The seventh annual Workers’ Comp Industry Insights Survey was conducted in collaboration with Risk & Insurance® magazine, in person at the National Comp conference and online through November 2024. This survey continues to reveal important insights and challenges. Please scroll down for high level results or download the report for full details.
Highlights
Industry challenge is workers’ comp litigation
medical program priority is solutions to support front line claims staff
say comorbidities are top challenge to injured worker recovery
see healthcare provider and service shortage as top challenge
say the #1 pharmacy program goal is opioid and substance abuse prevention
Only 24% report implementing beneficial AI/analytics investment
Industry Challenges
What challenges facing the workers’ comp industry most concern you today?
-
1
Workers' comp litigation
61% -
2
Healthcare provider/ service shortages
58% -
3
Poor worker health/comorbidities/social determinants of health
58% -
4
Workforce recruiting, retention, and succession
54% -
5
Medical/pharmacy price inflation
51%
Take Note
For insurance carriers, medical or pharmacy price inflation was the #1 challenge
Beneficial Programs
What programs implemented by your organization over the past 2-3 years have been the most beneficial to your worker's comp program/claims outcomes?
-
1
Claims process improvements/operational efficiency
55% -
2
Integration/strategic relationships with partners and providers
47% -
3
New or improved technology
44% -
4
Initiatives to improve the injured worker experience
43% -
5
Access to medical services for injured workers
35%
Take Note
The #1 beneficial implementation for the past three years has been claim process improvements and operational efficiency programs
Medical Program Priorities
What are the top priorities for your workers’ comp medical management program?
-
1
Solutions to support front-line claims decisions and efficiency
55% -
2
Manage individual patient chronic conditions/comorbidities
44% -
3
Increase use of in-network providers
43% -
4
Injured worker population segmentation and management (risk identification and analysis, customized patient experience)
42% -
5
Identify and manage social determinants of health (e.g., substance abuse, language barriers, social isolation)
35%
Take Note
For medical program managers, the #1 priority was implementing mental and behavioral health programs
Pharmacy Program Goals
What are the goals for your workers’ compensation pharmacy management program in the next 2-3 years?
-
1
Opioid and substance abuse control & prevention
47% -
2
Decrease usage of high-priced private label topicals (PLTs)
39% -
3
Reduce physician and third-party dispensing of drugs
39% -
4
Improve provider outreach and education
38% -
5
Increase pharmacy network penetration
29%
Take Note
Participants from third-party administrators (TPAs) said their #1 pharmacy goal is increasing pharmacy network penetration
Recovery Barriers
What do you feel are the biggest barriers to injured worker recovery?
-
1
Comorbidities/poor worker health (e.g., diabetes, hypertension, obesity)
63% -
2
Injured worker disengagement/unfamiliarity with work comp system
58% -
3
Limited availability of transitional duty/return to work options
47% -
4
Psychosocial/mental/behavioral health concerns
43% -
5
Access to timely/quality care
38%
Take Note
Participants from healthcare provider organizations and state or government agencies put injured worker disengagement and unfamiliarity with the workers’ comp system ahead of comorbidities as the top recovery barrier
Technology
Which technological advances will be most important to your workers’ comp medical management program in the next 3-5 years?
-
1
Claims process automation (i.e. using analytics to segment and drive claims along appropriate path)
60% -
2
Telemedicine
50% -
3
Mobile applications
44% -
4
Predictive/prescriptive analytics
42% -
5
Artificial intelligence/machine learning (e.g., foundational and generative models: ChatGPT/GPT-4, etc.)
37%
Take Note
Claims process automation and telemedicine have been the #1 and #2 most important technologies for the past 4 years
Analytics and AI
For which areas do you expect to find advanced analytics and artificial intelligence tools (i.e. machine learning, ChatGPT) most applicable?
-
1
Identifying potential fraud, waste, and abuse
63% -
2
Summarizing and sharing medical records/history
54% -
3
Personalizing the injured worker experience
49% -
4
Customer service (i.e. chatbots, virtual assistants)
46% -
5
Automated referral and authorization activity
46%
Take Note
85% of participants from managed care organizations (MCOs) said summarizing and sharing medical records/history is the most applicable use of AI
Claim Complexity
Which types of medical/health related claim complexities most concern you?
-
1
Comorbidities (e.g., hypertension, diabetes)
60% -
2
Mental health conditions (e.g., PTSD, depression, anxiety)
59% -
3
Undetected medical fraud, waste, and abuse
54% -
4
Type of injury (e.g., musculoskeletal injuries/disorders)
49% -
5
Charges for medical services unrelated to injury
41%
Take Note
For executive leaders, mental health conditions and undetected medical FWA are the top two concerning claims complexities
Claim Professional Perspective
If you are a claims professional or adjuster, what obstacles do you face when facilitating medical care for injured workers?
-
1
Difficulty obtaining information from medical providers
63% -
2
Difficulty reaching and/or obtaining information from injured workers
49% -
3
Limited/inadequate in-network options for medical care and services
46% -
4
Working between multiple systems and communication channels
46% -
5
Too many claims to manage/delays in referral and transaction processing
40%
Take Note
Difficulty obtaining information from medical providers has been the top obstacle for claims professionals for the past three years
Perspective on industry stakeholders' thoughts and opinions