ADDING INEQUALITY TO INJURY: 

THE COSTS OF FAILING TO 

PROTECT WORKERS ON THE JOB

OCCUPATIONAL SAFETY & HEALTH ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR

Photo credit: Aaron Sussell.
The failure of many 

employers to prevent 

millions of work 

injuries and illnesses 

each year, and the 

failure of the broken 

workers’ compensation 

system to ensure 

that workers do not 

bear the costs of their 

injuries and illnesses, 

are truly adding 

inequality to injury.

“

”
1

Table of Contents

2 Executive Summary

3 Work injuries and illnesses impose heavy costs on workers, families and the economy

6 Injured workers and taxpayers subsidize high hazard employers

8 The changing structure of work in the U.S. increases risk of injury and contributes to 

income inequality

10 Occupational injuries and illnesses strain social insurance programs and result in 

taxpayer subsidies of unsafe employers

11 The most effective solution: greater efforts to prevent work injuries and illnesses

13 Endnotes 
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

Executive Summary

Work injuries and illnesses exact a tremendous toll on 

society. Despite the decades-old legal requirement that 

employers provide workplaces free of serious hazards, 

every year, more than three million workers are 

seriously injured, and thousands more are killed on the 

job. The financial and social impacts of these injuries 

and illnesses are huge, with workers and their families 

and taxpayer-supported programs paying most of the 

costs. 

For many injured workers and their families, a 

workplace injury creates a trap which leaves them less 

able to save for the future or to make the investments 

in skills and education that provide the opportunity for 

advancement. These injuries and illnesses contribute 

to the pressing issue of income inequality: they force 

working families out of the middle class and into 

poverty, and keep the families of lower-wage workers 

from entering the middle class. Work injuries hamper 

the ability of many working families to realize the 

American Dream. 

The costs of workplace injuries are borne primarily by 

injured workers, their families, and taxpayer-supported 

components of the social safety net. Changes in statebased workers’ compensation insurance programs 

have made it increasingly difficult for injured workers 

to receive the full benefits (including adequate wagereplacement payments and coverage for medical 

expenses) to which they are entitled. Employers now 

provide only a small percentage (about 20%) of the 

overall financial cost of workplace injuries and illnesses 

through workers’ compensation. This cost-shift has 

forced injured workers, their families and taxpayers 

to subsidize the vast majority of the lost income and 

medical care costs generated by these conditions.

Important changes in the structure of the employment 

relationships in U.S. workplaces are also exacerbating 

the incidence and consequences of work injuries. 

The pervasive misclassification of wage employees as 

independent contractors and the widespread use of 

temporary workers have increased the risk of injury 

and the number of workers facing financial hardships 

imposed by workplace injuries. The change in 

employment relationships also reduces the incentives 

for companies to assume responsibility for providing 

safe working conditions, which may result in increased 

overall risk of workplace injury. 

The most effective solution to the problem posed by 

this paper is to prevent workplace injuries and illnesses 

from occurring. This would spare workers and their 

families from needless hardship and suffering, as well 

as the loss of income and benefits associated with these 

conditions. At the same time, it is vitally important 

that state-based workers’ compensation programs take 

steps to eliminate roadblocks that prevent workers with 

compensable injuries or illnesses from receiving the full 

compensation to which they are entitled. 

The failure of many employers to prevent millions of 

work injuries and illnesses each year, and the failure 

of the broken workers’ compensation system to ensure 

that workers do not bear the costs of their injuries and 

illnesses, are truly adding inequality to injury. 
3

and benzene.5 In comparison, about 33,000 people died 

in traffic crashes in the United States in 2013.6

The economic costs of these occupational injuries and 

illnesses are enormous. The National Safety Council, for 

example, estimates the cost of fatal and non-fatal work 

injuries at $198 billion in 2012.7 Compare this cost to 

the estimated costs of dementia (Rand Corporation 

estimates the annual costs of dementia, including 

Alzheimer’s, in 2010 was between $159 billion and $215 

billion) and of diabetes (2012 costs were estimated by 

the American Diabetes Association at $245 billion).8

In concept, employer-provided workers’ compensation 

insurance covers lost wages, first dollar (no co-pay) 

medical expenses, and rehabilitation costs associated 

Work injuries and 

illnesses impose 

heavy costs on 

workers, families 

and the economy

Forty-four years after Congress passed the 

Occupational Safety and Health Act of 1970, requiring 

employers to provide workplaces “free from recognized 

hazards that are causing or likely to cause death or 

serious physical harm” to their workers,1 the toll of 

workplace injuries, illnesses and fatalities in the United 

States remains unacceptably high. The Bureau of 

Labor Statistics (BLS) reports that approximately 4,500 

workers are killed on the job each year. BLS estimates 

that employers record nearly three million serious 

occupational injuries and illnesses annually on legally 

mandated logs.2 Recordable workplace injuries and 

illnesses range in severity from wounds, amputations, 

back injuries and other serious condition requiring care 

beyond first aid (injuries receiving only first aid are 

not recordable) to fatal injuries. About half of recorded 

injuries require at least a day away from work, a job 

transfer or a work restriction for recovery.3 

While the estimate of three million serious workrelated injuries each year may seem extremely high, 

it is undoubtedly only a fraction of the true number. 

Numerous studies provide documentation that many, 

and perhaps the majority, of work-related injuries are not 

recorded by employers, and that the actual number of 

workers injured each year is likely to be far higher than 

the BLS estimate.4 

Trying to estimate the burden of work-related illnesses 

is complicated further by the fact that many chronic 

illnesses occur long after exposure has ended and are 

generally not identified as work-related. However, 

studies have estimated that approximately 50,000 

annual U.S. deaths are attributable to past workplace 

exposure to hazardous agents, such as asbestos, silica 

10 Year Earnings 10 Year Earnings - 

After Injury

Workers earn $31,000 (15%) less 

over 10 years following an injury9

-15%
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

with work-related injuries. The coverage is actually 

quite limited, however. A recent study found that 

workers in New Mexico who receive workers’ 

compensation benefits for wage loss caused by 

workplace injuries lose an average of 15 percent of the 

earnings they would have been expected to earn over 

the 10 years following the injury. Even with workers’ 

compensation benefits, injured workers’ incomes are, 

on average, almost $31,000 lower over 10 years than 

if they had not been injured. This figure does not 

reflect the even more substantial losses suffered by the 

many injured workers who never enter the workers’ 

compensation system.9 

For workers and their families, economic and noneconomic losses because of work injuries are inevitable, 

and some are difficult to measure. These costs have 

greater impact on lower-wage workers. For example, 

following a worker injury, family caregivers must often 

reduce their own hours of work and wages to care for 

“Statistics are People with the Tears Washed Off” 

Reports and studies based primarily on statistical analyses mask the experiences 

of real people, aspects of whose complex lives are measured and then quantified 

in the statistics. This is certainly true of the workers and families coping with the 

consequences of work injuries and illnesses. Workers trying to support their families 

after suffering a disabling injury face daunting challenges, and statistics alone 

cannot convey their experiences and the difficulties they face. Here is one example:

Robert worked for a Virginia employer that manufactured foam insulation. He climbed on a foam 

grinder to clean out some material and the manager turned on the machine. His right foot was pulled 

and mangled by the machine. Robert has had multiple surgeries, and must wear a special boot to walk. 

