People with IDD are often denied choices based on concerns for their safety, including to prevent and reduce injuries. This study examined the relationship between the service-related choices of people with IDD and their injuries. In this cross-sectional analysis, we analyzed secondary Personal Outcome Measures® interview data and injury data from 251 people with IDD. Our findings revealed, controlling for all demographics, for every one-unit increase in service-related choice outcomes present, there was a 35% decrease in injuries. Expanding people with IDD's choice-making opportunities may result in fewer injuries. We must move beyond custodial models of care and ensure people with IDD are supported to live the lives of their choosing.