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Care access problems strain comp sector, slowing worker recovery, increasing costs - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Care access problems strain comp sector, slowing worker recovery, increasing costs by Louise Esola Technology , Workers Comp Coverage Apr 24, 2026 As provider shortages across health care persist, delays in treatment are becoming one of the most consistent pressure points in the workers compensation industry. From prolonged disability durations to increased pharmaceutical use and a higher likelihood of litigation, experts say access barriers can reshape the trajectory of a claim in ways that are difficult and costly to unwind. Provider shortages stem from a variety of factors, including the large number of physicians reaching retirement age, rural hospital closures and the limited number of newcomers in health care. “Access to care initially can really have a detrimental effect on those claims in the long run — their duration, their severity,” said Silvia Sacalis, Tampa, Florida-based vice president of clinical services for Healthesystems. The delays can cause a “cascade of unintended consequences,” said Jean Feldman, Tampa, Florida-based director of managed care at Sentry Insurance. “Delays in care can make what should be simple, such as a musculoskeletal injury, become more complex,” said Kim Radcliffe, Jacksonville, Florida-based senior vice president of product management at Enlyte-owned Apricus, which coordinates physical therapy, which is one area seeing delays. In musculoskeletal claims, which make up a large share of workers comp cases, even a short delay in treatment can alter outcomes significantly, with claimants taking more medication and for longer periods. A 2020 study by the Workers Compensation Research Institute found that earlier initiation of physical therapy for low back pain was linked to lower medical costs, fewer opioid prescriptions and shorter disability durations. “When care is delayed, it complicates recovery, increases costs and leads to more opioids and more interventions,” said Sebastian Negrusa, Washington-based vice president of research for WCRI. While opioid prescribing has declined in recent years, other drugs, such as nonsteroidal anti-inflammatory drugs and neuropathic agents, are increasingly used as stopgap measures. Many drugs are not meant for long-term use, experts said. “If someone’s unable to get an appropriate assessment, you can see (that) increased need for pain medications,” said Melissa Burke, New York-based senior vice president and head of client services for AmTrust. In some cases, medications are effectively used to maintain stability until care becomes available, which reverses traditional treatment models, she said. “It feels like we’re keeping patients medicated until they can get treatment, and that’s not the intention,” she said. Delayed care can also take a psychological toll on injured workers. Uncertainty about diagnosis, treatment plans and recovery timelines can contribute to anxiety, stress and depression, which are factors that may hinder recovery and return-to-work. Industry experts often refer to this phenomenon as “mental creep,” where psychological issues gradually become intertwined with the physical injury. “When you’re waiting and delayed for care to find out what’s happening, that uncertainty can lead to anxiety and depression,” Ms. Burke said. That dynamic is compounded by a lack of communication or clarity in the claims process. “If an injured worker doesn’t feel prioritized or doesn’t know what’s happening next, that’s where problems start,” she said. While data linking delayed care directly to mental health remains limited, many experts suspect the connection is real. “It lays the foundation of frustration,” said Stacy Whalen, Loudoun County, Virginia-based medical management director at Safety National. “All the injured worker knows is they’re supposed to see a specialist and they don’t have an appointment.” One of the most immediate consequences of that frustration is an increased likelihood of litigation. When injured workers perceive delays as neglect or denial — even when caused by systemic issues such as provider shortages — they may seek legal representation to advocate for their care, according to attorneys. “If a claimant is not getting treatment, they’re going to seek counsel quicker,” said Rich Lenkov, a Chicago-based partner at Bryce Downey & Lenkov. “In their mind, an attorney is going to help them get what they need.” Litigated claims tend to last longer, cost more and involve additional administrative complexity. “Any delay, including for medical treatment, prolongs the case and fosters litigation,” Mr. Lenkov said. In some jurisdictions, litigation can exacerbate delays. Complex medical evaluation systems, competing expert opinions and scheduling challenges can create a “merry-go-round that never stops,” said Jeff Adelson, a partner with Irvine, California-based Bober, Peterson & Koby. Underlying many of these challenges is a shrinking pool of providers willing to treat workers compensation patients. Specialists in fields such as neurology and mental health are particularly difficult to access, while some physicians have opted out of workers comp entirely due to administrative burdens or reimbursement concerns, according to Jennifer Cogbill, Dallas-based senior vice president of GB Care, a division of Gallagher Bassett Services. “Oftentimes, the best providers don’t take insurance at all,” she said. Against that backdrop, early intervention has emerged as one of the most effective strategies for mitigating the downstream effects of delayed care. “The most effective strategy is upfront identification of risk and early advocacy,” Ms. Cogbill said, adding that the approach requires a shift from “reactive” to “proactive” claims management, with greater emphasis on communication and holistic care. “Focusing only on the physical injury and ignoring the whole person is where the industry has fallen short.” Keeping injured workers informed about delays, next steps and available options can reduce uncertainty and help maintain trust, said Ms. Whalen. “Open communication and collaboration are key. … Let the injured worker know, ‘We’re working on this. Here are the challenges. Here’s what to expect,’” she said. Tech use rises as comp care delays linger Technology is playing an increasingly central role in helping workers compensation professionals bridge gaps, particularly in the early stages of a claim, as access to care challenges intensify. A growing body of research indicates that digital tools, data analytics and telehealth solutions can improve coordination, reduce delays and enhance the injured worker experience. One of the most widely adopted tools is telephonic nurse triage, which connects injured workers with clinical guidance immediately after an injury. Available 24/7, these services help determine the appropriate level of care — whether self-care, telemedicine, urgent care or emergency treatment — reducing unnecessary emergency room visits and accelerating access to treatment. “We’re trying to get the injured worker to the right resource at the right time,” said Jennifer Stephens, Dallas-based senior director of operations for Clinical Care 24 at Enlyte. In many cases, that initial guidance can prevent delays entirely by directing workers to appropriate providers without waiting for traditional scheduling processes, she said. Even a nurse giving home care instructions can make a significant difference, said Jean Feldman, Tampa, Florida-based director of managed care at Sentry Insurance. “This is access to a professional who can help them so that they’re not sitting at home, wondering what’s going to happen,” she said. Telemedicine has also expanded access, particularly in rural areas or for follow-up care, allowing injured workers to consult with providers without traveling long distances. Beyond front-end triage, analytics platforms are helping insurers and employers identify potential delays and intervene earlier. By tracking key events, such as missed appointments or gaps in treatment, technology can trigger alerts to claims professionals, prompting timely action. “Systematized notifications that prompt the right people at the right time can make a significant difference,” said Larkin Shull Rau, Denver-based director of consultative analytics at Broadspire. Artificial intelligence is increasingly being used to analyze large volumes of claims and medical data, identifying patterns and risk factors that might otherwise be missed. While AI is not replacing human decision-making, it is enhancing efficiency and consistency, particularly in areas such as pharmacy management, risk scoring and clinical oversight, according to Jennifer Cogbill, Dallas-based senior vice president of GB Care, a division of Gallagher Bassett Services. “AI is helping us identify things that may be missed in the minutia,” she said. 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