Potential Implications for Workplace Violence and Workers’ Comp

Workplace violence spans a wide range of behaviors, from threats and verbal abuse to physical assault and homicide. But the two ends of that spectrum are moving in opposite directions: nonfatal assaults continue to climb steadily, while homicides have stayed essentially flat over the last two decades.

NCCI’s recent three-part Workplace Violence series examined trends in both fatal and nonfatal instances of workplace violence, as well as potential implications for the workers’ compensation system.

According to the most recent U.S. Bureau of Labor Statistics assault case data, workplace assaults have shown a clear upward trend: They increased at an annualized rate of 5.3% per year from 2011 through 2021-2022. In the same period, the rate of workplace assaults per 10,000 full-time equivalent (FTE) workers increased by 62%, far outpacing the comparatively modest 13% increase in the nationwide aggravated assault rate over the same period.

Assault cases are most heavily concentrated in the health care and social assistance North American Industry Classification System (NAICS) sector, where frequent, direct interaction with patients and clients elevates exposure relative to other sectors. The number of annual assaults in this sector is 10 times the number of assaults in the next largest NAICS sector, retail trade.

Within the sector, hospitals and nursing/residential care facilities together account for 75.1% of all violence-by-others cases. General medical and surgical hospitals alone account for 30.5% of the sector total, making them the single largest contributor by count.

At the same time, the highest rates are concentrated in behavioral-health and residential-care settings rather than in general acute care: psychiatric and substance abuse hospitals post a rate of 138.8 cases per 10,000 FTE workers, while residential intellectual and developmental disability, mental health, and substance abuse facilities post a rate of 60.9.

While health care has the highest share of assault cases, risk has risen across most major sectors. In education, violence is concentrated in elementary and secondary schools, which account for 91.2% of the sector’s cases and post a rate of 22.5 cases per 10,000 FTE workers.

Although women and men participate in the labor force in roughly equal numbers, women account for a disproportionate share of assault cases, and they experience assault rates nearly three times higher than men. Much of this disparity reflects sector composition because women are heavily represented in health care and social assistance, as well as in education.

In contrast, nearly 83% of workplace homicide victims are men. The disparity also largely reflects occupational composition: men are heavily concentrated in fields such as protective services and transportation/material moving, where fatal violence is most common. Workers in these occupations may face greater violence exposure because their jobs combine frequent public interactions, cash handling, and, in some cases, enforcement duties.

Shooting by another person accounts for more than four-fifths of all workplace homicides in 2023-2024, far surpassing every other method. This dominance reflects the higher lethality of firearms relative to other forms of interpersonal violence.

Taken together, the means and relationship data underscore that workplace homicides are predominantly criminal events involving firearms, rather than escalations of routine workplace interactions.

For workers’ compensation, workplace violence can be an occupational hazard, particularly in sectors such as health care, retail, protective services, and education. Federal agencies recommend a layered approach: a comprehensive written prevention program, work-site risk assessments, environmental and engineering controls, administrative controls, and employee training, all monitored and updated over time.

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Workers’ Compensation
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