Comp claims, litigation often muddied by preexisting conditions, MRI findings

November 25, 2025

As the workforce ages, the workers compensation industry faces a convergence of pressures that include rising claim severity and litigation pitting injury causation against preexisting conditions, with many disputes fueled by a familiar diagnostic flashpoint: magnetic resonance imaging.

Known as an MRI, the tool is effective at diagnosing musculoskeletal injuries and degenerative conditions, yet experts say the technology also introduces gray areas that can complicate claims, inflate costs, prolong claim duration and trigger legal battles over causation.

“There’s always been back and forth around compensability because degenerative situations have always existed, and there’s always been incidents that can or cannot make that condition worse,” said Leah Sharp, Huntsville, Alabama-based senior vice president of clinical services at Gallagher Bassett. She added that the issues are now “more prevalent as the workforce is aging.”

“This is certainly an area to watch, as (diagnostics) can convolute and muddy claims management,” said Susan Doering, Scottsdale, Arizona-based director of clinical operations for utilization review at Enlyte.

Over the 10 years leading up to 2033, the workforce is projected to see a 22.4% rise in workers 65 to 74 and a 79% increase in those over 75, according to the U.S. Bureau of Labor Statistics. At Sedgwick Claims Management Services, workers 60 and older had the highest increase in overall new claim volume each year from 2020 to 2024.

As with most accepted work-related injuries, the first task for insurers and employers managing a musculoskeletal claim is to review evidence-based guidelines and work with doctors to understand what they are and why they matter, said Dr. Dorian Kenleigh, Phoenix-based national medical director at MedRisk and a section leader with the American College of Occupational and Environmental Medicine, which provides injury guidelines for states such as California. That organization, along with the equally common Official Disability Guidelines, has established guidelines saying that for most injuries, an MRI typically is not needed in the first six weeks, Dr. Kenleigh said.

That hasn’t stopped the medical profession from ordering the test, primarily when a doctor is not used to working within the scope of workers compensation and may not understand the rules on injury causation, experts said. MRIs can be expensive alone and it’s the cost related to prolonging or complicating a claim can add up, they said.

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