Most moral injury literature focuses on moral harm occurring in the context of occupational events, including war. There is, however, emerging understanding that moral harm may also occur as a sequela to workplace injury itself. With its recent inclusion in the DSM-5-TR, moral injury can now be formally identified and addressed within psychological assessment, treatment, and rehabilitation frameworks. This recognition represents a pivotal shift for occupational rehabilitation providers, who have historically been limited in naming or documenting moral injury as a factor impacting recovery, even when worker's experiences clearly reflected moral harm.

Moral injury occurs when individuals feel they have transgressed, been betrayed by, or witnessed violations of deeply held moral beliefs. In the context of workplace injury, moral injury can arise not only from the precipitating event, but also by feeling betrayed by leadership, the organisation, or the system designed to support recovery – undermining the core of their external moral framework.

Emerging evidence points to such factors in the policing context, however, we propose that environmental and relational factors, such as lack of support, recognition, or adversarial claims processes, could be seen as a potential trigger for a secondary moral injury across industries, compounding distress and eroding trust. The result can be disengagement, loss of meaning, and worsening health outcomes, all of which significantly impede return-to-work.

Although terms such as secondary psychological injury or perceived injustice are often used in personal injury, they may only partially capture the moral dimension of workers’ experiences. Understanding these experiences through a moral injury lens provides a more comprehensive and human-centred framework for recovery.

This presentation will explore how lack of recognition and perceived injustice may act as a trigger or contributor to moral injury and how the employer’s initial response to injury — including communication, empathy, and procedural fairness — can either mitigate or amplify experiences of moral harm. It will also outline case studies where using a moral injury framework has facilitated greater participation in rehabilitation for injured workers.

Recognising and responding to moral injury in the context of workplace injury rehabilitation offers a new opportunity to enhance recovery, strengthen organisational ethics, and restore meaning and trust in the return-to-work journey.