The Cost of Work-related Physical Assaults in Minnesota

Health Services Research, August, 2000 by Patricia McGovern, Laura Kochevar, William Lohman, Brian Zaidman, Susan Goodwin Gerberich, John Nyman, Mary Findorff-Dennis

Objective. To describe the long-term productivity costs of occupational assaults. Data Sources/Study Setting. All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed.

Study Design. The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996.

Principal Findings. The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee).

Conclusions. Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions.

Key Words. Costs, work-related, assaults, injuries

Violence is a substantial contributor to injury and death on the job in the United States, accounting for approximately 922 homicides per year between 1994 and 1998 (Bureau of Labor Statistics 1999). It has become the second leading cause of occupational injury death, exceeded only by motor vehicle- related deaths (Jenkins 1996), and is the leading cause of occupational injury death for women. In addition, there are approximately a million nonfatal occupational assaults each year (Bachman 1994). Although the spectrum of work-related violence ranges from offensive language and harassment to homicide, the National Institutes for Occupational Safety and Health (1996) has defined work-related violence as "violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty."

Most studies have assessed violence in association with physical injuries, in part because injuries can be more readily defined and measured. Such research reveals that the circumstances associated with fatal and nonfatal assault injuries vary markedly. For example, Toscano (1996) reported that most homicide victims are men shot during a robbery by an unknown perpetrator, whereas women, commonly employed as nursing staff and assaulted by their patients, are most often the victims of nonfatal violence. Industries at highest risk of homicide included taxicab operations (79/100,000), gasoline service stations (13/100,000), grocery stores (6/100,000), and detective and armored car services (5/100,000). Occupations at greatest risk of homicide included taxicab drivers and chauffeurs (43/100,000), gas station attendants, sales counter clerks, and police and detectives (each occupation approximately 11/100,000). Analysis of 22,396 nonfatal assaults revealed that women were more frequently the victims (56 percent) a nd that hitting, kicking, and beating were the most common violent acts (47 percent), resulting in an average of four days of time lost from the job (Toscano 1996). While nonfatal assaults were primarily encounters between patients and nursing staff in health care institutions, other occupations in which violence produced lost work time included private security guards, truck drivers, and sales workers.

Relatively little is known about the costs of work-related assaults. Data from the National Crime Victimization Survey (NCVS) for 1987-1992 indicate that crime victimizations, which include rape, robbery, and assault cost about one-half million employees 1,751,100 days of work each year, an average of 3.5 days per crime. This missed work resulted in over $55 million dollars in lost wages annually (excluding days covered by sick or annual leave) (Bachman 1994).

Few studies have attempted to estimate the costs of work-related violence. The majority have assessed short-term costs with whatever data were accessible. Adler, Kreeger, and Zeigler (1983) reported 422 lost workdays due to 28 incidents of violence incurred by health care workers at a 312-bed private psychiatric facility between 1978 and 1980. An escalating trend with time was noted as the stimulus for administrative investigation of contributing factors in order to initiate prevention and control measures, as there had only been 62 lost days associated with 11 incidents between 1975 and 1977. The authors raised the concern that the increase in incidents might be related to a change in reporting practices, but they found no evidence for this concern.