Out of Balance: Workforce Gender Disparities and What They Mean for Workers’ Comp

Fast Focus

Women workers were more adversely affected by the pandemic and its subsequent recession than were men, which is likely to have an impact on the labor force and workers’ compensation for some time to come.

The COVID-19 pandemic depressed economic activity and decimated employment numbers to levels not seen since the Great Depression.1 The impact was felt across industries and throughout the world. But, as with all disasters, the damage was more severe for certain sectors of the population. In this case, women have been more adversely affected,2 not only by direct job losses, but also by the infrastructural impact of the pandemic, such as closing schools and daycare facilities, that made it difficult to impossible for women to manage conflicting responsibilities.

A disproportionate impact to women’s employment was apparent from the earliest days of the pandemic. In April 2020, the unemployment rate in the U.S. increased by 10.3%, bringing the total unemployment rate to 13% for men, but a considerably higher 15.5% for women.3 Black and Hispanic women suffered even greater employment losses, accounting for 46% of the total decrease in women’s employment, even though they represent less than a third of the female labor force.4

Between February 2020 and February 2021, 2.4 million women left the labor force (meaning they were neither working nor looking for work), as compared to 1.8 million men who left the labor force.5 And there is evidence to suggest a good number of those women may not come back to work, such as the 18% of employed mothers who reported to McKinsey in 2020 that they were considering leaving the workforce entirely.6

Why Women?

All segments of the American population were affected by the pandemic and job losses were staggering across the board, but women were particularly vulnerable to the idiosyncrasies of this particular recession for multiple and overlapping reasons, including:

Occupational Distribution

Nearly half of all women (46%) work in low-wage jobs7 where employment fell by 11.7% during 2020, as compared to 5.4% for middle-wage earners and virtually no change for high-wage workers.4

Women account for 78% of healthcare workers who were at greater risk of exposure to COVID-19 during 2020.7

Women fill the majority of service sector occupations where most of the job losses occurred.9

Competing Priorities

Childcare responsibilities: Labor force participation among women with children dropped 2.3% from February 2020 – January 2021, whereas the drop for men with children was only 0.8%.8 A significant drop in employment occurred among women with children in August and September of 2020 when home schooling began for many.9

Elder and other family care: 1 in 7 women provide care to elder or disabled relatives10 and external support, such as adult daycare, became scarce during the pandemic.

Motivational Factors

More women (62%) than men (46%) feared contracting COVID19, which may have made them more reluctant to go out to work.8

Women earn less than men for the same work – women without a bachelor’s degree make 78 cents for every dollar of their male counterparts and women with a bachelor’s degree or higher fare even worse, earning 74 cents for every dollar a man makes for similar work.11 Lower earnings provide less incentive for women to stay in the workforce, especially with competing priorities, such as child and elder care.

All of these factors combined to create a perfect storm that put more women involuntarily out of work, while simultaneously making it more difficult for employed women to do their jobs. The consequential decrease in women’s employment, even if it’s only temporary, could have resounding effects on women’s career progress, the success of individual businesses, and the U.S. economy as a whole.2

Job Sectors Dominated by Women

Job Sectors Dominated by Women8


2020-21 Unemployment Increase

2020-21 unemployment increase graph

Workers’ Comp Impact

Any change to the U.S. workforce has an impact on workers’ compensation and the balance of male to female workers is no exception. The pandemic exposed issues that make women vulnerable to unemployment and work-related health risks, both of which could affect injured worker trends and patient care.

The ratio of women to men in the workforce has a direct effect on worker injury rates for a number of reasons, the first being that women are less likely to be injured on the job. Overall, women account for 17% fewer injuries than men 12 and 35% fewer injuries that involve time away from work.13 This is partly due to the fact that fewer women work in high-risk industries, such as construction and mining, but even within industry sectors men are injured at higher rates than women.12

The most common injury causes are also different for women who are more likely to be hurt slipping or falling and less likely to sustain a contact injury. Women report more work-related injuries for carpal tunnel syndrome, tendonitis, respiratory diseases, and infectious diseases.12 Overall, women’s injuries tend to be less severe, requiring an average of seven days to recover as compared to 10 days for men.14

Workplace Injury Causes by Gender

Workplace Injury Causes by Gender12


However, women experience higher rates of depression15 and anxiety,16 the incidence of which has risen significantly since the pandemic began.17 These mental health conditions can complicate treatment and delay recovery. In addition, although men are more prone to substance abuse disorders, women are more frequently prescribed opioids and twice as likely to be prescribed benzodiazepines, both of which pose high risks for adverse drug effects. The psychosocial issues associated with injury, unemployment, and caregiving responsibilities can cause or exacerbate mental health conditions and/or lead to dependence on problematic medications.

