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Digital Edition2026 Theo Award Winner: City of Los Angeles
Managing workers’ compensation for the City of Los Angeles is, in most respects, a problem of scale unlike any other municipal program in the country.
Los Angeles is the second-largest city in the United States. Its workforce spans 33 operating departments — each functioning, in many ways, like an independent organization with its own practices, leadership, and culture. Police, fire, sanitation, public works, libraries, airports, harbors — all governed by different priorities, different labor agreements, and different levels of engagement with the central workers’ comp program.
In that environment, consistency is hard. Accountability is harder. And when the system begins to tilt toward dysfunction, the problems compound across tens of thousands of employees and hundreds of millions of dollars in annual claims exposure.
That’s where Los Angeles found itself. A litigation rate approaching 70%. Medical treatment delays so entrenched that more than seven in ten treatment requests were being routed to full utilization review, often escalating from there to independent medical review. Return-to-work outcomes lagging badly, driven by a pervasive departmental assumption that employees couldn’t return unless they were cleared for full duty.
“The program had become too reactive, too slow, and not sufficiently centered on the employee experience,” said Tyrone Spears, the Division Chief of Workers’ Compensation for the City of Los Angeles.
Building Trust From the Ground Up
The Division Chief and the team were clear-eyed about what they were dealing with: not just an operational problem, but a cultural one. A litigation rate that high doesn’t just reflect disputes. It reflects a breakdown of trust — employees who feel they have no other way to get their questions answered, their care approved, or their concerns heard.
Incremental fixes weren’t going to be enough.
Tyrone Spears, Division Chief of Workers’ Compensation for the City of Los Angeles
“It quickly became clear that a piecemeal approach would not address the underlying issues,” Spears explained. “We needed a comprehensive strategy that tackled litigation, medical access, and return-to-work simultaneously.”
The cornerstone was an Alternative Dispute Resolution program designed specifically for the city’s unique complexity. Rather than simply routing disputes into a parallel process, the ADR program focused on education and transparency — helping injured workers understand what was actually happening with their claim, and creating human points of contact who could answer questions before frustration hardened into litigation.
Ombudsmen and member advocates were embedded in the process to assist employees directly. The goal was simple: give people someone to talk to, and many of them won’t feel the need to call an attorney.
Leadership was supportive but appropriately cautious throughout.
“They wanted to see results without increasing exposure,” Spears noted. The feedback from employees, meanwhile, was direct: they wanted fewer delays, more transparency, and a sense that someone in the system was actually on their side. That feedback shaped every element of the redesign.
Fixing the Bottleneck
At the heart of the medical delay problem was a utilization review process that had become a default rather than a targeted tool — capturing the vast majority of treatment requests in a review cycle that added weeks and generated enormous frustration for employees, providers, and departments alike.
The fix required both structural and clinical changes.
Adjuster authority was expanded through a robust approval trigger list, allowing straightforward treatment requests to be approved without escalating to formal utilization review. An additional review layer was added using independent registered nurses with no affiliation to the UR vendor — giving the team a clinical checkpoint that could approve appropriate care based on medical judgment, quickly, before a request ever reached the next level of review.
The results were dramatic. Treatment requests sent to full utilization review fell from more than 70% to less than 20%. Roughly 80% of requests are now approved in-house or through the first-level nurse review.
“Access to medical care improved significantly,” Spears said. “This has reduced delays and improved the overall experience for injured employees.”
Accountability Across 33 Departments
The return-to-work transformation required a different kind of intervention — less about clinical protocols and more about organizational behavior.
Departments that had long assumed “full duty or nothing” needed to be shown another way. A citywide initiative brought HR partners, ergonomics providers, and departmental leadership into a shared accountability structure. Departments were required to track accommodation decisions, report monthly disability data, and explain — in writing, with visibility up to executive leadership — why return-to-work wasn’t happening in specific cases.
The effect of that visibility was significant. When department heads knew their accommodation data was being reviewed at the executive level, the culture began to shift.
Creative solutions emerged: cross-departmental placements that allowed employees to work in another city department during recovery, and shared sit-stand workstations that removed physical barriers to accommodating restrictions. Educational roadmaps gave supervisors and employees alike a clearer picture of what return to work actually looks like — and why it matters.
Disability payments tied to non-accommodation fell by more than half.
A More Balanced System
The City of Los Angeles’s partnership with Sedgwick provided the operational backbone for consistent execution across a program of this complexity — maintaining professional claims handling and close coordination across the highest-volume departments throughout the transformation.
The cumulative results have been substantial. Litigation dropped from over 60% to approximately 35%. Medical treatment timelines improved dramatically. Return-to-work outcomes strengthened measurably. Costs declined.
But what Spears points to with the most conviction isn’t any single metric.
“Perhaps most importantly, we’ve shifted the culture,” Spears reflected. “The program is now more collaborative, more responsive, and more focused on delivering timely care while maintaining strong fiscal discipline. It’s a more balanced system — one that works better for employees, departments, and the organization as a whole.”
For a city the size and complexity of Los Angeles, that balance is not a small achievement. It is, arguably, the whole game. &
The Theo Award celebrates its sophomore year, honoring 28 workers’ compensation programs for their excellence and service to workers across the nation. To learn more about the award and amazing qualities each winner possesses, visit here.
