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Access to timely, appropriate medical care remains one of the most important drivers of recovery, claim progression, and overall experience for injured individuals. But in 2026, the access story is no longer defined solely by provider shortages. Instead, it is shaped by a more complex care environment in which provider mix, geography, health system dynamics, technology, new care access points and network stability all influence how and where care begins.
Workers' compensation claims vary dramatically in complexity, duration, and cost. While some injured workers recover quickly with minimal intervention, others experience prolonged disability requiring extensive medical treatment. Pharmacy data provides a unique window into claim trajectory, often revealing patterns that predict complexity before other clinical indicators emerge.
An employee strains a shoulder lifting inventory. On day one, the injury looks routine. The diagnosis is familiar, and the treatment plan feels straightforward. Nothing about the claim seems especially concerning.
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.