Report Explores Forces Driving Claim Complexity

Insurers and employers face mounting pressure from rising severity, lengthier claim durations and expanding operational demands, a new report shows.

Enlyte on Tuesday released its 2026 Envision Trends Report, which reflects growing complexity for the claims space.

Related: Study: California Workers’ Comp Claim Costs Continue to Rise

In workers’ compensation, medical severity is driving costs. Claim frequency remains flat nationally, but average allowed medical costs per claimant rose 9.5% between 2022 and 2025, reaching $4,398. The primary drivers were increased utilization, with injured workers receiving more services per claim, according to the report.

Claims involving behavioral health, opioids, obesity, diabetes or hypertension generated costs roughly higher than average claims, because they require longer treatment durations and more services. Behavioral health involvement has increased 15.3% since 2022, adding 10% to total severity of all claims.

Related: State Regulatory Surge, Federal Shifts Reshaping Workers’ Comp

Claims involving psychiatric conditions such as obsessive-compulsive disorder/impulse disorders and dementia/delirium represented significant cost drivers, with average medical expenses averaging between $200,000 to $300,000 per claim.

Musculoskeletal and soft tissue injuries accounted for nearly half of all claims last year. Growth in this category outpaced other injury types, according to the report, which reflects:

• Workforce aging and degenerative conditions complicating recovery
• Greater diagnostic specificity over the life of the claim
• Occupational shifts toward physically demanding industries
• Emphasis on conservative treatment prior to invasive intervention

In auto claims, severity was tied to claim complexity rather than frequency. However, first-party auto medical claims showed signs of improvement in 2025, the report shows.

“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,” the report states.

The shift coincides with a compression in treatment duration, while unit pricing pressures continued. “The data suggests that recent utilization management and claim-handling strategies are influencing overall severity, even as provider charges and allowed amounts per unit remain elevated,” the report states.