After his injury, Robert and his wife Jessica could no longer save money toward a new home. The family 

lived in a shelter until they found a new apartment, mold-ridden and infested with fleas. Jessica wrote to 

President Obama:

“My husband lives with constant chronic pain every day of the week and he tosses and turns throughout 

the night. As soon as he wakes up in the morning he has to put on this ‘boot’ in order to do anything. 

This boot stays on his foot all day long because he is unable to walk without it on. Before being injured 

my husband played basketball or football every single day and he ran and played outside with our two 

toddler sons. He was a weight lifter and a fisherman and a hunter, these are all things he can no longer 

partake in due to his injuries from work. One of our sons took off towards the road, running full speed one 

day and I was seven months pregnant and all my husband could do was yell at me and watch from his 

wheelchair as I scurried as fast as possible to grab my son before he went into the road.

“His life the way he lived it was robbed from him and he will never be the same. We have three children, 

Evan who is three-and-a-half, Tristan who is two-and-a-half, and their new sister Halley who is three 

months old, my husband is unable to be the kind of father that so many people wish to be due to his 

injuries. He cannot be the ‘man’ that so many men are not, because of his limitations. We are struggling 

financially so badly because of this ‘accident’ and the negative effect it has had on his pay. 

“We wish to have answers to why there are so many laws in Virginia to protect the employers, when in 

cases like this, if the employer had done THEIR job enforcing OSHA regulations, accidents like the one my 

husband was involved in would never happen.” 
5

a disabled partner or family member. For working 

families already struggling to meet basic necessities and 

set aside some savings, a work injury to a primary wage 

earner can be especially devastating. There are also less 

tangible effects that are important but impossible to 

monetize. Workplace injuries can diminish self-esteem 

and self-confidence, increase stress between spouses, 

children and other family members, and strain relations 

with friends, colleagues and supervisors. These indirect 

costs can translate into tangible economic costs, 

including lower wages.10 

Lower wage workers like Robert also disproportionately 

bear the burden of occupational injuries and illnesses. 

Many lower-wage jobs (defined as jobs whose median 

wages do not raise a family of four above the poverty 

line) are also high-hazard jobs, and low-wage workers 

are injured on the job at a disproportionate rate.11 

Stagnant wages have forced some wage earners, 

especially those supporting a family, into holding two 

or more jobs. Beyond its detrimental impact on family 

life, long work days lead to worker fatigue and increase 

the risk of both work-related and non-work-related 

injuries, as well as of motor vehicle crashes.12

Photo credit: Keith Tsubata.
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

Injured workers and 

taxpayers subsidize 

high hazard employers

The workers’ compensation systems created in each 

state were originally intended to have employerprovided insurance reimburse workers for lost wages 

while providing first-dollar medical coverage and 

rehabilitation for work-related injuries. Under this 

“no-fault” system, workers have lost the right to sue 

their employer, but, in theory, have gained relatively 

certain access to benefits following their injury. 

In reality, the costs of workplace injury and illness are 

borne primarily by injured workers, their families, 

and taxpayer-supported safety-net programs. State 

legislatures and courts have made it increasingly 

difficult for injured workers to receive the payments for 

lost wages and medical expenses that they deserve.13

As a result of this cost-shifting, workers’ compensation 

payments cover only a small fraction (about 21 percent) 

of lost wages and medical costs of work injuries and 

illnesses; workers, their families and their private health 

insurance pay for nearly 63 percent of these costs, with 

taxpayers shouldering the remaining 16 percent.

Moreover, only a fraction of injured workers receive 

any workers’ compensation benefits through state 

workers’ compensation programs. Several studies have 

found that fewer than 40 percent of eligible workers 

21%

13%

11% 50%

5%

Who bears the cost of worker injuries?14

Workers’ 

Compensation

Private Health 

Insurance

Federal 

Government

State and Local

Government

Out of Pocket
7

apply for any workers’ compensation benefits at all.15 

Indeed, recent BLS-supported analyses that match 

cases reported to workers’ compensation carriers with 

those cases recorded by their employer on OSHA logs, 

treated in emergency rooms or admitted to hospitals, 

found a sizable proportion of injured workers receive 

no benefits through the workers’ compensation system. 

For example, a review of all recordable work-related 

amputations in Massachusetts found that a sizable 

proportion (around 20%) of the cases did not receive 

any workers’ compensation benefits.16 A similar 

California study found that one-third of workers who 

had amputations that were recorded by their employers 

had not received workers’ compensation benefits. That 

same study also found that one-third of workers with 

employer recorded carpal-tunnel syndrome had not 

received workers’ compensation.17 

 

While this system proves inadequate for the average 

worker, the workers’ compensation system performs 

even more poorly for low-wage workers. Many face 

additional barriers to filing, including even greater job 

insecurity, lack of knowledge about their rights, or a 

limited command of English. OSHA staff members have 

encountered many injured immigrant workers who 

have not filed for workers’ compensation out of fear 

of losing their jobs. These barriers are documented in 

numerous surveys of low-wage and immigrant workers 

who report being injured on the job and not filing 

workers’ compensation claims.18 

The challenges facing individuals with work illnesses 

are even greater than for those with injuries. Few 

workers with occupational illnesses receive any benefits 

from the workers’ compensation system; one study 

estimates that as many as 97 percent of workers with 

occupational illness are uncompensated.19 Most cases 

of work-related chronic disease are never diagnosed as 

work-related. When a linkage is made, the diagnosis 

generally comes long after employment ends. Even 

when a proper diagnosis is made, a worker who 

is eligible for benefits under Medicare, Medicaid, 

Veterans’ Benefits or private insurers is more likely 

to take that route, and avoid the barriers to obtaining 

benefits through the workers’ compensation system.20 

Fewer than 40% of eligible 

workers apply for workers 

compensation benets15
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

The changing structure 

of work in the U.S. 

increases risk of injury 

and contributes to 

income inequality

Several trends in the labor market today create even 

greater challenges to worker safety and health. These 

trends include the increased presence of employees of 

multiple employers at the same worksite, the pervasive 

misclassification of wage employees as independent 

contractors and the widespread use of temporary 

employees provided by labor staffing agencies. 

