By Healthesystems
For 2026, the top medical program priority for workers’ comp stakeholders is improving the injured worker experience. This is one of many insights revealed in the eighth annual Workers’ Comp Industry Insights Survey, conducted by Healthesystems in collaboration with Risk & Insurance® magazine. Over 500 stakeholders from across the workers’ comp industry responded to the survey, which continues to reveal insights about the challenges, successes, innovations, and evolving needs in workers’ comp medical care.
Here are the top five major findings from this year’s survey:
#1. Injured Worker Patients Front and Center
A direct focus on injured workers is a priority for industry professionals in 2026. Most notably, the number one medical program priority this year is improving injured worker engagement. Industry stakeholders want more and better information about the injured workers they serve. In fact, the top three areas into which survey participants said they need greater visibility directly involve the injured worker: injured worker medical history, injured worker patient engagement and adherence, and injured worker psychosocial factors. The desire for more detailed information about the health, behaviors, and life circumstances of injured worker patients reflects the growing complexity of workers’ compensation claims.
#2. Comorbidities Bear Blame for Complexities
A big reason that industry professionals are keen to engage with injured workers is the prevalence of comorbidities among the working population. Studies have shown that comorbidities delay recovery and contribute to higher medical costs. For the past several years, survey participants have expressed concern about comorbidities in a variety of ways – and this year is no different. Sixty percent of respondents ranked comorbidities as the number one barrier to recovery, and 56% ranked them as the most concerning claim complexity. Poor worker health/comorbidities was also cited as the number two industry challenge.
#3. AI Sparks Expectations and Apprehension
Artificial intelligence has taken the world by storm, but the workers’ comp industry appears to be moving cautiously – appreciating its potential benefits, but wary of unforeseen negative impacts. As part of this year’s survey, many stakeholders expressed the opinion that truly personal attention cannot be replaced by AI. For instance, providing customer service via AI, such as through chatbots and virtual assistants, is no longer among participants’ top five most useful applications of AI. Meanwhile, survey participants have consistently selected identifying fraud, waste, and abuse as the most useful application of AI every year since 2023.
#4. Strong Support for Claims Staff Solutions
This year’s survey further confirms the industry’s need for claims process automation. Participants expressed the desire to help claims professionals manage high volumes of claims while also giving necessary attention to more complex cases. For instance, this year 55% of claims professionals reported they have too many claims to manage, as compared to 40% last year. Technological solutions have long been seen as the answer to this challenge. Beginning in 2022, the number one most important technology, according to survey participants, has been claims process automation. This year was no exception, with 54% of participants selecting claims process automation as the most important technology to their medical management program.
#5. Cost Control Underlies Pharmacy Program Priorities
The top three pharmacy program goals for 2026 are similar to those of 2025. Opioid and substance abuse control and prevention is again the number one goal. Reduce physician and third-party dispensing moved into the second spot and decrease usage of high-priced private-label topicals is number three. This differs only slightly from last year. Meanwhile, survey participants ranked increasing transparency into pharmacy program economics as the number four pharmacy goal, a significant climb from last year’s number eight ranking. In addition to out-of-network activity, high prices and other cost pressures are driving this greater demand for transparency across the spectrum of healthcare products and services.
Learn More
To delve deeper into these insights and more, download the full 2026 Workers’ Comp Industry Insights Survey Report.
