A pilot scheme in the United Kingdom to double-check death certificates has found that work related fatalities may be being significantly underreported because doctors are failing to give an accurate cause of death for one in four patients.

Results suggest that doctors may blame the wrong type of disease in as many as one in 10 cases, by either getting it wrong or failing to acknowledge a pre-existing underlying cause. The findings came in a Sheffield pilot of a medical examiner system due to be introduced across England and Wales in April 2014. A 1,000-strong body of medical examiners will be tasked with double-checking death certificates.

Alan Fletcher, who is leading the Sheffield pilot scheme, found a quarter of more than 8,000 certificates studied over four years fell short. He said faults stemmed from doctors not 'reading' the full stories behind patients' fatal illnesses. He added doctors do not always understand when they must refer cases to a coroner.

'There was a failure to appreciate a cause of death that might be unnatural,' he told The Guardian. 'Take pulmonary fibrosis - a disease that might be acquired industrially. This is an area of mining and steelworks. The registrar would be required by law to refer this to a coroner. Doctors receive little or no training in death certification or coroner referral.' Dr Fletcher told Hazards magazine there 'are definitely a significant number' of cases where 'industrial causes' are overlooked.