Why Musculoskeletal Recovery Is Getting More Complex, And What Claims Teams Can Do About It
As workplace injury rates fall, a new challenge is rising: complexity.
Musculoskeletal (MSK) injuries still account for more than 80% of workers’ compensation claims. But the claims that remain aren’t just fewer, they’re harder to treat. They’re taking longer to resolve, requiring more clinical coordination, and demanding more from claims professionals across the board.
“We’re seeing fewer claims overall, but the ones that persist are tougher to manage,” said Brian Peers, PT, DPT, VP of Clinical Solutions at MedRisk. “It’s not that injuries are getting worse, it’s that the simpler ones are disappearing.”
This shift: fewer claims, higher complexity, isn’t just a trend. It’s a structural change that’s reshaping how MSK recovery must be approached. And for claims teams, adapting isn’t optional, it’s essential.
The Frequency-Severity Paradox
Cheryl Gulasa, SVP of Managed Care, AmeriSys, a Davies Company
The core challenge is what experts call the frequency-severity paradox: as workplace safety improves and automation eliminates lower-severity risks, the cases that remain are more resource-intensive, more multifaceted, and more prone to setbacks.
“Injured workers today are more likely to need surgery, more likely to experience delays, and more likely to need complex coordination of care,” said Greg Nichols, PT, President of SPNet, a division of MedRisk.
Several factors are driving this shift, and understanding them is key to responding effectively.
“We’re seeing three major forces at play,” said Sandip Chatterjee, MedRisk’s Chief Product Officer. “Comorbidities, psychosocial dynamics, and the aging workforce.”
Let’s take a closer look:
- Comorbidities: Workers are presenting with more underlying health issues, like diabetes, obesity, and hypertension that complicate treatment and slow recovery. These overlapping conditions often require specialized care coordination and longer timelines.
- Psychosocial factors: Claims teams are increasingly accounting for mental health, motivation, social support, and fear of reinjury. These invisible variables are now recognized as major influences on recovery, and require tools and training to identify and manage.
- An aging workforce: As the average age of workers rises, so does the risk of delayed healing, limited physical capacity, and age-related degeneration. Recovery plans must now be tailored to functional age, not just biological age.
This growing complexity has made it clear that traditional playbooks aren’t enough, and that’s where technology promised to help.
Technology’s Promise, and the Reality Check
Brian Peers, PT, DPT
Vice President of Clinical Services and Provider Management, MedRisk
Digital MSK tools, from wearable sensors to app-based recovery tracking, have been positioned as game-changers. In theory, they offer more visibility into progress, enable remote monitoring, and support patient engagement.
But in practice, adoption has lagged, and outcomes remain mixed.
“There’s a gap between the hype and what’s actually working,” said Peers. “We haven’t yet seen outcomes that definitively prove these tools can consistently improve recovery timelines.”
One of the biggest hurdles is physician buy-in.
“Doctors are cautious about relying on tech for return-to-work decisions,” said Cheryl Gulasa, SVP of Managed Care at Amerisys, a Davies Company. “They’re ultimately responsible, and that means they’re putting their licenses on the line.”
Meanwhile, access to providers is shrinking. A national physician shortage, combined with the specialized demands of workers’ compensation, is making it harder to find and schedule care, especially with MSK-focused occupational medicine providers.
“Wait times that used to be one or two weeks are now one or two months,” Gulasa noted. “By 2035, over half of our medical providers will be of retirement age.”
These challenges are pushing the system toward alternative care delivery models, such as direct-access physical therapy and expanded roles for physician assistants and nurse practitioners. These models can help close the care gap, but only if claims teams are prepared to adapt.
“As we move forward, we’ll need to educate our health care providers on new approaches to dealing with musculoskeletal injuries. It’s easy to fall into the same routine with a knee, shoulder, or back injury – ice it, rest it, and proceed through standard physical therapy protocols, Gulasa said.
Where Real Progress Is Happening: Smarter Use of Data
Greg Nichols, PT, President of SPNet, a division of MedRisk
While tech tools mature, data and analytics are already changing how MSK cases are managed, and with much more immediate impact.
“There’s so much more data available now,” Nichols said. “We’re not just looking at age and injury type, we’re digging into clinical notes, prior interactions, even tone of voice during calls to get a clearer picture.”
These tools allow for early identification of high-risk cases, giving claims teams the opportunity to intervene before a delay turns into a derailment.
“With generative AI, we’re surfacing insights from clinician notes and conversations that were previously inaccessible,” added Chatterjee. “This gives us a more complete view of the injured worker.”
But turning data into impact requires more than technology, it requires people who know how to act on it.
“We have to educate our nurses and adjusters on what these data points actually mean,” Nichols said. “It’s not just about more information, it’s about smarter decision-making.”
Ultimately, success means shifting the focus away from isolated metrics and toward functional recovery: the real-life ability to return to meaningful work and everyday activities.
“The goal isn’t just to reduce pain or improve range of motion, it’s to restore confidence, mobility, and purpose,” Peers said.
What Claims Teams Can Do Now
Sandip Chatterjee, Chief Product Officer, MedRisk
To respond effectively to this evolving MSK landscape, claims professionals should focus on four key strategies:
1. Use predictive analytics to spot complexity early
Advanced models can flag potential high-risk claims at intake or shortly after, allowing for earlier interventions, faster diagnostics, and more tailored recovery plans.
2. Build person-centered recovery strategies
Incorporate comorbidities, psychosocial factors, and functional goals into assessment and planning, not just clinical symptoms. This holistic view enables more accurate forecasting and better engagement.
3. Prepare for new care delivery models
With provider shortages worsening, direct-access physical therapy and non-physician providers will continue to play bigger roles. Teams should ensure they’re ready to support and integrate these models into their networks and workflows.
4. Choose partners with real data strategies
Look for vendors who aren’t just offering new tools, but who can clearly demonstrate how their data strategy improves decision-making, reduces delays, and leads to better outcomes.
A New Era for MSK Claims Requires a New Approach
The transformation of musculoskeletal recovery in workers’ compensation isn’t temporary, it’s a fundamental shift that mirrors broader trends in healthcare: more data, fewer providers, more individualized care, and higher expectations for outcomes.
For claims professionals, adapting to this complexity is no longer optional. It’s the new standard. That means thinking holistically, acting earlier, and choosing partners who are equipped to translate data into action. It means evolving alongside the challenges, without losing sight of the injured worker at the center of it all.
And it means being proactive in addressing any areas that need improvement or more support.
“We’re working with occupational medicine doctors and urgent care physicians to bridge these gaps,” Gulasa said. “In Georgia, our return-to-work team conducts in-person education with doctors, bringing job analysis information to them. Our role becomes education and buying time until we can either get patients to specialists or, in some cases, the injury resolves without specialist intervention.”
All of this without losing sight of the goal of workers’ compensation, a safe and productive return to work.
“First, we need to get individuals back to work as quickly and safely as possible. Second, we must accomplish this with the best economics for our clients,” Nichols said.
“We now incorporate psychosocial factors as well, which would have been unthinkable earlier in my career as a case manager,” Gulasa said.
“Today it’s commonplace to recognize that mental health support might benefit recovery—not necessarily long-term psychotherapy, but perhaps some conversation about the accident to help patients progress in their healing journey,” she added.
Getting there will take smarter systems, better insight, and a willingness to embrace change. The good news? Claims teams already have many of the tools, they just need the strategy to use them well.
