Bill review is complex — but the right approach can unlock major savings. Learn how to streamline the process and boost efficiency.
First-party automobile medical claims reflect a market that is beginning to demonstrate measurable cost discipline after several years of steady severity growth. Following increases in allowed medical cost per claimant from 2022 through 2024, the 2025 loss year marks the first year-over-year decline in allowed cost per claimant, decreasing 0.6% from the prior year.
This study looked at all lost-time (LT) claims with dates of injury 1/1/2025–12/31/2025, valued at 15 months (3/31/2026) to determine the impact of behavioral health treatments on the costs of a workers’ compensation claim. We looked at the impact of behavior health treatments (identified by diagnosis and/or CPT treatment codes) on the total medical costs of claims, the total medical treatment duration days, and the frequency of the different types of behavioral health diagnoses.
Medical severity — not overall claim frequency — emerges as the defining trend across the 2022–2025 loss years. Enlyte data is consistent with NCCI and WCRI reporting, overall workers’ compensation claim frequency remains flat to declining nationally. The notable change within this dataset is not the number of claims occurring across the system, but rather how medical services are being delivered, accessed, and utilized within existing claims.
Workers’ compensation continues to be one of the P&C industry’s most consistent underwriting success stories, supported by sustained operational discipline rather than short‑term tailwinds.
Claims management does not operate in isolation. It responds to — and reflects — broader economic, legal and structural forces shaping the insurance market. Pricing cycles, inflationary pressures, labor dynamics, medical cost trends, litigation patterns and capital market performance all converge to influence loss ratios and operational strategy.
Complex claims require more than a utilization review determination. Learn how connecting UR with case management, pharmacy, peer review and clinical oversight helps claims teams identify risks, remove barriers and improve outcomes.