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Isn't this how big change works: Forces emerge unexpectedly strong enough to shock our expectations and drive us onto new paths? The last time was in the early '90s, when medicine began to be managed and return-to-work programs got serious. A lot changed; a lot didn't.

Any field as old as workers' comp is a lattice of old and new, such as roads in rural New England. A portion of an 18th century Montreal-to-Boston highway is still visible close by, its original bed still holding back the assault of bush and trees. Ridge roads, now worn down to the rock, used to connect 19th century hill farms, whose passing is noted in poetic laments by Robert Frost and by cellars abandoned deep in the woods.

We've progressed, but predicting change is difficult, even menacing. Like economists, derided for heralding events that don't happen by predicting "10 of the last three recessions," so I too have been quite good at predicting 10 of the last three new big things.

Chastened, I still see three unlikely but plausible developments that could change our field. One is a pandemic that sickens or kills many healthcare and other workers.

I don't know what the catastrophe modeling firms lay as odds that one will occur. But the spread of disease need not be big for the occupational safety and workers' comp fields to respond in prevention, claims management and underwriting.

The implications for workers' comp are ugly. State laws as written today will disallow workers' comp claims for all but--perhaps--healthcare workers. Most states limit the diseases covered and require that the disease pose an inherent, regular risk at work.

Denying claims or foot-dragging by insurers will raise such a stink that federal takeover of workers' comp will become politically viable.

This crisis is predicted in the articles Steve Yahn and I are writing this fall on the World Trade Center rescue and recovery workers, including the current issue of Risk & Insurance® magazine.

A second unlikely change is a massive transformation of claims management into an online craigslist kind of marketplace. Some of you have used craigslist to locate a plumber or baby-sitter. The selling and buying of claims services would be atomized, flattened. Boutiques would flourish.

For years I've been waiting for online markets for case managers, fraud investigators, subrogation experts and the like to emerge. But I think there is a low likelihood it could catch on. I'll be here if it does.

A third improbable change is a merger of workers' comp with health insurance, and/or with short- and long-term disability. I notice that California is once again toying with the idea of 24-hour care, that is, the close coordination of workers' comp and health insurance.

Does it make sense from the workers' perspective? Yes. They will enjoy a seamless, wider range of benefits options instead of one-size-fits-all workers' comp packages.

Will states promote it? Given the glacial and largely incremental pace of legislative changes, probably not.

If one happens, you read it here first.

PETER ROUSMANIERE, a Vermont-based consultant and writer, is the workers' comp columnist for Risk & Insurance®.

October 15, 2007

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