By Healthesystems
Workers’ compensation is always evolving. As the economy, regulations, and workforce demographics change, so too does workers’ comp. Here’s where we saw the biggest impacts on workers’ comp claims management last year:
#1. Claim Complexity Is on the Rise
More complex – and therefore costly – claims have become a persistent issue in workers’ comp. And this didn’t just happen in 2025; it’s been building for a while. According to NCCI, while claim frequency dropped 5% in 2024, claim severity increased 6%. And the prevailing consensus among industry leaders is that the incidence of complex claims is increasing, with over 50% of surveyed stakeholders believing that complex claims are a major challenge for the industry. There are many factors that could lead to this complexity, from mental health conditions to climate change. For an overview of these factors and mitigation strategies, read our RxInformer magazine article: Common Exceptions: The Rising Incidence of Complex Claims in Workers’ Compensation.
#2. More Opioid Alternatives Become a Reality
In recent years, the workers’ comp industry has seen much success in the decline in opioid prescribing for chronic pain. Part of this success can be attributed to alternative pain medications that have stepped in to fill the void. These include suzetrigine (marketed under the brand name Journavx™), a new non-opioid analgesic and first-in-class medication approved in January 2025. And more recently, research has emerged supporting cannabis as a form of pain relief. In October 2025, Reuters reported that an experimental cannabis-derived medication (VER-01) was safer and more effective than placebo and opioids for treating chronic lower back pain in two late-stage trials. While cannabis has been talked about in workers’ comp for several years now, its clinical efficacy has always been a question mark. This study goes a long way toward validating cannabis as a true opioid alternative for pain management.
#3. Industry Makes Measured Progress in Applying AI
Artificial Intelligence (AI) is ubiquitous these days, and in 2025, the workers’ comp industry continued to make measured – though cautious – progress in applying it to healthcare delivery. Work comp stakeholders are typically using AI to improve the way they do things, from claims professionals making more informed medical decisions to physicians identifying inconsistencies in medical records. But we’ve really only begun to scratch the surface of what AI can do. And in workers’ comp, where we deal with sensitive health information, there are concerns about biases and accuracy within the systems as well as data privacy. Some states have attempted to regulate the use of AI, but that may be a thing of the past. In December 2025, President Trump signed an executive order aimed at restricting the states from crafting their own AI regulations. Only time will tell how things shape up in the realm of workers’ comp and AI – both in the regulatory space and in how we use the technology.
#4. Weight Loss Drugs Are Here to Stay
Weight loss medications (GLP-1 agonists) have become wildly popular among the general population and have slowly made their way into workers’ comp. A 2024 employer survey by the International Foundation of Employee Benefit Plans found that 8.9% of organizations’ total annual claims are for GLP-1 drugs used for weight loss – an increase over the 2023 average of 6.9%. And the drugs are becoming more widely available, with the White House announcing a deal with pharmaceutical manufacturers to make them more affordable. In September 2025, the U.S. Food and Drug Administration also approved Saxenda® (liraglutide), the first GLP-1 generic for obesity. Additionally, in late December the FDA approved the first oral version of a GLP-1: the Wegovy pill by Novo Nordisk. This daily pill is expected to be widely available this month and should be cheaper than weekly GLP-1 injections.
#5. Increased Focus on Mental Health in Medical Program Priorities
The link between mental health and physical injury and recovery has been well established – and this understanding is translating into new policy and programs throughout the industry. According to our 2025 Workers’ Comp Industry Insights Survey, medical program managers said their top priority was implementing mental and behavioral health programs. Regulatory trends affirm this focus on mental health, as regulations are increasingly validating mental health claims in workers’ comp. In particular, Post-Traumatic Stress Disorder (PTSD) presumptions have seen significant activity over the last several years, with a flurry of bills introduced in 2025. For more detail on the evolution of presumptions in workers’ comp, read our RxInformer magazine article: Burden of Proof: Unpacking Presumptions in Workers’ Comp.
#6. Attorney Representation/Litigation Is a Major Concern
According to our Workers’ Comp Industry Insights Survey,the most concerning challenge facing the workers’ comp industry in 2025 was litigation. Slightly more than 61% of survey participants cited litigation as the top challenge (a 14-point year-over-year increase), and post-survey interview subjects expressed the belief that a greater portion of injured workers are hiring attorneys. And evidence that attorney representation increases claim duration and costs is more than anecdotal. A 2024 Workers Compensation Research Institute study concluded that attorney involvement increases payments by $7,700 to $12,400, increases lost time days by 284%, and inflates expense payments by 200%. The reasons injured workers hire attorneys are many and varied. To read more, see our RxInformer magazine article: Concerning Counsel: A Look at Litigation in Workers’ Comp.
#7. For Managed Care Programs, Integrated Partnerships Are Key
We live in a world of rapidly advancing technology and greater access to data – and in workers’ comp, that’s coupled with ever-increasing complexity (as we’ve explored in this blog). Navigating this environment and its many complex facets now depends on a more collaborative, connected model. Rather than going it alone, organizations are embracing partnerships with specialized experts and integrating best-in-class resources, helping them to more readily adapt to change, leverage new innovations, and meet the evolving needs of injured workers. This shift reflects a natural evolution in how we solve problems – where the interoperability of tools and solutions is just as important as the tools themselves.
For example, imagine a mid‑sized workers’ comp insurer juggling multiple vendors and manual workflows for services like diagnostics and transportation. Instead of adding internal burden, the insurer partners with a third-party integrator that unifies these functions into a single platform. Claims teams gain integrated referral tools, automated decision support, and data‑driven insights that highlight risks earlier in the claim. What once required manual coordination becomes a streamlined, intelligence‑supported process – improving efficiency, enhancing visibility, and allowing teams to focus on higher‑value work while supporting better outcomes for injured workers. It’s a glimpse into what’s possible when the industry leans into connection, collaboration, and the shared pursuit of better care.
