Introduction Every year, large numbers of workers have an injury at work or develop a work-related disease. A range of worker compensation systems exist across countries for which epidemiological studies potentially provide critical evidence. This paper discusses the adequacy of current epidemiological research for this purpose.

Methods Compensation schemes need to identify the occupational circumstances, or dose, that increase (e.g. double) the risks of the disease, and to define these so they can be administered effectively by decision-makers who lack epidemiological experience. Large studies or meta-analyses with effective control for confounders, adequate exposure assessment, and clear case definition are (ideally) required.

Results Although epidemiological studies may show consistent evidence of an increased health risk from an occupational exposure, definitions of exposure are often unsuitable for converting into an appropriate exposure schedule for a compensation scheme. Direct measurements of occupational exposure are usually scarce and not available for individual workers; both claimants, perhaps, assessors would find these measurements difficult to access and use. Exposures defined by industry or job title, particularly with a qualifying time-period, although perceived by epidemiologists as rather simplistic, are more straightforward to use, e.g. ‘osteoarthritis in miners who have worked 10 or more years underground’. If quantitative exposure measurements are unavailable, epidemiologists often define qualitative metrics such as ‘high’, ‘medium’, or ‘low’ or develop more complex semi-qualitative exposure metrics such as ‘exposed or not’ at a given level of certainty or probability; intensity of exposure based on expert judgement of proximity to the substance and effectiveness of control procedures. Application of these in a compensation scheme may be problematical.

Discussion Epidemiology plays a vital role in ensuring workers are compensated for work-related ill-health. Epidemiological study design, exposure metrics and primary and subsidiary analyses should be tailored to directly support compensation schemes.