Introduction Despite of the strong link between occupational asbestos exposure and mesothelioma (MM), only a small fraction of MM are recognised and compensated as occupational disease (OD). Lack of awareness of health risks of asbestos and negligence of workers’ compensation rights may be underlying factors for low recognition of occupational diseases. While medical and legal professionals are key players in the compensation process, their knowledge and attitudes towards disease causation and compensability of MM as well as attitudes towards welfare state policies are not well understood.

Methods An anonymous survey was conducted among 281 physicians and 929 legal professionals in Taiwan. Provided in the questionnaire was a vignette case. Study participants were asked to comment on the work-relatedness and compensability of the case. Also included was an 8-item scale of the role of government adopted from the International Social Survey Programs to assess participants’ attitudes towards welfare state policies.

Results 10.7% of physicians and 2.7% of legal professionals considered the case as an OD with certainty. Uncertainty was much higher in legal professional, as 53.1% of them could not give an answer on this issue. Despite of uncertainty, the majority of physicians (85.1%) and legal professionals (56.6%) agreed that such a case should be compensated under the workers’ compensation scheme. After excluding participants who could not answer the question on the work-relatedness of disease, we found that those with lower scores in the role of the government scale were more likely to disapprove MM as an OD and to disagree its compensability.

Conclusion Findings of this study suggest that attitudes of medical and legal professionals towards the compensability of asbestos-related mesothelioma are influenced not just by their knowledge about asbestos hazards and epidemiologic features but also by the ideas they hold about the role of the government in social protection.