Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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California Publishes Independent Billing Review Report

About 6% of medical bills challenged through the dispute process were initially paid correctly.

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February 9, 2026

Claim Data

WCRI Reports on Trends in Joint Replacement Surgery

Using data from 2 million claims across 32 states, the study found that the prevalence of these surgeries increased, driven by shoulder joint replacements.

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February 9, 2026

Claim Costs Claim Data

NCCI Publishes Report on Fast-and-Slow Emerging Claims

Both claims reach costs of $1 million or more, but at different points in time after injury.

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February 9, 2026

Cost Containment

Missouri Proposes Fee Schedule

The bill would require a formal fee schedule for all services provided under workers’ comp, taking effect August 28, 2026.

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February 2, 2026

Technology

Multiple States Seek to Limit AI-Generated Care Decisions

Alabama, Hawaii, Kentucky, Oklahoma, Pennsylvania, and Virginia have all introduced bills to limit AI-generated care decisions.

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February 2, 2026

Presumptions

Arizona Could Cover Travel Injuries for Firefighters

Injuries occurring when traveling to and from work would be covered, assuming no criminal activity was undertaken.

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February 2, 2026

Mental Health Presumptions

Florida and Vermont Could Extend PTSD Coverage to 911 Dispatchers

Pre-existing PTSD presumptions for first responders could be extended to 911 dispatchers.

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February 2, 2026

Presumptions

Maryland and Arizona Target Hypertension Presumptions for Firefighters

Maryland would create a hypertension presumption, while Arizona would strengthen theirs by increasing rebuttal requirements.

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February 2, 2026

Presumptions

Vermont and Virginia Consider Covering Additional Cancers for Firefighters

Vermont could soon cover larynx, pharynx, and trachea cancers, while Virginia could cover lung cancer and non-Hodgkin’s lymphoma.

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February 2, 2026

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Preliminary Findings from the 2026 Workers’ Comp Industry Insights Survey Report

Risk & Insurance® magazine published high-level findings from the eighth annual survey, in collaboration with Healthesystems.

Year in Review: What Made the Biggest Impacts in Workers’ Comp Claims Management in 2025?

From claims complexity to mental health, here’s what impacted workers’ comp claims management last year.

New York Could Remove References to CDC Guidelines

After regional public health collaboratives formed in September, New York could be the first state to formally shift policies away from deferring to federal guidelines.

On the Front Lines: How Does Climate Change Continue to Impact Workers?

What are the latest developments in climate change, and how does it continue to impact front-line workers such as ocean workers and construction workers?

Expert Q&A: What Are the Impacts of the New Prescription Drug Tariff Policy?

With the Trump Administration’s new tariff on prescription medications, how are drug manufacturers reacting, and how might the workers’ compensation system be impacted?