Absence of basic pain behaviors when an injury or illness is typically painful suggests that the experience of pain may be significantly altered. In the present study third-party reporting of injury/illness incidents was used to estimate the incidence of pain insensitivity/indifference and provide evidence of its impact. A significantly elevated pain threshold was noted for 25.2% of 123 individuals with developmental disabilities. Those with more severe mental retardation were also more likely to display signs of pain insensitivity or indifference. These individuals risk avoidable death and increased physical disability as a result of failure to recognize and respond to illnesses and injuries that would be painful for others. Implications for rehabilitation practitioners and medical personnel were discussed.