If several firms employ workers at the same site, and 

employers do not actively collaborate to ensure safe 

workplaces, all workers at the site may be a higher 

risk of injury. Although this pattern of employment 

has been true in the construction industry for many 

years, it has now become more common in other 

sectors of the economy. More and more, workers are 

not actual employees of the employer who owns or 

controls the workplace where they work. Instead, they 

may be employed by a contractor or subcontractor, 

or by a staffing agency.21 This trend has a significant, 

negative impact on the safety and health of U.S. workers 

To address this, OSHA often cites employers for 

endangering the employees of other employers working 

at the same jobsite. 

Misclassification of employees as independent 

contractors also increases the risks for these individuals. 

In the construction industry, the proportion of the 

workforce misclassified as independent contractors is 

substantial, although the illegality of misclassification 

makes researching this topic challenging. Researchers 

associated with the McClatchy newspaper chain 

recently studied this topic and estimated that in 

Texas, 37.7 percent of all construction workers were 

misclassified as independent contractors. They reported 

smaller but still substantial proportions of misclassified 

of construction workers in North Carolina (35.2 

percent) and Florida (15.5 percent). The researchers 

estimated that in these three states alone, more than 

500,000 construction workers were misclassified as 

independent contractors.22 

Misclassifying workers increases the likelihood 

of work injuries through two mechanisms. First, 

by misclassifying wage employees as independent 

contractors, employers do not have to worry about 

the OSHA requirement to provide a safe workplace, 

since the OSHA law does not cover the self-employed. 

Second, these employers avoid paying workers’ 

compensation insurance premiums (as well as 

unemployment insurance and other benefits and 

taxes). The misclassifying employer is no longer 

concerned about workers’ compensation premiums 

rising following a work injury, so is less likely to invest 

in safety. The result is increased risk of work injuries at 

workplaces where employees have been misclassified, 

and, when those injuries do occur, the injured 

workers, their families and the taxpayer bear the costs, 

subsidizing the employer’s hazardous operations.

This misclassification hurts not only workers, but also 

employers who follow the law. These honest employers 

are put at a disadvantage, having to compete with 

scofflaws who ignore safety and health requirements, 

and shirk paying taxes, benefits and insurance 

premiums.23 

The increased employment of temporary workers also 

increases the risk of work injuries. Temporary workers, 

often employed through staffing agencies, are generally 

at the worksite for shorter time periods. Researchers in 

the state of Washington found temporary workers in 

the construction and manufacturing sectors had twice 
9

the rate of injuries of workers in standard employment 

relationships. For each injury, they lost more days 

from work than the other workers. At the same time, 

temporary workers received less medical and time loss 

reimbursement payments for their injuries.24 

Why are temporary workers likely at greater risk 

of injury? There are several factors. New workers 

often lack adequate safety training and are likely to 

be unfamiliar with the specific hazards at their new 

workplace. As a result, new workers are several times 

more likely to be injured in the first months on the job 

than workers employed for longer periods.25 Consistent 

with these findings, OSHA has investigated numerous 

incidents in recent months in which temporary workers 

were killed on their first days on a job.26

Temporary workers are also likely to be newly assigned 

to unfamiliar workplaces multiple times in any given 

year and may carry this increased risk as long as they 

are in the temporary workforce. For employers, there is 

less financial incentive to invest training resources on 

temporary employees because shorter tenure will yield a 

lower return on investment than similar investments for 

permanent employees. OSHA has encountered many 

situations, including some in which temporary workers 

have been killed, in which employers have chosen to not 

provide required safety training to temporary workers. 

And the temporary workers themselves, recognizing the 

precarious nature of their employment, are less likely 

to complain to their employers, or to OSHA, about the 

existence of even serious hazards.27

While lacking a financial incentive to train temporary 

employees, employers do have a financial incentive 

to contract out their most dangerous jobs. For many 

employers, the state’s workers’ compensation premiums 

are experience-rated, meaning that, in general, 

employers with fewer claims pay lower premiums. In 

theory, this experience rating provides some financial 

incentive for employers to invest in safety to prevent 

injuries and lower insurance premiums. By assigning 

workers employed by a staffing agency to the most 

dangerous tasks, host employers may hope to avoid 

higher premiums.28 

These trends in the labor market also minimize the 

incentive to provide a safe workplace that exists when 

an employer who controls the workplace also bears 

financial responsibility for worker injuries. This is 

particularly true with temporary workers employed 

through staffing agencies. Host employers have 

primary control of the temporary employees’ work 

environments, but the host employers generally have 

no financial responsibility when temporary workers 

are injured, since those workers are covered by staffing 

agencies’ insurance policy. This shift in risk is likely 

to reduce investments in safety and health and create 

more hazardous workplaces, increasing the number 

of injuries among both temporary workers and any 

permanent workers whom they work alongside. Given 

the practice of outsourcing the more hazardous jobs, 

and the lower wages of temporary workers, lower-wage 

workers have the most to lose in this new reality.

As noted earlier, temporary workers are less likely to 

be compensated for their injuries, making matters 

worse. Temporary workers say they are more hesitant 

to report their injuries and claim compensation, out of 

concern their employer (the staffing agency) will not 

assign them additional work, or out of confusion as to 

which employer is responsible. The result is that injured 

temporary workers are less likely to receive workers’ 

compensation benefits than permanent workers. As a 

result, neither the temporary staffing agency nor the 

employer whose work is being performed by temporary 

workers bears the cost of workplace injuries. Instead, 

the cost of the injury is shifted completely to the 

workers, their families and the taxpayers.
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

