Introduction Asbestos products have been manufactured and consumed in large quantities in many East Asian countries over the past few decades. However, relatively few asbestos-related diseases (ARDs) have been recognised and compensated. This study compared the recognition and compensation schemes for ARDs in Japan, South Korea, Hong Kong and Taiwan.

Methods Published materials were reviewed, followed with interviews with key informants. We first reviewed the conditions of asbestos exposures and compared the compensation statistics of ARDs across the studied regions. Secondly, we examined the legal frameworks for the recognition and compensation for ARDs, including the designs of compensation policies, sources of fund, eligibility for compensation, types of diseases and recognition criteria, and the scopes and levels of compensation benefits.

Results In Japan, South Korea and Hong Kong, confirmed ARDs can be compensated regardless of claimants’ employment status, either through workers’ compensation insurance scheme or through compensation scheme under relief acts specifically designed for asbestos related health damages. In 2011, Japan, South Korea and Hong Kong compensated 1922, 632 and 18 ARD cases, respectively. In contrast, there have been very few ARDs being recognised in Taiwan (0 case in 2011), where compensation is restricted to workers with occupational asbestos exposure and thresholds for filing workers’ compensation are relatively high.

Discussions Low recognition of ARDs can be attributed to biomedical factors, which involve the difficulties in making precise diagnosis, lack of information on previous exposure dose and duration, difficulties in establishing causality due to long disease latency and contamination from confounding exposures. Nevertheless, social factors are also important in determining how the social burden of occupational disease is negotiated. Among all, the design and function of workers’ compensation system, including policy frameworks and mechanisms for the recognition of occupational diseases, play an essential role.