See RxInformer-Opioid IMBALANCE: RISK DISPARITIES AMONG DIVERSE PATIENT POPULATIONS  → for more detailed information about opioid risks for women and other population sectors.

What’s more, there is evidence that psychosocial-related medical conditions, including depression, headache, and poor sleep, are associated with the likelihood of injured women workers filing subsequent workers’ compensation claims, but not so for men.18

The COVID-19 virus also affects men and women differently. In the general population, men are somewhat more likely to contract and die from COVID-19 but women file significantly more workers’ comp claims for COVID-19,20 probably due to their over representation in healthcare services. Women are also more likely to suffer the effects of “Long COVID-19”21 which includes a range of symptoms, including cognitive issues and depression, that could affect recovery, not only from COVID-19 itself, but from other injuries and illnesses as well. (See The Long Haul: Chronic Health Complications of COVID-19, also in this issue of RxInformer.)

Claim Distributor by Gender


And of particular concern in workers’ compensation, female patients – who express the same intensity of pain as male patients – are perceived to be in less pain than they report, due to gender bias on the part of both male and female observers in clinical settings.22 If women injured workers pain is not accurately evaluated, it is more likely that it will not be properly treated, increasing the likelihood of depression and extended recovery time.

What to Do

The potential impacts of sustained change in women’s workforce participation are many and variable. When it comes to injured worker medical care, workers’ compensation payers should be aware that patient population patterns may shift. Changing demographics, alternative work settings, increased psychosocial issues, and a virus about which much is still to be learned, all add up to an imperative for a comprehensive approach to workers’ comp medical management that includes data analytics, risk management strategies, and personalized clinical services capable of attending to the needs of injured women workers.

Checklist for a Changing Workforce

Analyze population and claims data regularly to spot shifting patterns and get ahead of changing trends by taking pro-active steps, such as enhancing drug formularies and referral processes for cognitive behavioral therapy (CBT), physical medicine and/or return to work services.

Use predictive analytics to identify patients at risk and inform more targeted clinical interventions, taking into account biological, physiological and psychosocial differences between male and female patients.

Educate claims professionals and nurse care managers about gender bias in medical treatment, particularly pain management.

Monitor medications closely as they can serve as early warning signs for health factors that can complicate the course of treatment and delay recovery. Be alert to addictive medications more commonly prescribed to women, such as benzodiazepines, antidepressants, and opioids.

Offer outreach services for at-risk patients to engage them in discussions about comorbidities, medications, psychosocial conditions, and any other factors that may impact their care and recovery.

Whether the alterations in women’s workforce participation will be short-lived or enduring remains to be seen. However, it is clear now that the pandemic and the subsequent recession exposed vulnerabilities for working women that will continue to impact the labor force and women’s health, both of which are important concerns for workers’ compensation and injured worker medical care management.


