Ask Congress To Make Your Falls Risk Assessment A Medicare-Covered Benefit!

Learn More

The Cost of a Fatigued Worker

Recent data released by Liberty Mutual states that almost 22% of non-fatal workplace injuries are caused by overexertion. They estimate this equates to over $12 billion in annual claims cost1. For those engaged with workers’ compensation systems, this shouldn’t come as a huge surprise, as there have been numerous studies in the past decade warning employers of the hazards of fatigued workers.

Exhausted workers, either due to poor conditioning or simply putting in too many hours are more likely to be injured. Furthermore, employees who struggle to meet the essential functions of the job are also at increased risk, particularly as the work shift progresses.

How Does Fatigue Impact Workers’ Injuries?

A June 2003 publication from the Journal of Occupational and Environmental Medicine (JOEM) outlined that fatigue, as well as a need for recovery, were found to be independent risk factors for being involved in an occupational injury or accident2.

This same publication (JOEM) released a more expansive meta-analysis in October of 2016 concluding that occupational fatigue leads to cognitive and physical degradation, illnesses, workplace errors and injuries3.

This fact can be seen across multiple industries and publications. For example, a 2019 study in CJEM found that fatigued paramedics were twice as likely to report injuries, three times more likely to report safety compromising behaviors, and 1.5 times more likely to report errors/adverse outcomes4. Similar detriments to health were seen among US mining employees who work long hours and are therefore susceptible to fatigue5.

If individual studies don’t convince you of the injury risks associated with fatigue, the CDC released a report in 2004 citing overtime work as having numerous deleterious effects on individuals’ health including increased risks for injury, illness, mortality, alcohol use, smoking, preterm birth, and weight gain. The publication also provided evidence that injury often occurs at the end of a long shift, when fatigue is at its greatest6.

How Can Physical and Occupational Therapy Help Prevent Workers’ Injuries?

So what can employers do to minimize these types of fatigue-related injuries? After all, it’s unlikely that we’re going to see employers tolerate a reduction in productivity to accommodate fewer working hours.

Additionally, employers are unlikely to hire additional staff, simply because many employers are already struggling to fill their labor force. This is where Upstream Rehabilitation, and our fantastic team of physical and occupational therapists, can be of help.

For example, a PT/OT could perform an industrial ergonomic assessment and/or develop a Post Offer Employment Test (POET). Ergonomic evaluations will provide information to employers and employees that can help limit the risk of injury to workers by outlining safer and more efficient ways to perform tasks.

Avoiding unnecessary motions and activities will assist with minimizing occupational fatigue, and therefore reduce injury rates. POETs can also help assure that employers are matching candidates to the appropriate job. This is by physically testing each conditional hire to ensure that they’re capable of performing the essential job functions. Employees placed in positions they are not suitable for are more likely to get injured, and POETs can reduce this risk significantly.

While the two examples above showcase how a PT/OT can help reduce risk, a common barrier to the implementation of these programs by employers is the perceived cost. This concern, while warranted, is ultimately short-sighted. In fact, while there is an expense to implementing these types of safety programs, it is typically negligible compared to the potential cost savings.

For example, and as outlined on the OSHA “$afety Pays” estimator7, a single “strain” type injury can have a direct/indirect cost of ~$67,000. Implementation of a POET program, or performance of an onsite ergonomic analysis is significantly less expensive than this strain, and will likely prevent multiple injuries (some of which may be significantly more expensive than a strain).

In fact, evidence has demonstrated the return on investment for these types of programs is significant, ranging from 14:1 and 18:189.

If you think your company could benefit from Post Offer Employment Testing or other ergonomic consulting, please reach out to Upstream Rehabilitation via our website or contact our Director of Industrial Services, Jennifer Kostik Johnson at



  2. Swaen GM, Van Amelsvoort LG, Bültmann U, Kant IJ. Fatigue as a risk factor for being injured in an occupational accident: results from the Maastricht Cohort Study. Occup Environ Med. 2003;60 Suppl 1(Suppl 1):i88-i92. doi:10.1136/oem.60.suppl_1.i88
  3. Techera U, Hallowell M, Stambaugh N, Littlejohn R. Causes and Consequences of Occupational Fatigue: Meta-Analysis and Systems Model. J Occup Environ Med. 2016;58(10):961-973. doi:10.1097/JOM.0000000000000837
  4. Donnelly EA, Bradford P, Davis M, Hedges C, Socha D, Morassutti P. Fatigue and Safety in Paramedicine. CJEM. 2019;21(6):762-765. doi:10.1017/cem.2019.380
  5. Friedman LS, Almberg KS, Cohen RA. Injuries associated with long working hours among employees in the US mining industry: risk factors and adverse outcomes. Occup Environ Med. 2019;76(6):389-395. doi:10.1136/oemed-2018-105558
  8. Littelton M. Cost Effectiveness of a pre-work screening program for the University of Chicago physical plant. Work. 2003; 21 (3): 243-250
  9. Harbin GL, Shenoy C, Garcia A, Olson JC. Shoulder injury reduction with post-offer testing. Work. 2011;39(2):113-23