Background: Quality deficiencies in occupational disease (OD) procedures usually lead to rejection of an OD. This article describes the deficiencies evaluated within a project of occupational physicians in medical labor inspection divisions processing OD according to § 4 of the Ordinance of Occupational Diseases in Germany and presents suggestions for improving these procedures. 

Methods: In this study a working group of the Association of German Federal State Occupational Physicians evaluated the quality of the OD procedures and their review by statutory accident insurance institutions using structured questionnaires and own experience. Deficiencies in OD procedures from 3 federal states are described and 15 cases are presented for common deficiency categories. 

Results: Following the decrease in the number of occupational physicians in the federal states in Germany, the processing rate of OD cases is < 40% in 10 states, ≤ 28% in 8 and ≤ 6% in 4 states. Between 2017 and 2022 the following deficiency categories were identified: problems in the investigation of hazardous occupational exposure, incompetent medical advice or expert opinions and procedural errors by the statutory accident insurance institutions administration. Statutory accident insurance institution statements indicate that no effective supervision of the quality of OD procedures is implemented. 

Discussion: Numerous deficiencies were identified for which the statutory accident insurance institutions, advisory physicians, or appraisers were responsible in most cases. The results of this study should be representative for federal states with relevant OD processing rates. In the absence of quality evaluation a considerable number of deficiency cases can be assumed. Higher processing rates in the federal states by occupational physicians and implementation of these proposals are suitable to improve the quality of OD procedures.