In Harm’s Way: The Impact of Violence in Workers’ Comp

Fast Focus

As part of our Social Determinants of Health series1, an exploration of the types of violence workers may experience and the potential impacts on their health and healing.

Exposure to violence can have serious impacts on worker health. Violence in the workplace may cause direct injury and other types of violence can also be a concern in workers’ compensation. Violence that takes place outside the workplace, including domestic and community violence, can adversely affect overall health and job performance, lead to accidents, and impede recovery.

Types of Violence

Workplace Violence: The Occupational Safety and Health Administration (OSHA) definition of workplace violence is broad and includes “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site” 2 and, by this standard, over 2 million workers are affected by violence every year.3 In 2019, over 20,000 workers experienced trauma from workplace violence that was serious enough to require time away from work – most commonly in the healthcare industry, which accounted for 71% of the incidents.4

Types of Workplace Violence:


Criminal Intent

Generally perpetrated by a stranger intent on crime that is unrelated to the business or the workers



Violence committed by someone the organization serves, such as patients in a healthcare setting



Conflict, altercations, and harassment between workers, as well as extreme violence, such as workplace shootings by current or former employees



Usually current or former intimate partners who assault, harass, or intimidate their victims at their place of work 5

Domestic Violence: 98% of domestic violence survivors reported that the abuse they experienced made it difficult for them to concentrate at work. Of the nearly 100% who had difficulty concentrating, 17% said that the lack of concentration resulted in a work accident or near miss, with 65% of the accidents resulting in injuries.6 These numbers are considerable, especially considering that, according to one study, 21% of fulltime employed adults reported that they were victims of domestic violence.7


of domestic violence survivors reported difficulty concentrating at work

Community Violence and Crime: In 2020, over 4.5 million violent crimes were committed in the U.S. and 44% of violent crimes reported to police were committed by strangers.7 People who are victims of violent crime and behavior – and even those who are merely exposed to violence by association with victims within their communities – are at higher risk for depression, anxiety, and PTSD.8 These mental health conditions can manifest in physical symptoms, such as insomnia, headaches, and chronic pain, potentially resulting in decreased productivity and increased accident risk.

How Violence Impacts Work

2 million

Americans are victims of workplace violence each year9

U.S. businesses lose an average of


annually due to workplace violence10

Violence preparedness and prevention costs healthcare facilities nearly

$3 billion

annually 11

Victims of intimate partner violence (IPV) lose

8 million

workdays per year

at a cost of over


per year to employers12

The lifetime lost productivity cost due to IPV, sexual violence, or stalking is


per victim or

$110 billion

across the U.S.13


of IPV victims reported disruption in their ability to work and


lost at least one job as a result of abuse14

Violence and Health

Violence is now widely considered a public health issue15 and regardless of whether workers experience domestic, community, or workplace violence, the health impacts and risks are similar.

Exposure to violence can lead to an increased risk of:

Heart disease
Post-traumatic stress disorder

In addition, people who experience violence are more likely to engage in unhealthy behaviors, such as poor sleep, smoking, social isolation, and substance abuse,16 any and all of which can hinder a patient’s recovery from injury or illness. Opioid abuse is, of course, a particular hazard in workers’ comp.

Any one of these comorbidities will obviously make an individual less healthy and there has long been evidence that chronic conditions negatively impact job performance, causing poor productivity at work and absenteeism.17 Comorbidities can also complicate injured worker treatment and recovery and cause claims cost to escalate.


What To Do

Community, domestic, and even workplace violence are unfortunate features of society over which no workers’ comp payer has complete control. But there are some steps that employers and insurers can take to mitigate risks and facilitate better outcomes for injured workers, including:

Communication and Support: General information about safety and protection against violence in the workplace and community can heighten awareness and help prepare workers should they be exposed to any kind of violent incident. Support in the form of employee assistance programs (EAP’s), educational resources, and ready access to HR professionals can bolster awareness with the knowledge that assistance is available if needed.

Policy, Procedure, and Training: Clear policies prohibiting any type of violence in the workplace are essential, as well as procedures for reporting and/or seeking assistance regarding any violence or injury that occurs, within or outside of the workplace. Training programs should be established for the general employee population, as well as more specialized training for HR professionals and appropriate managers.

Identification and Intervention: Employers and insurers are unlikely to know that a worker has suffered violence unless it took place in the workplace and was reported. As noted earlier, workers who experience domestic or community violence may be at higher risk for injury on the job and are almost certain to be at higher risk for complications, such as depression or PTSD. Predictive analytics can be used to flag risk factors and HR managers and claims professionals should be acquainted with the risk symptoms of violence to identify patients and alert healthcare providers.


  1. Note: Violence is most commonly considered a component of the Neighborhood and Built Environment category of the Social Determinants of Health (SDOH), but the types and causes of violence are complex and cross over into other categories, such as Social and Community Context and Economic Stability. See
  2. U.S. Department of Labor, Occupational Safety and Health Administration. Workplace Violence.
  3. Society of Human Resource Management. Workplace Violence: A Growing Threat or Growing Awareness? 2019.
  4. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Workplace & Safety Topic: Occupational Violence. August 11, 2021.
  5. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Types of Workplace Violence. February 7, 2020.
  6. Ridley, E and Roux, J et al. Domestic Violence Survivors at Work: How Perpetrators Impact Employment. State of Maine Department of Labor. October 2005.
  7. Morgan R. and Thompson, J. Criminal Victimization, 2020. U.S. Department of Justice. October 2021, NCJ 301775.
  8. Rivara, F, Adhia A, et al. The Effects Of Violence On Health. Health Affairs. Vol 38, No 10. October 2019.
  9. Doherty, M. A Shared Responsibility: Preventing Violence in the Workplace. Occupational Health and Safety. May 4, 2021.
  10. Kurtner, H. Healthcare Remains America’s Most Dangerous Profession Due To Workplace Violence. Forbes. November 24, 2019.
  11. America’s Health Rankings. Annual Report. Violent Crime. 2021.
  12. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Costs of Intimate Partner Violence Against Women in the United States. 2003.
  13. Peterson, C., Liu, Y. et al. Partner Violence, Sexual Violence, or Stalking. American Journal of Preventive Medicine. July 2018: 55(1): 106-110.
  14. Hess,C and Del Rosario, A. Dreams Deferred: A Survey on the Impact of Intimate Partner Violence on Survivor’s Education, Careers, and Economic Security. Institute for Women’s Policy Research, October 24, 2018.
  15. Freire-Vargas, L. Violence as a Public Health Crisis. AMA Journal of Ethics. 2018;20(1):25-28.
  16. Barczy, A. Seeing Crime and Violence as Public Health Issues. MI Blues Perspective. Blue Cross and Blue Shield of Michigan. August 31, 2021.
  17. Jinnett, K, Schwatka, N, et al. Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance. February 2017.



Since 2010, the semi-annual RxInformer clinical journal has been a trusted source of timely information and guidance for workers’ comp payers on how best to manage the care of injured worker claimants and plan for the challenges that lay ahead. The publication is an important part of Healthesystems’ proactive approach to advocating for quality care of injured workers while managing the costs associated with treatment.