The 2026 Enlyte Envision Trends Report, released this week, shows average days to first workers’ compensation treatment rose from 9.2 in 2022 to 16.1 in 2025. The median held at one day, meaning most injured workers still reach care quickly. But a growing subset is waiting significantly longer, particularly for professional office visits, and that delay is reshaping the loss development patterns self-insured employers rely on to set reserves.
Who it affects
Self-insured employers across all industries with retained WC programs, particularly those in states or regions where provider access has tightened. The effect is sharpest for employers with large shares of musculoskeletal and soft tissue injuries, which account for nearly half of all WC claims and are disproportionately routed through professional office settings rather than emergency departments or urgent care. Urgent care usage rose from 16.7% to 20.5% of injured workers over the same period, suggesting some workers are substituting immediate-access facilities when scheduled care is unavailable. Many others are simply waiting.
The reserve mechanism: development pattern shift
When an injured worker waits 16 days instead of nine to see a provider, everything downstream shifts: first medical payment, initial case reserve establishment, and the point at which the claim appears in the employer’s loss data. For a self-insured employer whose actuary selects chain ladder development factors from 2019-to-2021 experience, that shift matters. The early-maturity link ratios, particularly the 12-to-24-month factors, were calibrated to a world where first treatment happened in roughly nine days. With that window now 75% wider for a growing share of claims, those factors will understate the volume of loss still emerging.
The effect compounds two ways. First, pure IBNR rises because the lag between occurrence and first payment extends the window during which a claim is incurred but not yet reported. Second, case reserves on late-presenting claims are set with less diagnostic information. A claim that reaches an orthopedist on day 16 instead of day nine has not yet had imaging, a treatment plan, or a disability duration estimate when the adjuster sets the initial reserve. That reserve is more likely to develop adversely.
This is not a frequency problem. National WC claim frequency remained flat through 2025. The pressure is entirely on the severity and development side. Average allowed medical costs per claimant reached $4,398, up 9.5% since 2022, and behavioral health comorbidity is adding further duration and cost to claims already delayed in reaching care.
What this means for your next review
Ask your actuary whether the 12-to-24-month development factors in your current study reflect 2023-to-2025 diagonal experience or are still anchored to pre-2022 patterns. If the newer diagonals show hotter development at early maturities, the treatment delay trend is a likely contributor.
Request a distribution of days-to-first-treatment from your TPA, segmented by injury type. If the tail of that distribution is lengthening, your IBNR estimate at early accident year maturities may need a loading factor or a Bornhuetter-Ferguson prior that accounts for the access lag. The actuarial report should disclose whether the expected claim ratio reflects the current treatment environment or a historical baseline that no longer holds.
For employers in states where provider network access is thinning, monitor the gap between injury date and first medical bill at the claim level. That metric is a leading indicator of development pattern shift and should be on every interim monitoring agenda.