The Top Workers’ Comp Trends Every Physician Should Prepare for in 2026

The workers’ compensation landscape continues to evolve.

For physicians in orthopedics, pain management, spine, and multi-specialty practices, understanding these trends is important for staying aligned with the needs of employers, carriers, and injured employees.

While overall claim volume remains steady, the complexity, cost, and expectations surrounding care continue to change in ways that directly affect clinical practice.

Below are the key developments shaping 2026, presented clearly and focused on what physicians need to know.

Medical Cost Inflation and Increasing Claim Severity

The severity and cost per claim are increasing due to rising medical costs across the healthcare system. Physicians may face pressure to manage these costs effectively.

How this affects practices

When claim costs rise, practices may see more attention placed on treatment plans, what is being prescribed, and the overall duration of care. This makes it even more important for practices to have a strong workers’ compensation program with clear processes and consistent outreach in place. Practices that follow best practices and maintain steady communication are often viewed as dependable partners for employers and carriers as they work to navigate these rising costs.

Provider Shortages and Workforce Strain

The healthcare industry is experiencing physician and healthcare worker shortages due to an aging workforce and physician burnout. This increases demand for physicians who accept workers’ compensation cases and may also raise operating costs for practices.

How this affects practices

Practices that remain accessible and reliable may see increased referral opportunities because employers and carriers need timely access to care. At the same time, shortages may require adjustments to scheduling and staffing to support patient volume and maintain consistent availability. This can create room for growth for practices that can stay organized and responsive.

Growth in Telemedicine and Technology Integration

Telemedicine is now a well-established part of workers’ compensation care. It supports faster access at the time of injury, improved continuity for follow-up visits, and broader reach in areas facing provider shortages. Physicians are also seeing increased use of technology such as data analytics, outcome tracking, and predictive case management tools.

How this affects practices

Telemedicine can reduce delays and provide flexibility for both patients and physicians. Technology tools can streamline communication, strengthen decision-making, and support steady case progression. Practices may need to adjust workflows to integrate these tools in a way that maintains accuracy and supports overall efficiency. For many practices, these tools offer opportunities to improve organization and enhance the patient experience.

More Complex Claims and Comorbidities

Claims involving pre-existing conditions and comorbidities continue to increase. These cases often require thorough evaluations, clear treatment plans, structured documentation, and coordination across specialties.

How this affects practices

Complex cases may require more communication and more involvement from the physician and support staff. Practices with structured workflows and consistent documentation are better positioned to manage these cases, reduce delays, and keep care moving forward. This can strengthen the practice’s reputation for handling more challenging cases effectively.

Medicare Fee Adjustments in 2026

Medicare updates its physician fee schedule annually. For 2026, expected changes include efficiency adjustments and different conversion factors based on participation models. These changes determine reimbursement for Medicare-covered services.

What efficiency adjustments mean

Efficiency adjustments allow Medicare to reduce certain payments slightly to encourage operational efficiency. Specialties with higher procedure volume such as orthopedics and pain management may be more directly affected.

How Medicare adjustments relate to workers’ compensation

Workers’ compensation systems operate independently, but many states base their workers’ compensation fee schedules on percentages of Medicare rates. Because of this structure:

• Medicare adjustments can influence financial planning for practices

• Workers’ compensation often remains a stronger and more stable component of a diversified payer mix

Strengthening a workers’ compensation program helps practices maintain balance and stability when Medicare updates reimbursement levels.

How this affects practices

Medicare changes may shift how practices structure their payer mix and plan for reimbursement. A strong workers’ compensation program can help offset these adjustments by offering stability and predictable payments when Medicare rates fluctuate. This supports long-term planning and financial consistency.

Continued Emphasis on Return-to-Work Programs

Return-to-work expectations remain a central part of workers’ compensation. Physicians support this process by providing clear functional restrictions, detailed clinical reasoning, timely updates, and treatment plans designed to support safe and practical recovery.

How this affects practices

Consistent return-to-work guidance helps cases move forward and supports positive outcomes for employees. Practices that provide clear and timely information are often seen as strong partners in the recovery and claims process. This can strengthen relationships with employers, carriers, and case managers.

Looking Ahead

As we move into 2026, it becomes even more important for physicians to have a strong workers’ compensation program in place. Workers’ compensation continues to be one of the highest-paying and most stable payors, making it a valuable part of a balanced and diversified payer mix. Practices that have clear processes, an active outreach program, and a strong understanding of workers’ compensation best practices are better positioned for long-term stability and growth.

This article was prepared by OM as part of our ongoing commitment to keeping physicians informed about the latest developments in workers’ compensation. The information shared is based on statewide research and a range of industry news and research outlets that monitor national trends in workers’ compensation.

“While overall claim volume remains steady, the complexity, cost, and expectations surrounding care continue to shift. As these changes unfold across the healthcare system, workers’ compensation remains one of the most stable and highest-paying payors, making it an essential part of a balanced payer mix.”