White Paper

6 Complexities in Workers’ Comp Claims – and How to Address Them

Let’s look at common complexities in workers’ comp claims – and how a combination of technology, data, and people can help address them.

White Paper Summary

Forty-five percent of workers’ comp stakeholders cite increasingly complex claims as one of the greatest challenges facing the workers’ comp industry, according to a 2024 Healthesystems survey. And for claims professionals specifically, this was reported as the #3 industry challenge.

While most workers’ compensation claims are straightforward, a small contingent of claims become complex and end up driving the biggest proportion of claim costs in workers’ comp. Claims complexities include everything from clinical and social complexity to patient and provider behaviors. These factors can lead to delayed recovery, increased claims duration, and ultimately, higher costs.

Perhaps it’s not that claims are becoming more complex, but that we as an industry are getting better at addressing patients holistically and identifying the complexities that were there all along. Let’s look at six common complexities in workers’ comp claims – and how a combination of technology, data, and people can help address them.

 

For more content like this from Healthesystems visit their RxInformer clinical journal website.

Healthesystems is a leading provider of Pharmacy Benefit Management (PBM) & Ancillary Benefits Management programs for the workers' compensation industry.

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