  1. Kochhar, R. Unemployment rose higher in three months of COVID-19 than it did in two years of the Great Recession. June 11, 2020. Pew Research. https://www.pewresearch.org/fact-tank/2020/06/11/unemployment-rose-higher-in-three-months-of-covid-19-than-it-did-in-two-years-of-the-great-recession/
  2. Kashen, J. et. al. How COVID-19 sent women’s workforce progress backwards. October 30, 2020. Center for American Progress. https://www.americanprogress.org/issues/women/reports/2020/10/30/492582/covid-19-sent-womens-workforce-progress-backward/
  3. Bureau of Labor Statistics. The employment situation – April 2020. May 8, 2020. U.S. Department of Labor. https://www.bls.gov/news.release/archives/empsit_05082020.pdf
  4. Kochhar, R. and Bennett, J. U.S. labor market inches back from the COVID-19 shock, but recovery is far from complete. April 14, 2021. Pew Research. https://www.pewresearch.org/fact-tank/2021/04/14/u-s-labor-market-inches-back-from-the-covid-19-shock-but-recovery-is-far-from-complete/
  5. Wells, A. Returning to Work After COVID Workers’ Comp in a Post-COVID World. May 3, 2021. Insurance Journal. https://www.insurancejournal.com/magazines/mag-features/2021/05/03/612004.htm
  6. Corey, S., et. al. Women in the workplace 2020.” September 30, 2020. McKinsey & Company. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace
  7. Bateman, N. and Ross, M. “Why has COVID-19 been especially harmful for working women?” October 2020. The Brookings Institute. https://www.brookings.edu/essay/why-has-covid-19-been-especially-harmful-for-working-women/
  8. Rothwell, J. How have U.S. working women fared during the pandemic? March 8, 2021. Gallup. https://news.gallup.com/poll/330533/working-women-fared-during-pandemic.aspx
  9. Edwards, K. Women are Leaving the Workforce in Record Numbers. November 24, 2020. Rand Corporation. https://www.rand.org/blog/2020/11/women-are-leaving-the-labor-force-in-record-numbers.html
  10. National Alliance for Caregiving and AARP Public Policy Institute. Caregiving in the U.S. 2015. June 2015. AARP. https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf#:~:text=Caregiving%20in%20the%20U.S.%202015%20should%20be%20considered,for%20examining%20changes%20to%20caregiving%20in%20the%20future.
  11. Day. J.C. College degree widens gender earnings gap.” May 29, 2019. United States Census Bureau. https://www.census.gov/library/stories/2019/05/college-degree-widens-gender-earnings-gap.html
  12. Coate, P. “Changing workforce demographics and workplace injury frequency.” April 2019. National Council on Compensation Insurance. https://www.ncci.com/Articles/Documents/Insights-WorkforceDemographics.pdf
  13. U.S. Bureau of Labor Statistics. “Injuries, illnesses, and fatalities 2019.” November 4, 2020. U.S. Department of Labor. https://www.bls.gov/iif/oshwc/osh/case/cd_r71_2019.htm
  14. U.S. Bureau of Labor Statistics. Occupational Injuries and Illnesses and Fatal Injuries Profiles: Gender: Female; Gender: Mail.” 2019. https://data.bls.gov/cgi-bin/dbdown/ch
  15. Villarroel, M. and Terlizzi, P. “Symptoms of depression among adults: United States, 2019.” September 2020. NCHS Data Brief #379. U.S. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db379.htm
  16. Terlizzi, P. and Villarroel, M. “Symptoms of generalized anxiety disorder among adults: United States, 2019.” September 2020. NCHS Data Brief #378. U.S. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db378.htm
  17. Panchal, N., et. al. “The Implications of COVID-19 for Mental Health and Substance Use.” February 10. 2021. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
  18. Schwatka, N. et al. Reoccurring injury, chronic health conditions, and behavior health: Gender differences in the causes of workers’ compensation claims. Journal of Occupational and Environmental Medicine, December 8, 2017. https://journals.lww.com/joem/Citation/2018/08000/Reoccurring_Injury,_Chronic_Health_Conditions,_and.6.aspx
  19. Bwire,G. “Coronavirus: Why men are more vulnerable to Covid-19 than omen?” June 4, 2020. Nature: Public Health Emergency Collection. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271824/#:~:text=Generally%2C%20females%20are%20more,as%20compared%20to%20women.
  20. Colón, D. and Chadarevian, R. COVID-19’s impact on medical treatment in workers compensation—a third quarter 2020 perspective. March 2021. National Council on Compensation Insurance. https://www.ncci.com/Articles/Documents/Insights-COVID-19-Impact-Medical-Treatment-Workers-Comp-3QTR-2020-Perspective.pdf
  21. Sudre, C. and Murray, B. Attributes and predictors of long COVID. March 10, 2021. Nature: Medicine. https://www.nature.com/articles/s41591-021-01292-y
  22. Zhang, L., et.al. Gender biases in estimation of others’ pain.” March 5, 2021. Journal of Pain. https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext


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.