I have gone through a difficult period. Over the last year, I lost a sister-in-law, two brothers-in-law, three of my closest friends, and several close friends. The losses came one after another, each arriving before I had finished grieving the last.

The movie "Coco" resonates with me because it reflects how I choose to handle loss: by holding on to the good, remembering who people were at their best, and keeping those memories alive. It is my way of carrying them forward.

Every loss has also reminded me of something I came to understand slowly, over decades of professional life: Grief is not reserved for death. We grieve whenever we lose something central to who we are — a relationship, a capability, a role or a version of ourselves we expected to keep.

As human beings sharing human experience, we all encounter loss at some point in our lives. Supporting people as they navigate those losses is not only an act of compassion; in workers’ compensation, it is a professional responsibility with real consequences for recovery.

During my years managing workers’ compensation programs, I often told claims examiners that they were, in effect, grief counselors.

Many of the behaviors that frustrate and even anger claims professionals are not simply resistance to the claims process. They are expressions of grief over the loss of work, identity and normal life.

In many ways, and for too many claims, the workers’ compensation system is not only managing injuries, it is also managing grief.

Injured workers are not simply managing a medical condition. When they lose their job due to injury, they cope with the loss of identity, role, income and purpose associated with their work.

Work is far more than a source of income. It provides structure, social connection, identity and meaning. When a worker is injured and cannot perform his job, the loss he experiences is similar to other forms of grief. The injury disrupts not only his physical functioning but also his sense of self.

Understanding this psychological process is essential for anyone working in the workers’ compensation system. Recovery is not purely a medical process. It is also a psychological transition from the identity of “worker” to that of “injured worker” and, if successful, back to the identity of “worker.”

The grief process following work-related injury

Research and clinical experience suggest that many injured workers move through stages similar to the well-known five stages of grief:

• Denial.
• Anger.
• Bargaining.
• Depression.
• Acceptance.

These stages are not rigid or universal. Individuals may move through them at different speeds or revisit earlier stages. However, the pattern is commonly observed among workers coping with injury and disability.

Denial

In the early stages of an injury, workers often believe the condition is temporary and will resolve quickly. They expect to return to work soon and may minimize the seriousness of the injury.

Anger

As recovery becomes longer or more complicated than expected, frustration and anger may develop. The anger may be directed toward their employers, the claims adjuster, insurance companies, physicians or the workers’ compensation system itself.

Bargaining

Workers may search for solutions to return to their previous role. They may seek additional medical opinions, new treatments or legal strategies in the hope of restoring their previous identity.

Depression

When the realization emerges that life may not return immediately to its previous state, feelings of sadness, loss and discouragement often follow. Financial stress, uncertainty and prolonged work absence can deepen these emotions.

Acceptance

The final stage involves recognizing the new reality and beginning to move forward. This stage is critical for recovery because it allows the individual to focus on rebuilding function, reengaging with work and developing a renewed sense of purpose.

Identity loss and the 'injured worker' identity

A work-related injury often produces identity disruption. A worker who previously saw herself as productive, capable and independent may suddenly find herself defined by medical appointments, disability status and legal proceedings.

Over time, particularly in prolonged claims, a new identity may emerge: that of the “injured worker.”

This transition can occur gradually. Early in a claim, a person usually understands himself as a worker who was injured. The injury is a temporary interruption in a life centered on work.

But over time, the identity can invert. The worker who once saw himself as a worker with an injury may come to see himself primarily as an injured worker whose life revolves around the claim.

The longer the claim remains open, the more the worker’s life becomes organized around medical appointments, evaluations, benefit disputes and legal proceedings. The claim itself becomes the central structure around which daily life is organized.

Returning to work, therefore, requires more than physical healing. It requires a psychological transition away from the injured identity and toward a renewed sense of capability and purpose.

Claims professionals frequently help injured workers navigate this transition. In this sense, the claims examiner truly does become a grief counselor, guiding workers through a process of loss, adjustment and eventual reintegration.

System delay and the grief process

The length of time a worker remains in the workers’ compensation system profoundly influences this psychological transition.

In systems where claims are resolved promptly and recovery expectations are clear, workers are more likely to move through the stages of grief and reach acceptance. Once acceptance occurs, the worker can focus on rebuilding function and returning to productive activity.

However, when claims remain open for years, the grief process can stall. Repeated medical-legal evaluations, disputes over benefits and prolonged uncertainty reinforce the injured identity rather than helping the worker move beyond it.

