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In this episode of Deconstructing Comp, Yvonne and Rafael welcome Gina Jacobs, a defense attorney with Hamilton, Miller & Birthisel LLP, to share what it’s like navigating workers’ compensation from the defense side. Joining from Orlando, Gina brings a candid look at how defense counsel approaches claims, collaborates with employers and carriers, and works toward fair resolutions within Florida’s workers' compensation system.

Gina’s journey into law is one of purpose and passion. After spending more than 10 years as a claims professional, working with Crawford & Company, Zenith Insurance, and Gallagher Bassett, she made the leap to law school to deepen her understanding of the industry she already loved. Today, that background shapes her work as a defense attorney, giving her rare empathy for claims adjusters and a deep appreciation for how every stakeholder impacts the outcome of claims.

Throughout the conversation, Gina shares how she balances advocacy with understanding, why communication remains at the heart of every successful case, her commitment to partnerships, and how she’s using her experience to mentor and educate the next generation of professionals in workers’ compensation.

This engaging episode offers a thoughtful and balanced look at what it means to defend claims while staying true to the people and purpose behind the process.

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In this episode of Deconstructing Comp, Yvonne and Rafael talk to Paolo Longo, a claimant attorney based in Florida, to explore the realities of representing injured workers, especially first responders. Paolo shares how his career path led him from the state attorney’s office to becoming a dedicated advocate for employees navigating the workers’ compensation system.

He explains the unique legal protections and presumptions that apply to Florida’s firefighters, police officers, and other first responders, particularly around heart disease, hypertension, and other conditions presumed to be job-related. Paolo also highlights the burden-shifting process that makes these cases unique, and why communication and education are at the heart of effective advocacy.

A powerful part of the discussion centers on the fears and concerns first responders face after an injury. Paolo notes that the first question nearly every client asks is: “Am I going to lose my job?” Beyond that, they worry about whether they’ll ever return to work, finish their careers, or continue providing for their families. These uncertainties, coupled with a lack of clear understanding of the claims process, make strong legal guidance and compassionate communication for injured workers essential.

Another key legal point Paolo discusses is the “120-day rule.” While its meaning varies by state, in Florida, the focus of Paolo’s practice, it sets the timeframe for an employer or insurance carrier to decide on a claim. Once an employer begins providing benefits, they have 120 days to either deny the claim or continue paying benefits. If they don’t issue a denial within that period, the claim becomes compensable by law, unless the employer can later prove new “material facts” that weren’t discoverable during the initial investigation.

This rule is critical because it can determine the outcome of a case, whether benefits continue, or whether a carrier can still attempt to deny responsibility for an injury. Paolo explains how this plays out in practice and why it’s such a pivotal part of representing injured workers in Florida.

From candid reflections on the challenges of the system to insights on what truly makes a difference for injured workers, this conversation offers a rare look at the claimant’s side of workers’ compensation.

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In this episode of Deconstructing Comp, Yvonne Guibert and Rafael Gonzalez welcome Scynthia Syfrett, Workers’ Compensation Program Manager at SHARP Healthcare in San Diego. Scynthia offers her perspective on managing a large deductible program, with a $1 million per-claim deductible, and the lessons in risk that come with operating at this scale.

Our conversation examines how large deductible programs shift a significant portion of the claims exposure back to the employer, presenting both opportunities and challenges. Scynthia explains why careful oversight, proactive claims management, trusted vendor partners, and tailored processes are essential to ensure every claim is handled with both financial accountability and employee care.

She also highlights why healthcare systems, with thousands of employees, must maintain clear strategies for managing risk, controlling litigation, and supporting injured employees within such a high-stakes framework.

You'll also learn that Scynthia is passionate about education, just like Yvonne and Rafael!

Key terms and concepts mentioned in this episode to help guide your listening:

Large Deductible Program – SHARP's program features a $1 million per-claim deductible, shifting a significant portion of the financial responsibility back to the employer.

Risk Management – In workers’ compensation, risk management means recognizing and addressing financial, legal, strategic, and safety risks that can affect both employees and the organization.

Litigation Review – The process of evaluating claims before escalating to legal action; Scynthia discusses SHARP’s unique approach.

Return to Work (RTW) – Supporting employees in safely resuming their roles, often with modified duties.

Safety – Preventive measures and tracking of safety incidents within an employer's environment.

Employee Education – SHARP’s investment in training employees to understand workers’ compensation processes and responsibilities.

Trusted Vendor Partners – External claims, legal, and medical partners who work closely with an employer to manage claims effectively.

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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.

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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)

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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

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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

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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