, and collaboration with claims teams. Evidence-Based Care – Medical treatment decisions based on the best available research, clinical expertise, and patient-specific factors to ensure optimal outcomes. Occupational Medicine – A branch of medicine focused on the prevention, diagnosis, and treatment of work-related injuries and illnesses. Provider Network – A group of medical professionals and facilities contracted to deliver care to injured workers under negotiated terms. Psychosocial Barriers – Non-medical factors—such as mental health concerns, fear, social isolation, workplace relationships, or financial stress—that can delay or prevent recovery. And here are a few references to things Dr. Iglesias mentioned during our discussion: On Ambient Scribe Technology Open Evidence (chatGPT for medical professionals) ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    53분

  3. 7월 29일

    Kirsten Kaiser Kus: Stakeholders in the Comp Ecosystem

    Send us a text In this episode, we talk to Kirsten Kaiser Kus. She is a defense attorney and an equity owner at Downey & Lenkov LLC, leading their Indiana practice. She brings deep experience from both the plaintiff and defense sides of workers’ compensation. She shares how her involvement with CLM and litigation education shaped her expertise and helped grow her professional network. We explore the many stakeholders in the workers’ compensation system. Kirsten discusses distinctions between plaintiff-side and defense-side stakeholders and how they interact—or clash—within systems that vary state by state. On the plaintiff (applicant) side, she highlights challenges such as unrealistic expectations, lack of understanding of legal metrics, and client control issues. Then she systematically breaks down the far more complex defense side, detailing the roles of carriers, TPAs, hearing members, medical providers, mediators, ombudsmen, vendors, brokers, excess carriers, self-insured clients, and even how politics play out in our system. Throughout our conversation, Kirsten emphasizes one central principle: communication is critical. Where, oh where have we heard that before? Whether navigating expectations, coordinating stakeholders, or managing the risk of expensive cases, clear, proactive, and coordinated communication is what drives effective outcomes. Stakeholders in the Workers’ Comp Ecosystem: Injured Worker The employee who was hurt at work and seeking benefits. Applicant’s Attorney / Claimant’s Attorney / Plaintiff's Attorney / Petitioner’s Counsel The lawyer representing the injured worker (term varies by state). Defense Attorney The attorney representing the employer or insurance carrier. Employer The company where the injured worker is employed; also referred to as "the insured." Insurance Carrier The insurance company providing workers’ comp coverage to the employer. Third-Party Administrator (TPA) An outside company that manages the administration of claims on behalf of self-insured employers or insurance carriers. Broker An insurance advisor who helps employers obtain and manage coverage. Self-Insured Employer A company that pays claims out-of-pocket, often with excess insurance coverage. Excess Carrier The insurer that covers costs beyond a self-insured employer’s retention layer. Hearing Member / Judge / Commissioner The official who hears and rules on workers’ compensation disputes. Ombudsman A state-provided guide who assists unrepresented workers. Mediator A neutral party who helps both parties involved in a litigated case try to settle the case before trial. Medical Provider Doctors and other clinicians who treat the injured worker. Nurse Case Manager (NCM) A licensed nurse who helps coordinate medical care and communicate with all stakeholders. NCMs are often called in to help coordinate more complex claims.  Vendors Service providers such as interpreters, transportation, Medicare compliance experts, durable medical equipment (DME) suppliers, and home modification specialists. Subrogation Counsel / Third-Party Recovery Attorneys or departments pursuing reimbursement when a third party (not the employer) caused the injury. Family Members Often involved in influencing the injured worker’s decisions and expectations, an important perspective to keep in mind througho ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    40분

  4. 7월 11일

    Mollie Kallen: Communication is Key

    Send us a text In this episode, we sit down with industry powerhouse Mollie Kallen to explore the often misunderstood role of case managers* in workers’ compensation. With over 30 years of experience leading one of the largest case management companies in the country, Mollie brings unmatched insight into how effective communication, not just clinical expertise, drives better outcomes for injured employees, employers, and claims professionals alike. We talk about what makes a great case manager, how communication breakdowns can derail even the best-intentioned care plans, and why advocacy and collaboration are more important than ever. Mollie also shares how her personal health journey reshaped her professional mission and led her to a new chapter of coaching cancer patients and their families with the same compassion and clarity that marked her work in workers' comp. Whether you're a case manager, claims adjuster, or anyone working in the comp system, this conversation will leave you with a deeper appreciation for the human connection at the heart of recovery. 🎧 Tune in and discover why communication truly is key. *NOTE: Rafael said "nurse case managers" when he started with his questions. While often, case managers are nurses and have a nursing background, they aren't always nurses, as is the case with Mollie. The reason many nurses become case managers is they have solid clinical backgrounds. So, just know, a case manager isn't always a nurse and people often use these terms interchangeably. Yes, we know! It is confusing.  Resources mentioned in this episode:  ReEmployability: https://www.reemployability.com/ Cancer Coach Connection: https://www.cancercoachconnection.com/ ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    48분

