Employers can play an active role in protecting employees from workplace injuries, including traumatic brain injuries (TBI) caused by workplace violence, which cost employers $120 billion in 2023, according to the Occupational Safety and Health Administration. The topic of creating safer workplaces is increasingly important considering mild TBI (mTBI), including concussions, affect more than one in 20 Americans annually and work-related injuries cause almost one-fifth of TBI cases.

These cases frequently result in employee limitations or restrictions that may require disability leave. New research1 shows that workplace violence, defined as incidents where employees are abused, threatened, harassed or assaulted in circumstances related to their work, causes 10% of mTBI cases.

While some populations are at higher risk for workplace violence, including employees who interact frequently with the public, all employers should have policies and programs that protect employees. Workplace violence policies have myriad benefits including an estimated 400% return on investment in the first year of implementation, according to research.2

Consider these strategies for creating a program that complies with the Workplace Violence Program3 developed by the U.S. Department of Labor. DMEC members can find additional information to support program development in The Power of Preparedness.4

Prevalence

An analysis of employees successfully returning to work after mTBI caused by workplace violence shows:

  • Workplace violence appears to be responsible for a higher percentage of mTBI diagnoses (10.5%) in the U.S. than previously estimated;
  • People who suffered mTBI as a result of workplace violence tend to be younger, have higher incomes and were more likely to have jobs with light or sedentary physical demands; and
  • More people whose mTBI resulted from workplace violence returned to work than those whose mTBI was caused by another factor.

Most workers diagnosed with mTBI can return to work and may do so sooner than employers anticipate. The likelihood of an employee returning to work after an mTBI diagnosis is influenced by their employer’s flexibility, willingness to offer accommodations related to limitations and restrictions, and the culture of support for return to work. However, improvement in symptoms after mTBI may be slow and non-linear. Employers need to remember that recovery can be a long-term process with a persistent symptom burden and provide ongoing support and accommodation for employee progress.

Some accommodations provided to employees with mTBI relate to the psychosocial work environment, such as a gradual return to work (43%), limited duty (40%), work from home (14%), modified break schedules (6%) and workload reduction (6%).5

Return-to-work case managers who function as liaisons between the employee, treating provider, and employer can be helpful when it comes to customizing accommodative strategies.

The likelihood of an employee returning to work after an mTBI diagnosis is influenced by an employer’s willingness to be flexible and offer accommodations related to the employee’s limitations and restrictions, and the company’s culture for return to work.

One barrier to success is other employees’ misperceptions regarding accommodations for employees with invisible disabilities that are perceived as special treatment or favoritism. This is difficult because employers are prohibited from explaining why accommodations are provided. As a result, employees with mTBI frequently experience stigma and discrimination in the workplace, so coworkers and managers may require education and training to reduce negative impacts.6,7

Take, for example, the disability stigma and discrimination experienced by U.S. Senator John Fetterman when he used live transcription as an accommodation following a stroke in 2022 that caused an auditory processing disorder.

To mitigate coworker resentment of perceived special treatment, the safest course of action is to deploy messaging strategies that are vetted by HR personnel and labor attorneys to explain policy deviations. These can encourage employees to contact their managers if they have medical conditions that qualify for similar accommodations.

Reducing Stigma

Accommodative strategies to address limitations and restrictions associated with mTBI include addressing symptoms such as problems with attention, emotional volatility, fatigue, memory loss and stress intolerance, as well as a recognition that additional support may be necessary for employees with concurrent mental health conditions, including post-traumatic stress disorder, as a result of workplace violence. 8,9 Mental health complications are common across all types of TBI, and the possibility of comorbid behavioral health conditions must be considered for employees who demonstrate persistent symptoms.10,11

In a sample of workers referred to a disability management program to facilitate returning to work following a disability leave for brain injuries including TBI (all levels of severity and causes), the most common accommodation was a gradual return to work from part-time to full-time as conditions improved.12

Limited duty was the second most common accommodation, which excuses employees from certain tasks and allows them to continue working despite limitations that inhibit their ability to complete all of their usual duties. Additional accommodations included ergonomic equipment, such as sit-stand workstations and seating, special training, working from home, job changes, modified break schedules, voice-to-text and text-to-voice software, lighting modifications and therapeutic lenses to prevent headaches.

While reasonable accommodations are required under the Americans with Disabilities Act, it is wise for employers to support workers regardless of any legal requirement. In fact, some employers are introducing approaches that designate them as recovery friendly workplaces that support employees with substance use disorders and employ trauma-informed management techniques to support workers with a history of trauma. How do you support your employees with brain injuries? Share your story on DMECommunities, an online platform for member discussion (https://dmec.org/community/dmecommunities/) and tag these authors (@name of author) to continue the conversation.

How do you accommodate employees with traumatic brain injuries? Employers are exploring different ways to support employees and encourage their return to work.

DMEC members will find additional details about workplace violence and traumatic brain injuries in the article “Safety at Work: Creating Safe Environments That Encourage Employees to Return to Work” in the November/December issue of DMEC @Work magazine. This piece is available exclusively to DMEC members.

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  1. Occupational and Environmental Medicine. July 9, 2024. Retrieved from https://oem.bmj.com/content/early/2024/07/09/oemed-2024-109437.full
  2. Power of Preparedness (March 19, 2025). A Clear Business Case and ROI Projection for Workplace Violence Prevention Training, https://thepowerofpreparedness.com/2025/03/19/a-clear-business-case-and-roi-projection-for-workplace-violence-prevention-training/, accessed on Oct. 5, 2025
  3. Department of Labor. Workplace Violence Program. Retrieved from https://www.dol.gov/agencies/oasam/centers-offices/human-resources-center/policies/workplace-violence-program
  4. The Power of Preparedness. Retrieved from https://thepowerofpreparedness.com/
  5. Occupational and Environmental Medicine. July 9, 2024. Retrieved from https://oem.bmj.com/content/early/2024/07/09/oemed-2024-109437.full
  6. Ralph A, Derbyshire C. Survivors of brain injury through the eyes of the public: a systematic review. Brain Inj. 2013;27(13-14):1475-91. doi: 10.3109/02699052.2013.823653. Epub 2013 Nov 11. PMID: 24215644. Accessed Oct. 5, 2025, https://pubmed.ncbi.nlm.nih.gov/24215644/
  7. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Health Sciences Policy; Committee on Accelerating Progress in Traumatic Brain Injury Research and Care; Matney C, Bowman K, Berwick D, editors. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington (DC): National Academies Press (US); 2022 Feb 1. 4, Traumatic Brain Injury Prevention and Awareness. Accessed October 5, 2025, https://www.ncbi.nlm.nih.gov/books/NBK580082/
  8. Job Accommodation Network, Brain Injury, accessed October 5, 2025, https://askjan.org/disabilities/Brain-Injury.cfm. See also https://askjan.org/publications/Disability-Downloads.cfm?pubid=226594&action=download&pubtype=pdf

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