The Reality We Face
When I was the Group Vice President of Risk Management for Safeway, we were the largest employer of individuals with disabilities in the United States. Among our hundreds of thousands of employees, those with disabilities—including many on the autism spectrum—were consistently among our hardest-working, most dependable, and lowest-risk workers. They showed up every day. They followed procedures meticulously. They cared deeply about doing things right.
But I also witnessed how easily our workers’ compensation system could fail them, often in ways that seemed inexplicable at the time.
I remember one of my risk directors telling me about her son, who worked as a courtesy clerk in one of our stores. He was on the autism spectrum, and one day, he came home genuinely upset—almost indignant—that a coworker wasn’t sweeping the floors with the same focus and precision he prided himself on. He couldn’t understand why someone wouldn’t approach the task with the same level of commitment and attention to detail.
His mother paused, then gently offered, “Maybe she’s also a bit challenged in her own way.”
He stood there stunned for a moment. “I never thought of that,” he said quietly. From that moment on, his attitude shifted completely. He became more understanding—not just of that coworker but of others who worked differently, communicated differently, or saw the world through a different lens.
That conversation stayed with me because it represents precisely the kind of shift we need in workers’ compensation. Sometimes, all it takes is a moment of awareness—the recognition that what looks like defiance or indifference might actually be someone trying their best to navigate a system that wasn’t designed with them in mind.
The numbers tell us this isn’t a rare situation. 1 in 36 children is now diagnosed with autism, according to the CDC, and many adults remain undiagnosed, particularly women and minorities. This means every claims professional will encounter injured workers on the autism spectrum, whether they realize it or not. When we fail to recognize and accommodate autism-related needs, claims can cost 40-60% more due to misunderstandings, delays, and unnecessary complications.
More importantly, we miss the opportunity to do what we’re really here to do: help injured workers heal and return to productive, meaningful work.
Understanding What We’re Working With
Autism Spectrum Disorder affects how people communicate, process sensory information, and navigate change and uncertainty. It’s called a spectrum because it presents so differently from person to person. Some individuals might be highly verbal professionals with subtle social challenges, while others might be non-verbal with significant support needs. What unites them is a different way of processing the world around them.
In the workplace, autistic employees often demonstrate exceptional attention to detail, strong adherence to procedures, remarkable reliability, and honest, direct communication. They frequently excel at pattern recognition and can develop deep expertise in their areas of interest. These are exactly the qualities most employers value.
But when injury strikes, the very traits that make these employees valuable can become challenges in our traditional claims process. Someone who thrives on routine and predictability suddenly faces a chaotic world of medical appointments, changing schedules, complex forms, and ambiguous instructions. Someone who processes information literally might misunderstand casual language or implied expectations. Someone who is sensitive to sensory input might be overwhelmed by the bright lights and noise of medical facilities.
The result can look like non-compliance when it’s actually confusion. It can appear to be indifference when it’s actually overwhelm. It can seem like obstinacy when it’s actually a desperate attempt to make sense of a system that feels incomprehensible.
What This Means for Claims Professionals
I’ve learned that recognizing autism-related needs doesn’t require becoming a psychologist or memorizing diagnostic criteria. It requires paying attention to patterns and being willing to adjust our approach when our usual methods aren’t working.
Consider the injured worker who consistently misses appointments but seems genuinely distressed about it. Before labeling them as non-compliant, ask whether there might be transportation challenges. Ask if the worker experienced any difficulties at the facility that made the appointment problematic. Bright fluorescent lights, unexpected sounds, and crowded waiting rooms can trigger sensory overload that makes it physically difficult for some people to remain in those spaces.
Think about the worker who gives flat, seemingly emotionless responses during interviews, leading you to question their credibility. Many autistic individuals express emotions differently than we might expect. A lack of facial expression doesn’t indicate a lack of pain or concern—it might simply reflect different neurological wiring for emotional expression.
Or consider the worker who seems to ignore your instructions, then calls repeatedly with the same questions. Rather than assuming defiance, consider whether your instructions were clear and literal enough. Phrases like “follow up as needed” or “take it easy” can be meaningless to someone who processes language literally. They need to know exactly what to do, when to do it, and how to measure success.
The key insight is this: when our standard approaches aren’t working, the solution isn’t to push harder with the same methods. It’s to step back and ask what might work better for this particular person.
Practical Changes That Make a Difference
The most powerful tool in supporting injured workers on the autism spectrum is clear, structured communication. Instead of saying “We need to touch base about your claim,” try “I need to discuss three specific items about your workers’ compensation claim with you. This call will take about fifteen minutes.” The difference is specificity and predictability.
After every significant conversation, send a written summary. Include what was discussed, what decisions were made, what the next steps are, and when they’ll happen. This isn’t just good practice for autistic individuals—it’s good practice for everyone, and it dramatically reduces misunderstandings and missed deadlines.
When scheduling medical appointments, ask about communication and environmental preferences. Some people need written instructions about what to expect. Others benefit from scheduling during quieter times of day. Some need advance notice about any changes, while others might need help navigating transportation or parking.
If you have the injured worker’s consent, share relevant information with medical providers. A simple note explaining that someone prefers written instructions, needs extra time to process questions, or is sensitive to bright lights can transform a medical encounter from stressful to successful.
For complex cases or when standard approaches aren’t working, consider requesting a medical management nurse with autism experience. These specialized nurses understand how autism affects medical treatment compliance, pain expression, and recovery processes. They can bridge communication gaps between the injured worker, medical providers, and your claims team. Their expertise in autism-informed care coordination often prevents the misunderstandings and treatment delays that drive up claim costs and prolong recovery.
