At the heart of Amazon’s sprawling logistics empire is an in-house medical unit called AmCare, presented as a first line of defence for worker health. Yet internal documents and worker testimony allege its primary function is not care, but a system designed to minimise the official tally of injuries and keep employees on the warehouse floor, prioritising operational metrics over well-being.
The “Maximise Utilisation” Mandate
A training PowerPoint document dated August 2022, obtained by The Guardian, lays bare the alleged operational goals. Under a heading of “best practices,” it instructs AmCare staff on how to “maximize AMCARE Utilization.” This key metric is defined as the percentage of injured employees treated in-house without needing a workers’ compensation doctor. The presentation explicitly advises on how to “prevent day 1 send outs,” where an injured worker bypasses AmCare for an external clinic. It states AmCare “CAN NOT send any one home or excuse time,” and instructs: “do not recommend they take time to rest it away… report to amcare and receive treatment early.”
Amazon has disputed the document’s validity. Company spokesperson Sam Stephenson stated it was “several years old, doesn’t reflect the priorities or policies of our Global Medical Health team, and was never approved for use,” adding that employees sometimes create documents that are never implemented.
This alleged culture is echoed by a current worker at the LGB5 sortation centre in San Bernardino, California, who requested anonymity for fear of retaliation. They compared AmCare to a school nurse, saying: “They only give you an ice pack or water… They’ll try to keep you there for the longest time because they want you to go back to work, they will do everything in their power to not let you go home.” The worker further claimed injuries are not formally logged until it is completely apparent an employee cannot work, alleging: “Amazon really, really likes it when their injury rate looks low, so they will do their best and not have injuries logged.” Amazon has denied these allegations, with Stephenson reiterating that safety is the company’s top priority.
Life-Altering Injuries and Alleged Retaliation
The human impact of these practices is detailed in ongoing litigation. Juan Loera-Gomez, 46, alleges in a lawsuit filed in March that he sustained a “life-altering workplace injury” to his back and shoulders in October 2024 after hours of manually moving heavy boxes alone in an area normally staffed by three people. He claims that after reporting the injury, he was told to keep working. Following a medical diagnosis and work restrictions, Amazon initially accommodated him on light duty before, he alleges, forcing him onto unpaid leave and terminating his employment by email in January 2025.
“They accommodated my work restrictions after my injury at first, but then suddenly forced me out on unpaid leave,” Loera-Gomez said. Amazon’s spokesperson said many of the claims in the lawsuit “appear to be false or misrepresent Amazon policies.”
His case is not isolated. Lashone Brown of Las Vegas has filed a separate lawsuit alleging he was fired while recuperating from surgery for two work-related hernias suffered at Amazon. Another case, going to trial in California, involves former workers suing over heat conditions in warehouses. Lauren Teukolsky, the attorney representing Loera-Gomez, asserts: “It looks to me there’s a pretty clear pattern of this occurring in Amazon warehouses.”
Tragically, the allegations extend to fatal incidents. Following the death of worker Billy Foister from a heart attack in a warehouse in September 2019, managers were accused of telling staff to “get back to work.” Amazon denied a similar report this month after a worker died at a facility in Troutdale, Oregon.
Regulatory Scrutiny Amid Shifting Political Winds
Amazon’s injury data has long drawn scrutiny. In 2019, its serious injury rate reported to the Occupational Safety and Health Administration (OSHA) was 7.7 per 100 employees, nearly double the industry average—a year the company now uses as a benchmark to tout improvement. While rates have fluctuated, they remain above industry averages. According to the Strategic Organizing Center (SOC), a coalition of labour unions, in 2024 Amazon employed 39% of US warehouse workers but accounted for 56% of all serious injuries in the industry.
A December 2024 US Senate report went further, alleging Amazon “manipulates its workplace injury data to portray its warehouses as safer than they actually are,” a finding Amazon disputed. Internally, studies like “Project Elderwand” reportedly identified links between repetitive movements and injury risk, but were not acted upon for “technical reasons,” according to the Senate report.
Regulatory action has been a mixed picture. In December 2024, OSHA and Amazon reached a corporate-wide settlement to resolve multiple hazardous working condition cases, involving a $145,000 penalty and a mandate for nationwide safety measures and biannual progress reviews. A former OSHA official in the Biden administration suggested the settlement was influenced by the changing political landscape ahead of Donald Trump’s return to office.
Enforcement intensity has shifted. OSHA conducted 20% fewer inspections from April to September 2025 compared to the same period in 2024, and workplace safety penalties have dropped 45% under the Trump administration. Meanwhile, a separate criminal investigation by the U.S. Attorney’s Office for the Southern District of New York, examining workplace safety and injury reporting, began under the Biden administration. The status of that probe under the Trump administration is unclear. Notably, the recently fired US attorney general, Pam Bondi, was registered as a lobbyist for Amazon in 2020 and 2021.
Amazon’s political engagement has scaled significantly, including a $1m donation to Trump’s inaugural fund before his return to office. Stephenson, the Amazon spokesperson, said the company “always try[s] to have a collaborative relationship with each administration.”
Internationally, similar concerns persist. In the UK, where Amazon employs around 75,000 people, the GMB union has reported over 1,000 serious injuries at Amazon sites. Data shows over 600 ambulance callouts to 14 UK warehouses in a three-year period, with more than half resulting in hospital admission. Amazon states its UK injury rate is over 75% lower than the industry average and highlights five-star safety accreditations at some facilities.
Despite pledging in 2021 to become “Earth’s safest place to work,” Amazon’s own numbers suggest it fell short of its goal to halve injury rates by 2025. The company reports investing billions in safety and a 43% reduction in its global recordable incident rate since 2019. Yet, as legal battles mount and allegations over the fundamental purpose of its medical response unit persist, the gap between corporate pledges and worker experiences appears stark.