Instead of progressing toward acceptance, workers may remain trapped in earlier stages such as anger, bargaining or depression. The longer the process continues, the more the identity of “injured worker” becomes central to the individual’s self-concept.

This dynamic helps explain why prolonged involvement in compensation systems is associated with higher rates of permanent disability, poorer health outcomes and lower rates of return to work. The system itself can unintentionally reinforce the very disability it was designed to address.

Role transition and recovery

The path back to productive employment often involves a process of role transition:

• Recognizing and accepting the loss of the previous role.
• Grieving the loss of identity and purpose associated with that role.
• Exploring new capabilities and possibilities.
• Developing a renewed sense of purpose.
• Reintegrating into productive work and social life.

This transition is rarely simple. Workers may need support from physicians, physical therapists, vocational rehabilitation professionals, claims examiners and employers to navigate the process successfully.

Psychological perspectives on identity and recovery

Several well-established psychological perspectives help explain the transition from injury to recovery.

Identity theory suggests that individuals build their sense of self around the roles they occupy in life, such as worker, parent or community member. When injury removes a person from one of these roles, the disruption can produce significant psychological stress.

Role theory emphasizes that people derive stability and meaning from fulfilling expected roles. Work provides structure, social interaction and a sense of contribution. When injury interrupts that role, individuals must reorganize their sense of identity and purpose.

Another useful framework is the transtheoretical model of behavioral change, which describes how individuals progress through stages as they adapt to major life changes. Injured workers often progress from denial and resistance toward acceptance and active participation in recovery. Delays in the workers’ compensation process can interrupt this progression and keep individuals psychologically anchored in earlier stages of adjustment.

Together, these perspectives reinforce a central insight: Recovery from work injury involves not only physical healing, but also the reconstruction of identity and role.

Training claims professionals to navigate the grief process

Recognizing that injured workers may be experiencing grief does not mean claims professionals must become trained psychologists. It does mean they must develop communication skills that acknowledge the human experience of injury while still fulfilling the administrative responsibilities of the claims process.

In many ways, the most effective claims professionals already practice these skills instinctively. Formal training makes these behaviors consistent across organizations.

The first skill is listening before acting. The injured worker’s first conversation with a claims examiner often occurs in the midst of uncertainty, fear and frustration. Allowing the worker to explain what happened and how the injury is affecting their life establishes trust and reduces the adversarial tone that can develop early in claims.

The second skill is acknowledging loss without reinforcing disability. A statement such as, “I understand that this injury has disrupted your life,” recognizes the worker’s experience without suggesting that recovery is unlikely.

The third skill is reinforcing recovery expectations. Research in occupational rehabilitation consistently shows that recovery expectations are among the strongest predictors of actual recovery outcomes. When the employer, physician and claims examiner communicate a shared expectation that the worker will recover and return to productive activity, that expectation becomes part of the recovery process itself.

The fourth skill is maintaining the worker’s connection to the workplace. Regular communication with the worker and coordination with the employer regarding modified duty helps preserve the worker’s identity as an employee rather than allowing the “claimant” identity to become dominant.

The fifth skill is recognizing when additional support is needed. Some injured workers experience deeper psychological distress, depression or prolonged disengagement from recovery. Claims professionals should be trained to recognize these signals and coordinate appropriate support through nurse case management, behavioral health resources or other specialized services.

The objective of this training is not to transform claims professionals into therapists. It is to equip them with the skills necessary to guide injured workers through a difficult transition while maintaining the central goal of the workers’ compensation system: recovery and return to productive work.

In my experience managing workers’ compensation programs across multiple carriers and a large self-insured employer, the best claims examiners were never simply administrators of benefits. They were guides helping injured workers navigate one of the most difficult transitions in their working lives.

Conclusion

Workplace injuries are not only medical events. They are also psychological and social disruptions that affect identity, role and purpose.

Understanding the grief process helps explain why some workers struggle to return to work even after their physical injury has stabilized. It also helps explain why prolonged involvement in compensation systems can unintentionally reinforce disability.

Claims professionals, employers and healthcare providers who recognize this process can play an important role in helping injured workers move from loss toward recovery.

I began this paper with my own losses. What those losses reminded me — and what decades in this industry confirmed — is that grief follows its own timeline and does not yield to administrative process.

The injured worker is often in the same place: trying to find a way forward through loss.

Recognizing and addressing that grief is not only compassionate, it is essential to shortening claims, preventing unnecessary disability and helping injured workers return to productive lives.

That recognition changes how we do this work.

It should.

Bill Zachry is a former board member of the California State Compensation Insurance Fund.