Occupational injuries 

and illnesses strain 

social insurance 

programs and result in 

taxpayer subsidies of 

unsafe employers

The costs of workplace injuries are massively subsidized 

by injured workers, their families and the taxpayersupported components of the social safety net. As 

discussed above (and presented in Figure One), 

employers cover only a small percentage of the overall 

cost of workplace injuries and illnesses through the 

workers’ compensation system; injured workers, their 

families and taxpayers bear the vast majority of the 

lost income and medical care costs generated by these 

conditions. Federal and state programs pick up 16 

percent of the overall costs of occupational injuries 

and illnesses; through Medicare and Medicaid alone, 

taxpayers pay almost 19 percent of the medical costs of 

these conditions.29 

This proportion of the costs of work injuries and 

illnesses covered by working families and taxpayers has 

likely risen in recent years, as many state legislatures 

and courts have implemented changes in their workers’ 

compensation systems that make it more difficult for 

injured workers to obtain benefits.30 The number of 

Social Security Disability Insurance (SSDI) beneficiaries 

and the amount of benefits paid by that program 

has also grown dramatically in recent years. An 

accumulating body of evidence shows that at least part 

of the growth in SSDI benefit payments is attributable 

to the program’s subsidy for work injuries and 

illnesses. In one study, for example, 20.5 percent of the 

participants in the 1992 Health and Retirement Study, a 

nationally representative sample of the U.S. population 

aged 51 to 61, reported having a health problem that 

limits the kind or amount of work they can do. Among 

those who reported some disability, 36 percent report 

having become disabled because of an accident, injury, 

or illness at work. Among the entire population sample, 

6 percent were enrolled in SSDI, and 37 percent of this 

group of recipients reported they were disabled as a 

result of a work-related condition. Extrapolating these 

findings to overall SSDI and Medicare expenditures, 

the study’s authors estimated that these two tax-payer 

supported safety net programs subsidized workplace 

injuries with $33 billion in benefits in 2001 alone.31

For more evidence of SSDI subsidizing work injury 

costs, consider a recent study which found that New 

Mexico workers experiencing lost-time work injuries 

(for which they received some workers’ compensation 

benefits) have a substantially increased likelihood of 

becoming SSDI recipients, even after controlling for 

personal and work characteristics. This is particularly 

true among the lower-wage workers in the study, who 

were more likely to have experienced a lost-time work 

injury, and more likely to become an SSDI recipient, 

than were the higher-wage workers. The researchers 

calculated that experiencing a lost-time work injury 

has the same impact on the risk of becoming a SSDI 

recipient as aging 10 years. As a consequence, those 

SSDI recipients who experienced lost-time injuries 

are likely to receive SSDI benefits at younger ages, 

Photo credit: Marsha Mitchell.
11

increasing the costs and the length of time for which 

they receive SSDI. Extrapolating the New Mexico 

experience to the country as a whole, 7 percent of the 

roughly one million people who became new SSDI 

beneficiaries in 2010 became disabled as a result 

of a work injury. The cost to the SSDI program is 

substantial: each annual cohort of workers with these 

lost-time work injuries who become SSDI recipients 

increases SSDI expenditures by roughly $12 billion, and 

adding Medicare costs nearly doubles this amount.32 

The magnitude of this subsidy strains the ability of 

social insurance programs to provide adequate benefits 

to claimants. 

The shifting of cases and costs from workers’ 

compensation to SSDI and Medicare also creates 

subsidies that may reduce employer financial incentives 

to prevent work-related injury and illness. As with the 

shift of workers’ compensation coverage from host 

employer to staffing agency, the overall failure of the 

workers’ compensation system to provide benefits to 

injured workers, as well as the shifting of the costs from 

the employer responsible for the injury to the taxpayer, 

means that any financial incentive from experience 

rating that encourages high-hazard employers to invest 

in injury prevention, is lessened or eliminated. 

The most effective 

solution: greater 

efforts to prevent work 

injuries and illnesses

The enormous number of workplace injuries and 

illnesses, the cost-shifting away from state workers’ 

compensation, and the fissuring of U.S. workplaces all 

increase the burdens on workers and their families, 

place significant stress on the social safety net, and 

contribute to income inequality. The costs of injuries 

not compensated through workers’ compensation 

or through the social safety net increase financial 

burden on injured low-wage earners and their families, 

tightening existing financial constraints and making 

it even more difficult for low-wage workers to support 

basic family needs, much less pursue education or other 

investments that increase future opportunities and 

earning potential. 

The most effective solution to the problem posed by this 

paper is, of course, to prevent workplace injuries and 

illnesses from occurring in the first place. This is what 

is required by the law, and it would spare workers and 

their families from needless hardship and suffering, as 

well as from the loss of income and benefits associated 

with these conditions. 

Reduction in the number of work injuries and illnesses 

would also have a significant impact on healthcare 

system costs, reducing expenditures for hospitalizations 

and other medical care. (The National Safety Council 

estimates the medical costs of work injuries alone were 

approximately $55 billion in 2012.33)
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

Over the past several decades, the U.S. has made great 

strides in reducing the incidence of workplace injuries, 

illnesses and fatalities. In 1970, an estimated 14,000 

workers were killed on the job, an annual rate of 18 per 

100,000 or about 38 workers killed on the job every 

day.34 Today, with a far larger workforce, that rate has 

fallen to 3.4 per 100,000, or about twelve every day.35 

While this represents great progress, twelve deaths a day 

is still twelve too many. 

More can, and must, be done. The acceptable number 

of work injuries, especially fatal work injuries, is zero. 

Many employers strive to prevent all injuries and 

illnesses while others do not. Within a given industry, 

there is often substantial variation in worksite-specific 

injury rates, evidence of the tremendous variation in 

the presence or effectiveness of an employer’s injury 

prevention program. For example, the average DART 

(more serious injuries or illnesses, the ones that result 

in Days Away, Restricted work activity or job Transfer) 

rate among nursing care facilities in 2012 was 5.2 per 

100 workers. One-quarter of the nation’s nursing care 

facilities had DART rates less than or equal to 0.8, while 

the rates of employers in the highest quartile were 

above seven per 100 workers, or more than eight times 

higher than the rates of the nursing care facilities in the 

lowest quartile.36 Similar disparities in injury risk can 

be seen in international comparisons. The work fatality 

rate in the United Kingdom is about one-third the 

rate of the United States and the rate in constructio¬n 

is about one-quarter the U.S. rate. While the rates in 

both countries are decreasing, the difference between 

the rates has grown substantially since the 1990s as 

construction work has become far safer in the United 

Kingdom than in the United States.37 

At the same time, it is vitally important that the statebased workers’ compensation systems take steps 

to eliminate roadblocks that prevent workers with 

compensable injuries or illnesses from receiving the 

full benefits (including adequate wage-replacement 

payments and full coverage for medical expenses) 

to which they are entitled. Currently, workers with 

work-related injuries or illnesses who are successful in 

claiming workers’ compensation receive only a small 

portion of the true costs of their injury or illness, and 

many others who are entitled to benefits receive no 

workers’ compensation benefits at all. Without ending 

this unfair and unwarranted income loss, these workers 

will never be able to catch up to the income level they 

maintained before their injury or illness.38

Further, by forcing the costs of injury and illness 

onto workers, their families and the taxpayer, unsafe 

employers have fewer incentives to eliminate workplace 

hazards and actually prevent injuries and illnesses from 

occurring. Under this broken system, these workers, 

their families and the tax-payer subsidize unsafe 

employers, increasing the likelihood that even more 

workers will be injured or made sick. 

