The sixth annual Workers’ Comp Industry Insights Survey was conducted in collaboration with Risk & Insurance® magazine, in person at the National Comp conference and online through October 2023. This survey continues to reveal important insights and challenges. Please scroll down for high level results or download the report for full details.
Highlights
#1
Industry challenge is healthcare provider/service shortage
think best application for AI is to identify fraud, waste, and abuse
have implemented beneficial claims process improvement programs
believe claims process automation is important industry technology
say comorbidities are top challenge to injured worker recovery
of claims professionals have difficulty obtaining information from medical providers
Industry Challenges
What challenges facing the workers’ comp industry most concern you today?
-
1
Healthcare provider/ service shortages
57% -
2
Other workplace safety challenges (communicable disease, remote work, marihuana, violence)
52% -
3
Mental health conditions and coverage
52% -
4
Workforce recruiting, retention, and succession
50% -
5
Workers' comp litigation
47%
Take Note
For executive leaders, workforce recruiting, retention and succession 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
61% -
2
Initiatives to improve the injured workers’ experience
46% -
3
Implementation of virtual/remote/digital technologies for workplace safety/ monitoring/ meetings
38% -
4
Employee retention and recruitment
36% -
5
Expanding integration with partners and providers
34%
Take Note
Claims process improvement/operational efficiency was #1 beneficial program last year but with a smaller 54%
Medical Program Priorities
What are the top priorities for your workers’ comp medical management program?
-
1
Align with RTW goals
54% -
2
Solutions to support front-line claims decisions and efficiency
44% -
3
Manage individual patient chronic conditions/comorbidities
35% -
4
Implement mental/behavioral health programs
31% -
5
Increase use of in-network providers
30%
Take Note
Clinical outreach/intervention programs was the #1 priority for medical program managers
Pharmacy Program Goals
What are the most pressing goals for your workers’ compensation pharmacy management program?
-
1
Contain costs
57% -
2
Opioid and substance abuse control/prevention
52% -
3
Improve provider outreach and education
35% -
4
Reduce physician dispensing of drugs
33% -
5
Manage other drugs of concern (i.e. benzodiazepines, gabapentinoids)
32%
Take Note
Opioid and substance abuse prevention was the top priority for TPAs with 68%
Recovery Barriers
What do you feel are the biggest barriers to injured worker recovery?
-
1
Comorbidities/poor worker health
65% -
2
Injured worker engagement
48% -
3
Limited availability of transitional duty/return to work options
47% -
4
Psychosocial/mental/behavioral health concerns
47% -
5
Care coordination/communication challenges
36%
Take Note
All job roles selected comorbidities as the #1 barrier to recovery except medical program managers who ranked psychosocial/mental/behavioral health concerns as #1
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)
68% -
2
Telemedicine/virtual technologies
55% -
3
Mobile technologies
43% -
4
Interoperability and data sharing between payers, providers & vendors
37% -
5
Predictive/prescriptive analytics
37%
Take Note
Claims process automation and telemedicine were also the #1 and 2 technologies in last year’s survey
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
60% -
2
Customer service (i.e. chatbots, virtual assistants)
59% -
3
Summarizing and sharing medical records/history
53% -
4
Personalizing the injured worker experience
42% -
5
Automated referral and authorization activity
42%
Take Note
Claims leaders put customer service (i.e. chatbots) ahead of identifying FWA with 67%
Claim Complexity
Which types of medical/health related claim complexities most concern you?
-
1
Mental health conditions
65% -
2
Comorbidities (i.e. hypertension, diabetes)
63% -
3
Undetected fraud, waste, and abuse
51% -
4
Type of injury (i.e. musculoskeletal injuries/disorders)
50% -
5
Lack of transparency into and/or inability to control medical prices
41%
Take Note
Comorbidities was #1 concerning claims complexity for both employers and insurance carriers
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
73% -
2
Limited/inadequate in-network options for medical care and services
54% -
3
Difficulty reaching and/or obtaining information from injured workers
51% -
4
Too many claims to manage/lack of support
51% -
5
Inflated provider prices and fees
41%
Take Note
Claims professionals at government agencies cited limited network options for medical care as their #1 obstacle
Perspective on industry stakeholders' thoughts and opinions