Workers' Comp Professionals Want AI — With Guardrails, Survey Finds

What National Comp 2025 Attendees Told Healthesystems

Workers' compensation professionals who gathered at the National Comp conference in Nashville in 2025 told Healthesystems that their priorities are shifting toward data, complexity management and the injured worker experience — while warning that the industry's biggest obstacles are increasingly interconnected.

According to the survey, improving the injured worker experience remains the leading goal for medical program management, followed closely by streamlining claims operations and getting better at managing complex claims involving comorbidities. Data-driven decision-making has risen in importance: respondents said analytics is becoming necessary for identifying trends, flagging risk early and guiding interventions. Looking ahead, they want to expand whole-person care, bring behavioral health into claims management and improve engagement with injured workers throughout recovery.

On the obstacle side, litigation ranked as the industry's top challenge, with medical and pharmacy cost concerns close behind. Respondents ranked comorbidities as the top barrier to recovery and the most concerning claim complexity, and they pointed to mental health conditions, psychosocial factors and social determinants of health as additional layers of difficulty. They also highlighted data silos and system integration problems: fragmented sources of information lead to duplicated efforts, delayed decisions and missed opportunities to intervene.

The AI findings are cautiously optimistic. Professionals see clear potential for AI to reduce administrative burden, detect fraud, waste and abuse, and summarize medical records. But they also raised concerns about data privacy and security, the transparency and explainability of AI decisions, and the risk of bias. Above all, respondents insisted that empathy, judgment and personal connection remain essential in claims work — suggesting adoption will depend as much on trust and governance as on technical capability.

Why Comorbidities, Litigation and Data Silos Dominate the Agenda

Survey results of this kind need to be read in context, but the patterns are consistent with pressures the workers' compensation industry has described for years.

The Data Bottleneck at the Centre of the Agenda

Respondents said their organizations collect more data than ever, yet fragmented systems make it hard to act on it. That matters because data-driven decision-making was a rising priority. Without integration across claims, medical and pharmacy data, even the best analytics tools will produce insights that arrive too late. The survey suggests the industry's problem is not a lack of information but a lack of usable information.

Litigation and Comorbidities Are Two Faces of the Same Complexity

Litigation ranked as the industry's top challenge, while comorbidities were named the top barrier to recovery and the most concerning claim complexity. The two are linked: claims involving multiple health conditions, mental health issues or social determinants are harder to manage, take longer to resolve and are more likely to end in dispute. That helps explain why respondents described cost containment and quality care as a persistent tension rather than a solvable trade-off.

AI Adoption Will Be Gated by Governance, Not Capability

The enthusiasm for AI is real — respondents pointed to administrative burden, fraud/waste/abuse detection and medical-record summarization as high-value uses. But privacy, security, explainability and bias concerns suggest deployment will be slower than the technology permits. Trust, not performance, is likely to be the deciding factor in how quickly AI moves from pilot to core claims processes.

A Survey With a Sponsor's Perspective

The findings were collected and published by Healthesystems, which organized the survey; the article does not disclose methodology details such as sample size or response rate. The results therefore reflect the views of conference attendees who chose to respond, not a statistically representative picture of the whole industry. The direction of the findings aligns with wider industry discussion, but precise priorities could vary across payers, states and organization types.

What Claims Leaders and Tech Vendors Can Act On

For claims leaders, payers and technology vendors, the survey points to three areas where effort will pay off.

• Prioritize data integration before adding new AI tools: respondents identified data silos and system integration as major hurdles, so claims teams need access to medical, pharmacy and behavioral health data in one place before automation can add value.
• Treat comorbidities and behavioral health as routine claim inputs: comorbidities were ranked the top barrier to recovery, so intake and triage processes should flag mental health, psychosocial and social determinant factors from the start.
• Set AI governance rules before rollout: privacy/security, explainability and bias were named concerns, so organizations should define which decisions AI can support, how outputs are explained to adjusters and how models are monitored.
• Watch litigation exposure alongside medical and pharmacy costs: litigation was ranked the top industry challenge, making litigated claim rates and legal spend necessary companion metrics to traditional cost tracking.
• For vendors, target the uses respondents actually want: administrative burden reduction, fraud/waste/abuse detection and medical-record summarization were the clearest perceived AI benefits.