Serious workplace injuries are devastating to the injured 

workers, their families and communities. Low-wage 

workers and their families are particularly impacted 

by injuries: unless we as a society take steps to address 

these issues, many of these people will continue to find 

it difficult to enter or remain in the middle class, and 

safety net programs like SSDI will be strained providing 

benefits to all the beneficiaries entitled to receive them.

In summary, despite a more-than-40-year-old legal 

obligation to provide safe workplaces, the unwillingness 

of many employers to prevent millions of work injuries 

and illnesses each year, and the failure of the broken 

workers’ compensation system to ensure that workers 

do not bear the costs of their injuries and illnesses, are 

truly adding inequality to injury. 

Photo credit: Hsiang-Jen Yen.
13

Endnotes 

1

 Occupational Safety and Health Act of 1970, 29 U.S.C. 651-678. 

The specific requirement of employers to provide workplaces 

“free from recognized hazards that are causing or likely to cause 

death or serious physical harm” (OSHA’s General Duty Clause) is 

29 U.S.C. 654(a)(1). 

2

 Census of Fatal Occupational Injuries Summary, 2013 (2014, 

September 11). U.S. Bureau of Labor Statistics. Retrieved February 

11, 2015 from http://www.bls.gov/news.release/cfoi.nr0.htm.

3

 Employer-Reported Workplace Injury and Illness Summary. 

(2013, November 7). U.S. Bureau of Labor Statistics. Retrieved 

February 8, 2015 from http://www.bls.gov/news.release/osh.nr0.

htm; Nonfatal Occupational Injuries and Illnesses Requiring Days 

Away From Work, 2013 (2013, November 26). U.S. Bureau of Labor 

Statistics. Retrieved February 8, 2015, from http://www.bls.gov/

news.release/osh2.nr0.htm.

4

 Rosenman KD, Kalush A, Reilly MJ, et al. How much work-related 

injury and illness is missed by the current national surveillance 

system? Journal of Occupational and Environmental Medicine

2006; 48:357-365; Boden LI, Ozonoff A. Capture–recapture 

estimates of nonfatal workplace injuries and illnesses. Annals 

of Epidemiology 2008; 18:500-506. To begin to understand the 

workplace injury undercount, BLS has commissioned a series 

of studies that match the work injuries recorded by employers 

with those that have led to a workers’ compensation award 

or that can be identified through hospital or clinic records. 

These studies suggest that the BLS estimates do not include a 

substantial proportion of workplace injuries identified in other 

data sets, with a capture rate ranging between 40 and 70%, 

depending on the type of establishment and nature of the injury. 

For the mechanisms through which injuries and illness fail to be 

recorded by employers, see Azaroff LS, Levenstein C, Wegman 

DH. Occupational injury and illness surveillance: Conceptual 

filters explain underreporting. American Journal of Public Health

2002; 92:1421-1429. For more on the efforts of BLS to examine 

the undercount, see Ruser JW. Examining evidence on whether 

BLS undercounts workplace injuries and illnesses. Monthly Labor 

Review 2008:20-33; Wiatrowski WJ. Examining the completeness 

of occupational injuries and illnesses: an update on current 

research. Monthly Labor Review June 2014 Retrieved February 8, 

2015 from http://www.bls.gov/opub/mlr/2014/article/examiningthe-completeness-of-occupational-injury-and-illness-data-anupdate-on-current-research.htm; and Spieler EA, Wagner GR. 

Counting matters: implications of undercounting in the BLS 

survey of occupational injuries and illnesses. American Journal 

of Industrial Medicine 2014; 57:1077-1084. For estimates of the 

total number of work injuries occurring annually, see Leigh JP. 

Economic burden of occupational injury and illness in the United 

States. Milbank Quarterly 2011; 89:728-772, who estimates more 

than 8.5 million non-fatal work injuries occurred in 2007. See also 

Smith GS, Wellman HM, Sorock GS, et al. Injuries at work in the 

US adult population: Contributions to the total injury burden. 

American Journal of Public Health 2005; 95:1213–1219. 

5

 Many illnesses that are caused by workplace exposure to 

toxic agents appear years after first exposure, and, since the 

treatment is unconnected to identifying the work-relatedness 

of the case, are never identified as occupational. The estimate of 

approximately 50,000 deaths annually was reached by scientists 

associated with the National Institute for Occupational Safety 

and Health and the American Cancer Society: Schulte PA. 

Characterizing the burden of occupational injury and disease. 

Journal of Occupational and Environmental Medicine 2005; 

47:607-622 and Steenland K, Burnett C, Lalich N, Ward E, Hurrell 

J. Dying for work: The magnitude of U.S. mortality from selected 

causes of death associated with occupation. American Journal 

of Industrial Medicine 2003; 43:461-82. Further, only a very small 

proportion of these cases ever enter the workers’ compensation 

system. See: Biddle J, Roberts K, Rosenman KD, Welch EM. 

What percentage of workers with work-related illnesses receive 

workers’ compensation benefits? Journal of Occupational and 

Environmental Medicine 1998; 40:325-331.

6

 National Highway Traffic Safety Administration. 2013 Motor 

Vehicle Crashes: Overview. 2013 Motor Vehicle Crashes: Overview. 

Retrieved February 11, 2015 from http://www-nrd.nhtsa.dot.gov/

Pubs/812101.pdf.

7

 National Safety Council. Injury Facts. 2014 edition. Itasca, IL. 

The Council’s estimate is similar to that of Prof. Paul Leigh of 

the University of California Davis, who calculated the direct and 

indirect cost of work injuries in 2007 to be $192 billion. Leigh also 

estimated the cost of workplace illnesses in 2007 at $58 billion, 

resulting in a total cost for workplace injuries and illnesses of 

$250 billion (in 2007 dollars). See: Leigh JP. Economic burden 

of occupational injury and illness in the United States. Milbank 

Quarterly 2011; 89:728-772.

8

 For the costs of dementia, see Hurd MD, Martorell P, Delavande 

A, Mullen KJ, Langa KM. Monetary costs of dementia in the United 

States. New England Journal of Medicine 2013; 368:1326-1334. 

Diabetes costs are from Economic costs of diabetes in the U.S. in 

2012. Diabetes Care 2013; 36:1033-1046.

9

 Seabury SA, Scherer E, O’Leary P, Ozonoff A, Boden L. Using 

linked federal and state data to study the adequacy of workers’ 

compensation benefits. American Journal of Industrial Medicine.

