How Workers Compensation Reform Can Cut Litigation Costs

Originally published on KevinMD.com | May 5, 2026

Workers compensation reform is overdue — and as a pain physician treating injured workers daily, a qualified medical examiner (QME), an independent medical examiner (IME), and a business owner paying workers’ comp premiums, I see the system’s strengths and serious strains up close. It started with good intentions: a no-fault safety net, so workers get care and some income if they’re hurt on the job, without dragging employers into endless lawsuits. That foundation still makes sense. But layers of rules meant to curb abuse have created so much friction that the system sometimes works against the very people it should help.

Denial culture and the cost of mistrust

From my chair, workers’ comp insurance sometimes feels like a denial-first business. Simple, evidence-based treatments get delayed or rejected, triggering peer reviews, appeals, and lawyers. What could cost pennies in care ends up costing thousands in legal battles.

The numbers bear this out. Recent data from the Workers Compensation Research Institute (WCRI) shows total claim costs rose about 6 percent per year from 2022 to 2025 in the median study state, driven by medical payments, indemnity, and rising administrative and litigation expenses. Benefit delivery costs keep climbing.

Initial denial rates land around 7 to 13 percent depending on the study and state. One analysis found denials rose about 20 percent from 2013 to 2017 to nearly 7 percent overall. Yet roughly 67 to 70 percent of denied claims eventually get paid, often after delays and higher costs. Converted claims can run 50 to 55 percent more expensive.

Attorney involvement and the litigation spiral

Once attorneys step in on both sides, things escalate fast. Studies consistently show litigated claims cost dramatically more and last longer.

• One analysis found litigated claims were 388 percent more expensive on average (median costs up 739 percent), with claims taking 195 percent longer to close.
• A major WCRI study of nearly a million claims across states showed attorney involvement boosts indemnity payments by $7,700 to $12,400 on average, increases lost-time days by 284 percent, and doubles (or more) expense payments.
• Other work pegs attorney-represented claims at 2.1 to 2.3 times longer to close and 2.3 times more costly overall, with indemnity costs up to 3.5 times higher.

The injured worker, who should be front and center, ends up as a pawn in a game between applicant attorneys, defense teams, and insurers. Everyone digs in, trust erodes, and the real goal (getting the person healed and back to work) takes a backseat.

Friction, secondary gain, and where the line gets crossed

Rules exist for good reason. Fraud and secondary gain aren’t imaginary, as estimates of claimant fraud range from 1 to 10 percent or so, though exact figures vary, and some broader analyses put total system fraud, including premium dodging, much higher. Job dissatisfaction, incentives, and comorbidities can also prolong disability. But when administrative heat exceeds the protection it provides, the system overheats.

WCRI and others document how high-cost claims, often the top 5 percent, drive much of the expense, frequently tied to back and shoulder injuries, delayed care, and disputes. Broader societal costs spill over too, as workers’ comp covers only a fraction of total workplace injury burdens.

Smarter ways forward, backed by evidence

We don’t need to burn it down, just recalibrate. Lean more on unbiased, independent medical opinions (properly done QMEs or IMEs) to resolve disputes faster. Streamline early approval for proven, low-cost treatments. Invest in the patient, not the process.

Some real-world examples show it can work:

• Medical provider networks have cut total claim costs by 26 percent in certain studies, with faster access to care.
• Past reforms, like California’s SB 863, delivered billions in savings while increasing some indemnity benefits and reducing unnecessary services and opioids.

Bottom line: The system still delivers to a lot of people, but the growing friction (rising administrative and litigation costs, delays, and adversarial energy) is limiting its effectiveness. Prioritizing timely, evidence-based care, trusting solid independent medical judgment, and cutting unnecessary fights would serve injured workers better, help employers control premiums, and actually lower overall costs. It’s practical, not ideological. The data is there; we just need to act on it more consistently.

At Advanced Pain Diagnostic & Solutions, we specialize in workers’ compensation pain management across our Northern California locations in Sacramento, Roseville, Rocklin, Folsom, Davis, and Yuba City. Our team includes qualified medical examiners (QME) and experienced WC pain specialists. Contact us today to learn how we can help injured workers get back to health and back to work.