Survey Reveals Workers’ Comp Industry Faces Rising Complexity, Shifting Technology Priorities

The workers’ compensation industry is facing multiple challenges.  According to the 2025-26 Workers’ Compensation Industry Insights Survey, from Healthesystems in partnership with Risk & Insurance®, nearly 60% of respondents identified workers’ comp litigation as a top concern — but by the slimmest of margins. Poor worker health, comorbidities, and social determinants of health followed at 59.19%, underscoring how closely intertwined legal and medical complexities have become.

The survey was conducted at the 2025 National Comp conference in Nashville and online, gathering responses from 507 professionals spanning employers, insurance carriers, TPAs, health care providers, government agencies, and other industry organizations. The results paint a comprehensive picture of an industry navigating unprecedented complexity while searching for solutions that can move the needle on outcomes.

The Compounding Challenge of Worker Health and Recovery Barriers

When asked about the biggest barriers to injured worker recovery, respondents pointed overwhelmingly to factors that often exist before an injury even occurs. Comorbidities and poor worker health — including conditions like diabetes, hypertension, and obesity — topped the list at 60%. Injured worker non-compliance and disengagement followed closely, with more than half of respondents citing these as significant obstacles.

The data reveals a troubling pattern: the factors that concern industry professionals most are often the ones over which they have the least direct control. Workplace safety challenges jumped from 44% in 2024 to nearly 53% in 2025, reflecting growing anxiety around inexperienced workers, climate-related hazards, and the evolving regulatory landscape around marijuana use.

Mental health conditions and coverage concerns resonated with more than half of respondents, while medical and pharmacy price inflation affected nearly 49%. For claims professionals specifically, providing medical care to injured workers is becoming more challenging — 70% reported difficulty obtaining information from medical providers, and nearly 56% said they simply have too many claims to manage effectively. This last finding represents a dramatic shift from the previous year, when only 40% of claims professionals cited overwhelming caseloads as a barrier. The 15-point increase suggests that staffing pressures and operational demands are reaching critical levels across the industry.

Strategic Priorities Point Toward Engagement and Efficiency

Despite these challenges, the survey points to where organizations plan to focus their efforts. Improving injured worker engagement and experience emerged as the top medical management priority at 47.35%, followed by streamlining referral and authorization workflows at 36%.

The emphasis on engagement aligns with respondents’ calls for greater transparency. More than 61 % indicated that better visibility into injured worker medical history would improve their ability to manage care and costs, while 57% wanted more insight into injured worker engagement and adherence levels. Understanding psychosocial factors and social determinants of health ranked third at 55%.

For pharmacy management programs, priorities clustered around control and transparency. Opioid and substance abuse prevention remained the top goal at nearly 45%, while reducing physician and third-party dispensing and decreasing usage of high-priced private label topicals followed. Notably, a third of respondents flagged the need to monitor emerging drug therapies — including new pain medications and weight loss drugs — as treatment landscapes continue to evolve.

The business opportunity embedded in these priorities is substantial. Organizations that can successfully address injured worker engagement while managing the complexities of comorbidities and mental health conditions position themselves to reduce claim duration, minimize litigation exposure, and improve both injured worker health and business outcomes.

Technology Investment Priorities Shift as AI Gains Ground

Perhaps the most notable evolution in the 2025 survey involves technology adoption patterns. While claims process automation retained its position as the most important technology at 54%, this figure dropped six points from 60% in 2024. Telemedicine saw an even steeper decline, falling from 50% to 41%, and mobile applications dropped from 44% to just 33%. These decreases may merely reflect the fact that these solutions have already been implemented in various organizations.

That next frontier appears to be artificial intelligence. When asked where AI tools are most useful currently or expected to prove valuable soon, respondents coalesced around practical applications that address their most pressing pain points. Identifying potential fraud, waste, and abuse led at 58%, followed by summarizing and sharing medical records at nearly 57%, and transcribing notes for claims records at 51%.

The alignment between AI use cases and identified challenges is striking. With claims professionals managing high caseloads and struggling to obtain information efficiently, tools that automate documentation and surface relevant insights can offer significant relief. Similarly, with comorbidities and medical complexity driving claim costs higher, AI-powered analysis of medical records and risk identification can help organizations intervene earlier and more effectively.

Some industry professionals also commented to make the point that AI can’t replace the human touch. Rather, it is hoped that its use will free up seasoned adjusters to perform more high-level tasks.

Interoperability and data sharing between payers, providers, and vendors ranked as important to nearly 32% of respondents, suggesting that the industry recognizes that technology’s value extends beyond any single organization. The most effective solutions will be those that facilitate information exchange across the ecosystem, reducing the friction that currently hampers communication and delays care.

Looking ahead, the survey data suggests an industry preparing for continued complexity. As worker health profiles evolve, litigation pressures persist, and technology capabilities expand, organizations that invest strategically in engagement, transparency, and intelligent automation will be best positioned to deliver better outcomes at sustainable costs. &

Readers who would like to receive a copy of the full survey report when published in February can request a complimentary digital copy from Healthesystems.