2014; 57:1165-1173. See also Boden LI, Reville RT, Biddle J. “The 

adequacy of workers’ compensation cash benefits.” In Workplace 

Injuries and Diseases: Prevention and Compensation: Essays in 

Honor of Terry Thomason. Burton J, Roberts K, Bodah M. eds. 

Kalamazoo: W.E. Upjohn. 37-68, 2005.

10 See Keogh JP, Nuwayhid I, Gordon JL, Gucer PW. The impact 

of occupational injury on injured worker and family: Outcomes 

of upper extremity cumulative trauma disorders in Maryland 
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

workers. American Journal of Industrial Medicine 2000; 38:498–506; 

Pransky G, Benjamin K, Hill-Fotouhi C, et al. Outcomes in workrelated upper extremity and low back injuries: Results of a 

retrospective study. American Journal of Industrial Medicine 2000; 

37: 400–409; Strunin L, Boden LI. Family consequences of chronic 

back pain. Social Science and Medicine 2004; 58:1385-1393; 

Mocan N, Tekin E. Obesity, self-esteem and wages. 2009 National 

Bureau of Economic Research NBER Working Paper No. 15101. 

Benabou, R, Tirole J. Self-confidence and personal motivation. The 

Quarterly Journal of Economics 2002; 117:871-915; and Bowles S, 

Gintis, H, Osborne M. The determinants of earnings: A behavioral 

approach. Journal of Economic Literature 2001; 1137-1176.

11 Baron SL, Steege AL, Marsh SM, Menendez CC, Myers JR. 

Nonfatal work-related injuries and illnesses - United States, 

2010. Morbidity and Mortality Weekly Report 2013;62(03):35-40; 

and Marsh SM, Menendez CC, Baron SL, Steege AL, Myers JR. 

Fatal work-related injuries - United States, 2005-2010. Morbidity 

and Mortality Weekly Report 2013;62(03):40-45; and Stanbury M, 

Rosenman KD. Occupational health disparities: A state public 

health-based approach. American Journal of Industrial Medicine 

2014; 57:586-604. Estimates of the medical and productivity 

costs of work injuries and illnesses to low-wage workers are at 

Leigh JP. Numbers and costs of occupational injury and illness in 

low-wage occupations, Center for Poverty Research, and Center 

for Health Care Policy and Research, University of California Davis 

(December 2012), Retrieved February 11, 2015 from http://

defendingscience.org/sites/default/files/Leigh_Low-wage_

Workforce.pdf. 

12 “Working in jobs with overtime schedules was associated 

with a 61% higher injury hazard rate compared to jobs without 

overtime. Working at least 12 hours per day was associated with 

a 37% increased hazard rate and working at least 60 hours per 

week was associated with a 23% increased hazard rate.” Dembe 

AE, Erickson JB, Delbos RG, Banks SM. The impact of overtime 

and long work hours on occupational injuries and illnesses: New 

evidence from the United States. Journal of Occupational and 

Environmental Medicine 2005; 62:588-97. See also Dembe AE, 

Delbos RG, Erickson JB. The effect of occupation and industry 

on the injury risks from demanding work schedules. Journal of 

Occupational and Environmental Medicine 2008;50:1185-94; Olds 

DM, Clarke SP. The effect of work hours on adverse events and 

errors in health care. Journal of Safety Research 2010; 41:153-162. 

Marucci-Wellman HR, Willetts JL, Lin T-C, Brennan MJ, Verma SK. 

Work in multiple jobs and the risk of injury in the US population. 

American Journal of Public Health 2014; 104:134-142. For increased 

risk of motor vehicle crashes, see Barger LK, Cade BE, Ayas NT, 

et al. Extended work shifts and the risk of motor vehicle crashes 

among interns. New England Journal of Medicine 2005; 352:125-

134.

13 Spieler, EA, Burton JF. The lack of correspondence between 

work-related disability and receipt of workers’ compensation 

benefits. American Journal of Industrial Medicine 2012; 55:487-505; 

Boden LI, Spieler EA. Compensation for work injury and illness. In 

D. Béland, C. Howard, and K. J. Morgan, eds. Oxford Handbook of 

U.S. Social Policy. Chapter 25, 451-468. Oxford University Press. 

2015. DOI:10.1093/oxfordhb/9780199838509.013.027. For an 

example, according to the Southern Poverty Law Center, the 

Alabama Legislature amended that state’s Worker Compensation 

Act in 1992 to enact a more difficult standard for workers 

reporting “injuries which have resulted from gradual deterioration 

or cumulative physical stress disorders” because such claims 

were “one of the contributing causes of the current workers’ 

compensation crisis facing [the] state.” This definition includes 

the musculoskeletal disorders associated with repetitive work 

prevalent in the poultry industry. Source: The Southern Poverty 

Law Center and Alabama Appleseed, “Unsafe at These Speeds: 

Alabama’s Poultry Industry and its Disposable Workers”, 2013. 

Retrieved February 8, 2015 from http://www.splcenter.org/sites/

default/files/Ala-poultry-report.pdf.

14 Leigh JP, Marcin JP. Workers’ compensation benefits and 

shifting costs for occupational injury and illness. Journal of 

Occupational and Environmental Medicine 2012;54:445-450.

15 Shannon HS, Lowe GS. How many injured workers do not file 

claims for workers’ compensation benefits? American Journal of 

Industrial Medicine 2002; 42:467-473; See also Biddle J, Roberts K, 

Rosenman KD, Welch EM. What percentage of workers with workrelated illnesses receive workers’ compensation benefits? Journal 

of Occupational and Environmental Medicine 1998; 40:325-331; 

and Azaroff LS, Levenstein C, Wegman DH. Occupational injury 

and illness surveillance: Conceptual filters explain underreporting. 

American Journal of Public Health 2002; 92:1421-1429. An excellent 

summary of the barriers to collecting the workers’ compensation 

benefits to which they are entitled facing workers with workplace 

injuries and illnesses is provided by Spieler EA, Wagner GR. 

Counting matters: implications of undercounting in the BLS 

survey of occupational injuries and illnesses. American Journal 

of Industrial Medicine 2014; 57:1077-1084: “Underreporting in 

workers’ compensation has been well-documented. The same 

forces that result in underreporting on OSHA 300 logs and in 

the SOII survey apply to workers’ compensation: workers fear 

retaliation; health care providers fail to certify work-relatedness; 

employers discourage filing for benefits both directly and 

indirectly. Workers may also fail to file for benefits because they 

are unfamiliar with the system or, alternatively, believe that the 

system cannot be navigated easily; because they fear stigma and 

prejudice; or because they simply do not know that a condition is 

work-related or qualifies for benefits. In addition, many workers 

believe that the experience of filing a claim can be frustrating 

and demeaning, potentially involving insurance personnel and 

doctors who impugn their character and even investigators who 

spy on them and question their neighbors and friends. While 

workers’ compensation also provides some incentives to workers 

to report injuries, by providing partial replacement of lost wages 

and first-dollar-coverage for medical care associated with a 

compensable injury, these incentives are often counterbalanced 

by these other factors.” 
15

16 Davis LK, Grattan KM, Tak S, et al. Use of multiple data sources 

for surveillance of work-related amputations in Massachusetts, 

comparison with official estimates and implications for national 

surveillance. American Journal of Industrial Medicine 2014; 

57:1120-32. 