When planning return to work, think beyond medical clearance. Consider whether the work environment has changed, whether new accommodations might be needed, and whether supervisors understand how to communicate effectively with this employee. Often, simple adjustments like providing written job expectations, giving advance notice of schedule changes, or allowing the use of noise-canceling headphones can make the difference between success and failure.
Reframing Our Claims “Red Flags”
One of the most important shifts in working with autistic injured workers is learning to interpret behaviors differently. What we traditionally view as red flags often have completely different meanings when autism is involved.
When someone repeatedly misses appointments, our instinct might be to question their motivation or commitment to recovery. But for an autistic individual, missed appointments might reflect sensory overwhelm, confusion about transportation, or anxiety about unfamiliar environments. The solution isn’t enforcement—it’s problem-solving. Ask what would make appointments more manageable and work together to address those barriers.
When someone seems to ignore instructions, our tendency might be to assume non-compliance or poor cooperation. But unclear or overly complex instructions can be genuinely impossible for some people to follow. Instead of repeating the same instructions more forcefully, try breaking them into smaller steps, providing written formats, or asking what part of the process is unclear or difficult.
When someone appears emotionally flat or disengaged, we might question their honesty or investment in their recovery. But emotional expression varies enormously among autistic individuals. Some feel emotions deeply but struggle to express them in ways others recognize. Rather than interpreting body language or tone, focus on what people actually say and ask direct questions to understand their experience.
The pattern here is consistent: when we encounter behaviors that don’t match our expectations, our first response should be curiosity rather than judgment. What might be driving this behavior? What accommodation or adjustment might help? How can we work together to achieve the goal we both want—successful recovery and return to work?
The Business Case for Getting This Right
When we handle autism-related needs appropriately, claims resolve faster and more successfully. Medical treatment becomes more effective when providers understand how to communicate with their patients. Return-to-work success rates improve when accommodations are thoughtfully planned and implemented. Worker satisfaction increases when people feel heard and supported. Litigation risk decreases when trust is maintained throughout the process.
Conversely, when we miss autism-related needs, costs escalate quickly. Medical care becomes ineffective when patients can’t communicate their symptoms clearly or can’t tolerate treatment environments. Claims drag on when instructions aren’t understood or followed. Workers may never return to productive employment when return-to-work planning ignores their communication and environmental needs. Legal exposure increases when workers feel discriminated against or inadequately supported.
The accommodations that support autistic workers are typically simple and low-cost. Written communication, structured processes, environmental modifications, and clear expectations benefit everyone involved. We’re not talking about expensive technology or major system overhauls. We’re talking about thoughtful adjustments to how we do work we’re already doing.
Resources for Immediate Support
When you need consultation on workplace accommodations, the Job Accommodation Network at askjan.org provides free guidance. For healthcare providers working with autistic patients, the Autism Healthcare Accommodations Tool at autismandhealth.org offers practical strategies. The CDC’s autism information page provides current statistics and basic educational material, while Autism Speaks offers toolkits specifically designed for healthcare providers and first responders.
For legal questions about confidentiality and disclosure requirements, consult your organization’s legal counsel and your state workers’ compensation commission for jurisdiction-specific guidance. Local disability advocacy organizations can provide community-specific resources and support.
The Autistic Self Advocacy Network offers perspective from autistic adults themselves, which can be invaluable in understanding how autism affects real people in real workplaces. Project ECHO Autism provides professional development opportunities for healthcare providers who want to improve their skills in working with autistic patients.
Your Path Forward
The changes I’m asking you to make don’t require extensive training or major system overhauls. They require awareness, curiosity, and a willingness to adjust your approach when your usual methods aren’t working.
Start this week by paying closer attention to communication patterns in your current cases. Are there workers who seem to struggle with verbal instructions but respond well to written communication? Are there people who appear anxious or overwhelmed by changes in schedule or procedure? Begin asking about communication preferences and providing written summaries of important conversations.
Over the next month, develop some simple templates for common situations. Create standard language for explaining benefits, scheduling appointments, and summarizing treatment plans. Build relationships with local resources that can provide consultation and support when you encounter situations that require additional expertise.
Looking ahead, advocate within your organization for autism awareness and accommodation training. Share what you learn with your colleagues. Track the outcomes when you use autism-informed approaches and document the improvements you see in claim resolution and worker satisfaction.
The Call to Action
The injured workers on the autism spectrum in your caseload are counting on you to recognize their needs and respond appropriately. They’re not asking for special treatment—they’re asking for the opportunity to recover and return to work successfully, just like any other injured worker.
This isn’t about political correctness or compliance checkboxes. It’s about effectiveness. It’s about doing our jobs well. It’s about recognizing that our systems weren’t designed for everyone, and that adapting them isn’t just the right thing to do—it’s the smart thing to do.
When we lead with empathy and curiosity instead of assumptions, when we provide structure and clarity instead of ambiguity, when we treat communication barriers as problems to solve rather than character flaws to judge, we don’t just improve individual claims. We build a better system for everyone.
The son of my risk director learned something profound that day: sometimes people who seem difficult or different are simply doing their best in a world that wasn’t designed for them. The same insight that helped a young man become more understanding of his coworker can help all of us become more effective at serving injured workers who see and experience the world differently than we do.
The question isn’t whether you’ll encounter injured workers on the autism spectrum. The question is whether you’ll recognize their needs and respond appropriately when you do.
Start today. The workers, depending on you, deserve nothing less than your best effort to understand and support their path to recovery.