  5. 6월 23일

    Bill Zachry: Sisterhood of Traveling Body Parts

    Send us a text In this engaging and insightful episode, co-hosts Yvonne Guibert and Rafael Gonzalez sit down with legendary industry leader Bill Zachry for a deep-dive into the realities shaping today’s California workers’ compensation system, and other state systems around the country.  We explore rising WC costs, why it makes sense to manage and treat psychosocial barriers to recovery early on in the claim — or risk higher costs down the road, and other tips and observances he's made along the way.  Bill shares powerful stories from his career, including how he entered the system as an injured worker, his role as a "baby claims adjuster," how he has helped shape public policy, the role of organized fraud in the Los Angeles basin and more. He also discusses his coined term, “sisterhood of the traveling body parts,” to describe recycled injury narratives. Our discussion also touches on prevention, prescription patterns, several issues related to public policy, and the cultural and systemic gaps that keep workers’ comp stuck in a reactive posture. This episode is equal parts candid, educational, and entertaining — and is a must-listen for any workers' compensation professional, regardless of tenure.  Resources: Rising Medical Solutions Annual Benchmarking Study ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    50분

  6. 6월 9일

    Melissa Steger: Hook 'Em and Go Until No!

    Send us a text Melissa Steger returns to walk us through the building blocks of the unique Texas UT System workers' compensation program. While the program is self-insured, they use a third-party administrator (TPA) in a hybrid system where the TPA staff sit on-site with the UT System staff who oversee the program.  Covering 160,000 employees and over 250,000 students, UT System uses a variable rating system and has set up a culture where the individual institutions within the system compete against one another to achieve superior outcomes. The results? Truly innovative and remarkable.  During Melissa's tenure with the WC program, and through a system of healthy competition, they initially saw program costs of eighty cents per $100 dollars of payroll. When Melissa retired last year, it had fallen to 8.5 cents per $100 dollars of payroll.  How did this happen? Melissa talks about some of the nuances of their program including an annual retreat, where the hybrid staff come together to improve communications, get focused on core program goals and learn how they could continuously improve their results.  Join us as we talk to Melissa and learn how UT System achieved such amazing results. Melissa also talks about flunking out of retirement. She is now VP of Business Development at WorkCompCollege.com  ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    47분

  7. 5월 27일

    Nelson Gonzalez: About Return To Work

    Send us a text In this episode, Yvonne Guibert catches up with Nelson Gonzalez, Executive Director - Florida, Rehab Without Walls® NeuroSolutions, and they talk about Return to Work.  In the workers' compensation system, a return-to-work (RTW) policy or program helps injured or ill employees safely and efficiently return to work. The goal or purpose is to minimize downtime, reduce costs, and maintain employee skills and productivity.  Join the conversation to hear Nelson's perspective on why RTW programs are so essential, why some RTW programs fall short, what a good RTW program should include, and more.  Companies and resources mentioned during this episode include:  Rehab Without Walls® - https://www.rehabwithoutwalls.com/ ReEmployability - https://www.reemployability.com/ Bag of Happies - https://bagofhappies.com/ ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    42분

  8. 5월 9일

    Joseph Sousa: California Love

    Send us a text In this episode, Yvonne and Rafael chat with Joseph Sousa, Workers' Compensation Program Manager for the City of San Diego. In our conversation, we learn from the perspective of a self-insured, self-administered workers' compensation program administrator, and what is important to that stakeholder perspective.  One thing that stands out is the numerous benefits of operating a self-insured, self-administered program for both the employer and employees. The employer gains total control over various aspects, especially compared to purchasing an insurance policy from an external insurer. Since all employees work for the same entity, there is a strong sense of pride and compassion when it comes to supporting colleagues. The City of San Diego is regarded as a gold standard in workers' compensation programs. Some key elements of San Diego's program include: - An established culture of wellness and safety - Early intervention - Peer support and compassion for fellow employees - Effective communication - Self-efficacy, where injured employees take ownership of their recovery - Quality partnerships with medical providers Join us as we delve deeper into Joseph's insights and learn more about the City of San Diego's workers' compensation program. More about City of San Diego: https://www.sandiego.gov/ Council of Self-Insured Public Agencies (COSIPA): https://cosipa.org/ Public Agency Risk Management Association (PARMA): https://parma.com/ ¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp

    49분
모두 보기(133개)

예고편

평가 및 리뷰

5
최고 5점
7개의 평가

소개

Now in Season 5! We are still breaking down complex issues of workers' compensation into bite-sized nuggets, one conversation at a time, with one slight twist. We are finally doing what we set out to do when we started: discuss the nuances of our fascinating system in "Cliff Notes" style summaries.  Yvonne Guibert and Rafael Gonzalez approach workers' comp conversations from different backgrounds. Still, they share many similar things, such as their love for family and friends, a passion for Latin culture, and good old-fashioned belly laughs. Join them as they chat with their industry friends and colleagues, learn more about their roles, laugh, and have fun on the journey. You might learn something along the way! See you soon! ¡Hasta pronto!

정보

  • 제작진
    Yvonne Guibert & Rafael Gonzalez
  • 방송 연도
    2021년 - 2025년
  • 에피소드
    133
  • 등급
    무삭제판
  • 저작권
    © 2025 Deconstructing Comp
  • 웹사이트 보기
    Deconstructing Comp

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