17 Joe L, Roisman R, Beckman S, et al. Using multiple data sets 

for public health tracking of work-related injuries and illnesses 

in California. American Journal of Industrial Medicine 2014; 

57:1110-19. 

18 Smith, R. Immigrant workers and workers’ compensation: The 

need for reform. American Journal of Industrial Medicine 2012; 

55:537-544; Culp K, Brooks M, Rupe K, Zwerling C. Traumatic injury 

rates in meatpacking plant workers. Journal of Agromedicine 

2008; 13:7-16. Scherzer T, Rugulies R, Krause N. Work-related pain 

and injury and barriers to worker’s compensation among Las 

Vegas hotel room cleaners. American Journal of Public Health 2005; 

95:483–488; Premji S, Krause M. Disparities by ethnicity, language, 

and immigrant status in occupational health experiences among 

Las Vegas hotel room cleaners. American Journal of Industrial 

Medicine 2010; 53:960–975; Herbert R, Janeway K, Schechter 

C. Carpal tunnel syndrome and workers’ compensation among 

an occupational clinic population in New York State. American 

Journal of Industrial Medicine 1999; 35: 335-342; Dong X, Ringen 

K, Men Y, Fujimoto A. Medical costs and sources of payment for 

work-related injuries among Hispanic construction workers. 

Journal of Occupational and Environmental Medicine 2007; 

49:1367-1375. This is also seen in the results of numerous studies 

and surveys, including: Lashuay N, Harrison R. 2006. Barriers to 

occupational health services for low-wage workers in California: 

A report to the Commission on Health and Safety and Workers’ 

Compensation, California, Department of Industrial Relations San 

Francisco. San Francisco, CA: University of California. Wilmsen C, 

et al. “Healthy Forests, Abused Workers”. The Alliance of Forest 

Workers and Harvesters and The Labor Occupational Health 

Program, UC Berkeley, 2012. Retrieved February 8, 2015 from 

http://www.nwforestworkers.org/publications/surveyreportcolor.

pdf; The Southern Poverty Law Center and Alabama Appleseed, 

“Unsafe at These Speeds: Alabama’s Poultry Industry and its 

Disposable Workers”, 2013. Retrieved February 8, 2015 from 

http://www.splcenter.org/sites/default/files/Ala-poultry-report.

pdf; Villarejo D, McCurdy S, Bade B, et al. The health of California’s 

immigrant hired workers. American Journal of Industrial Medicine 

2010; 53:387-397. Also, Brandworks and the Urban Justice 

Center, “Feeding New York: Challenges and Opportunities for 

Workers in New York City’s Food Manufacturing Industry”, 2014. 

Retrieved February 8, 2015 from http://www.brandworkers.org/

files/Feeding_New_York_0.pdf; Dietz M. Temporary Workers in 

California are twice as Likely as Non-Temps to Live in Poverty: 

Problems with Temporary and Subcontracted Work in California. 

UC Berkeley Labor Center, 2012. Retrieved February 8, 2015 

from http://laborcenter.berkeley.edu/jobquality/temp_workers.

pdf. And Workers Defense Project, “Construction Emergency: 

The Hidden Cost of Workplace Injuries”, 2011. Retrieved 

February 8, 2015 from http://www.workersdefense.org/wpcontent/uploads/2013/04/%E2%80%9CTexas_Construction_

EmergencyV2%E2%80%9D.pdf. 

19 Leigh, JP, Robbins JA. Occupational disease and workers’ 

compensation: coverage, costs, and consequences. Milbank 

Quarterly 2004; 2:689-721. See also Biddle J, Roberts K, Rosenman 

KD,Welch EM. What percentage of workers with work-related 

illnesses receive workers’ compensation benefits? Journal of 

Occupational and Environmental Medicine 1998; 40:325-331. 

20 Spieler, EA, Burton JF. The lack of correspondence between 

work-related disability and receipt of workers’ compensation 

benefits. American Journal of Industrial Medicine 2012; 55:487-505; 

Boden LI, Spieler EA. Compensation for work injury and illness. In 

D. Béland, C. Howard, and K. J. Morgan, eds. Oxford Handbook of 

U.S. Social Policy. Chapter 25, 451-468. Oxford University Press. 

2015. DOI:10.1093/oxfordhb/9780199838509.013.027.

21 Luo T, Mann A, Holden R. The expanding role of temporary help 

services from 1990 to 2008. Monthly Labor Review. August 2010:3-

16; Dey M, Houseman SN, Polivka AE. Manufacturers’ outsourcing 

to staffing services. Industrial & Labor Relations Review 2012; 

65:533-559. For a discussion of the changing structure of work in 

the U.S., see Weil D. The Fissured Workplace: Why Work Became 

So Bad for So Many and What Can Be Done to Improve It. Harvard 

University Press. 2014.

22 Locke M. Contract to cheat: How the reporting was done. 

Raleigh (NC) News and Observer. Retrieved February 8, 2015 from 

http://www.mcclatchydc.com/static/features/Contract-to-cheat/

Investigation-built-on-payroll-records.html?brand=mcd. 

23 Misclassification hurts honest employers in another way. Some 

state systems (like that of Massachusetts) pay compensation to 

injured workers who were misclassified by their actual employer. 

These payments come from the workers’ compensation system 

reserve funds collected from all employers who pay into the 

compensation system. This is yet another mechanism through 

which hazardous employers are subsidized, in this case by lawabiding ones. 

24 Smith CK, Silverstein BA, Bonauto DK, Adams D, Fan ZJ. 

Temporary workers in Washington State. American Journal of 

Industrial Medicine 2010;53:135-4. 

25 Recent studies on this topic include: Breslin FC, Smith P. Trial 

by fire: A multivariate examination of the relation between job 

tenure and work injuries. Journal of Occupational & Environmental 

Medicine 2006; 63:27-32; Morassaei S, Breslin FC, Shen M, Smith 

PM. Examining job tenure and lost-time claim rates in Ontario, 

Canada, over a 10-year period, 1999-2008. Journal of Occupational 

& Environmental Medicine 2013; 70:171-178; “Analysis of the 

Impact of Job Tenure on Workplace Injury Rates” (n.d.). Statistics -. 

