The fifth annual Workers’ Comp Industry Insights Survey was conducted in collaboration with Risk & Insurance® magazine, in person at the National Comp conference and online through mid November, 2022. This survey continues to reveal important insights and challenges. Please scroll down for high level results or download the report for full details.
industry concern is healthcare provider/service shortages
say managing patient comorbidities is top medical program priority
want better solutions to support front-line claims decisions
concerned about medical price inflation
Overview of Participants
503 stakeholders from across the workers’ comp industry responded to the survey.
PARTICIPANT ORGANIZATIONS
- Employer 117
- Insurance Carrier 105
- Healthcare Provider 55
- Brokerage 29
- State/Government Agency28
- Consultancy 28
- Third Party Administrator 27
- Managed Care Organization 18
- Law Firm 16
- Other 80
to Reveal Organizations
and Roles
PARTICIPANT INDIVIDUAL ROLES
- 123 Executive Leadership
- 74 Risk Management
- 70 Claims Leadership
- 40 Clinical/Case Management
- 37 Claims Professional/Adjustor
- 28 Broker/Agent
- 15 Medical Program Management
- 15 Legal/Regulatory
- 15 Healthcare Provider
- 81 Other (please specify)
Industry Challenges
What challenges facing the workers’ comp industry most concern you today?
-
1
Healthcare provider/ service shortages
58% -
2
Medical price inflation
58% -
3
Increasingly complex claims
56% -
4
Workers' Comp litigation
55% -
5
New workplace safety challenges
53%
Take Note
Healthcare provider shortages was a close second top challenge for executive leaders who ranked medical price inflation as their biggest concern.
Beneficial Programs
What programs implemented by your organization over the past 2-3 years have been most beneficial?
-
1
Claims process improvements/operational efficiency
54% -
2
Implementation of virtual/remote technologies
50% -
3
Employee retention and recruitment
49% -
4
Initiatives to improve the injured worker’s experience
46% -
5
Technological integration with partners and providers
33%
Take Note
Claims process improvement and efficiency reaped big benefits for most organizations, but initiatives to improve the injured worker experience was the most beneficial program for state and government agencies.
Medical Program Priorities
What are the top priorities for your workers’ comp medical management program?
-
1
Manage patient chronic conditions/comorbidities
71% -
2
Solutions to support front-line claims decisions
67% -
3
Increase use of in-network providers
60% -
4
Enhance claims process automation capabilities
58% -
5
Identify and manage social determinants of health (substance abuse, language barriers, social isolation)
56%
Take Note
Solutions to support front-line claims decision was the top priority for insurance carriers.
Recovery Barriers
What do you feel are the biggest barriers to injured worker recovery?
-
1
Injured workers’ unfamiliarity navigating workers’ comp system
66% -
2
Comorbidities
57% -
3
Limited availability of transitional duty/return to work options
53% -
4
Care coordination/communication challenges
52% -
5
Injured worker social determinants of health
48%
Take Note
Injured workers’ unfamiliarity navigating the workers’ comp systems has been cited as the #1 barrier to recovery for three straight years.
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
68% -
2
Telemedicine/virtual technologies
59% -
3
Interoperability and data sharing between payers, providers & vendors
49% -
4
Predictive/prescriptive analytics
45% -
5
Mobile technologies
44%
Take Note
Claims process automation increased in importance from roughly 48% last year to nearly 68% this year.
Analytics
Which applications of enhanced data analytics and artificial intelligence would be most valuable to your organization?
-
1
Personalize the injured worker experience
65% -
2
Identify potential fraud, waste, and abuse
59% -
3
Identify high litigation risk claims
55% -
4
Inform and guide clinical decision support for claims professionals
54% -
5
Identify, segment, and manage high-risk patient populations
50%
Take Note
Personalizing the injured worker experience was a clear #1 for employers, but insurance carriers selected inform and guide clinical decisions as the most valuable data application.
Claim Complexity
Which types of claim complexity most concern you?
-
1
Mental health conditions
62% -
2
Comorbidities
61% -
3
Undetected fraud
46% -
4
Lack of transparency into/inability to control medical prices
43% -
5
Injured worker substance abuse
41%
Take Note
Mental health conditions were a smaller concern for employers, who ranked it #3.
Claims Professional Perspective
If you are a claims professional or adjuster, what obstacles (if any) do you face when facilitating medical care for injured workers?
-
1
Difficulty obtaining information from medical providers
69% -
2
Difficulty reaching and/or obtaining information from injured workers
66% -
3
Too many claims to manage
62% -
4
Lack of reliable and accessible clinical decision support information
45% -
5
Legislative/regulatory requirements
41%
Take Note
62% of claims professionals reported having too many claims to manage, as opposed to 42% last year.