Retrieved February 8, 2015 from http://www.hse.gov.uk/statistics/

adhoc-analysis/workplace-injury-rates.htm. The increased risk of 

injuries among new workers has been known for many decades. 

For example, see Causes and Prevention of Accidents in the Iron 
Adding Inequality to Injury: The Costs of Failing to Protect Workers on the Job

and Steel Industry, 1910-1919. U.S Bureau of Labor Statistics, 1922, 

Bulletin No. 298.

26 See reports of temporary worker fatalities at: https://www.

osha.gov/temp_workers/.

27 ProPublica. Temp Land: Working in the New Economy. 

Retrieved February 8, 2015 from http://www.propublica.org/

series/temp-land. See also Foley M, Ruser J, Shor G, Shuford H, 

Sygnatur E. Contingent workers: Workers’ compensation data 

analysis strategies and limitations. American Journal of Industrial 

Medicine. 2014; 57:764-75.

28 Shifting workers’ compensation coverage to staffing agencies 

is not a zero-sum transition, in which the staffing agency must 

recoup these costs through higher prices paid by the host 

employer. In actuality, for workers doing the same high risk 

jobs, the workers’ compensation insurance costs to the staffing 

agency are lower than those for the host employers. Staffing 

agencies, whose employees are often spread across many 

industries, generally pay lower premiums than the higher risk host 

employers. In addition, staffing agencies pay lower wages, and 

therefore the wage replacement costs for those injured temporary 

workers who do receive compensation payments are lower than 

payments for higher-paid host employer permanent employees. 

The workers’ compensation costs to staffing agencies are further 

lessened by the reduced likelihood of injured temporary workers 

applying for workers’ compensation: these workers are less likely 

to know their rights, and, even if they do, they may fear that they 

are less likely to get the next work assignment if they report any 

injury, particularly a compensable one.

29 For breakdown of payment sources for medical costs, see 

Leigh JP, Marcin J. Workers’ compensation benefits and shifting 

costs for occupational injury and illness. Journal of Occupational 

and Environmental Medicine 2012; 54:445-450. In addition, 

see Leigh, JP. Economic burden of occupational injury and 

illness in the United States. Milbank Quarterly 2011; 89:728-

772; Groenewold MR, Baron SL. The proportion of work-related 

emergency department visits not expected to be paid by workers’ 

compensation: Implications for occupational health surveillance, 

research, policy, and health equity. Health Services Research 2013; 

48:1939-1959.

30 Spieler, EA, Burton JF. The lack of correspondence between 

work-related disability and receipt of workers’ compensation 

benefits. American Journal of Industrial Medicine 2012; 55:487-505; 

Boden LI, Spieler EA. Compensation for work injury and illness. In 

D. Béland, C. Howard, and K. J. Morgan, eds. Oxford Handbook of 

U.S. Social Policy. Chapter 25, 451-468. Oxford University Press. 

2015. DOI:10.1093/oxfordhb/9780199838509.013.027; Boden 

LI, Ruser JW. Workers’ compensation ‘reforms,’ choice of medical 

care provider, and reported workplace injuries, The Review of 

Economics and Statistics 2003; 85:923-929. See also Guo XS, 

Burton JF. The growth in applications for Social Security Disability 

Insurance: A Spillover effect from workers’ compensation. Social 

Security Bulletin 2012; 72:69-88. This paper’s conclusions are 

not consistent with those of another (McInerney M, Simon K. 

The effect of state workers’ compensation program changes on 

the use of federal Social Security Disability Insurance. Industrial 

Relations 2012; 51:57-88) whose authors find no correlation 

between changes in state workers’ compensation benefits and 

the growth of SSDI programs. Since these papers are correlational, 

they carry far less weight in identifying causal relationships than 

the other papers cited here on the relationship of work injury, 

workers’ compensation benefits and SSDI. 

31 Reville RT, Schoeni, RF. The fraction of disability caused at 

work. Social Security Bulletin 2004; 65:31-37. Of those reporting 

disability, 17% report the impairment was caused by a work 

injury, 15% said their impairment was due to the nature of their 

work, and an additional 4% were impaired because of work 

hazards. Among all study participants who reported being 

disabled and that their health condition was caused by work, only 

12% had ever received workers’ compensation benefits, while 

29% were currently enrolled in SSDI. 

32 O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E. 

Workplace injuries and the take-up of Social Security Disability 

benefits. Social Security Bulletin 2012; 72:1-17.

33 National Safety Council. Injury Facts. 2014 edition. Itasca, IL.

34 National Safety Council. Accident Facts. 1994 edition. Chicago, IL.

35 Bureau of Labor Statistics. Revisions to the 2012 Census of 

Fatal Occupational Injuries (CFOI) counts April 2014. Retrieved 

February 8, 2015 from http://www.bls.gov/iif/oshwc/cfoi/cfoi_

revised12.pdf. 

36 Quartile Data: Table Q2. Survey of Occupational Injuries and 

Illnesses. Bureau of Labor Statistics, Department of Labor, 2012. 

Retrieved February 11, 2015 from http://www.bls.gov/iif/oshwc/

osh/os/ostb3586.pdf.

37 Mendeloff J, Staetsky L. Occupational fatality risks in the United 

States and the United Kingdom. American Journal of Industrial 

Medicine. 2014; 57:4-14.

37 Improvements in benefits provided by the workers’ 

compensation system to injured workers would also, to a limited 

degree, reduce the economic impact of workplace injuries 

and illnesses on working families and would decrease income 

inequality, particularly among low-wage workers. While the 

Department of Labor has had an interest in improving the 

state-based workers’ compensation programs for many decades 

(see, for example, 1972 Report of the National Commission 

on State Workmen’s Compensation Laws, available at: http://

workerscompresources.com/?page_id=28), there is little federal 

input in or oversight of those systems. Further, under the 

Occupational Safety and Health Act of 1970 (OSHA’s authorizing 

legislation) the agency has no role in state workers’ compensation 

programs. This paper focuses primarily on prevention injuries 

and illnesses (rather than improving the compensation of those 

already injured), clearly the better approach to eliminating the 

income disparities caused by work injuries. 
More can, and must, be done. The acceptable 

number of work injuries, especially fatal work 

injuries, is zero. Many employers strive to prevent 

all injuries and illnesses while others do not.

“

”

Photo credit: Roberto Carlos Vergara.
David Michaels, PhD, MPH 

Assistant Secretary of Labor for Occupational Safety and Health 

 JUNE 2015