Occupational diseases and organizational constraint: proving the causal link in Ordinance no. 27444 of 2025

Psychophysical well-being in the workplace is a fundamental right of every worker, protected by both the Italian Constitution and European regulations. However, when psychic or psychosomatic pathologies arise in connection with the work environment, claims for indemnity or compensation often face the complex challenge of proving the causal link. The ruling of the Court of Cassation, with Ordinance no. 27444 of October 14, 2025, sheds light on this delicate aspect, redefining the boundaries of the burden of proof for so-called organizational constraint pathologies.

The case and the decision of the Court of Cassation

The dispute involved the worker M. G. P. and the employer T. O. (with the involvement of the insurance entity). The Court of Appeal of Palermo had previously declared the appeal inadmissible, prompting the appellant to turn to the Supreme Court. At the heart of the debate is the recognition of the occupational origin of a psychic pathology resulting from dysfunctions in work organization. The judges of legitimacy confirmed a rigorous approach: to obtain social security protection, a simple abstract correlation between duties and stress is insufficient; concrete evidence of hostile and reiterated employer conduct is required.

The principle of law of the Supreme Court

To fully understand the scope of this decision, it is essential to analyze the principle of law expressed by the judges of legitimacy in the ordinance:

Regarding insurance against occupational diseases, for the purpose of proving the causal link between exposure to risk and psychic or psychosomatic pathologies related to dysfunctions in work organization (so-called "organizational constraint" pathologies) referred to in group 7 of list II of the Ministerial Decree of December 11, 2009, it is not sufficient to demonstrate assignment to duties having the exemplary characteristics listed in said list (or others assimilable to them), since it groups "diseases whose occupational origin is of limited probability," consequently requiring the prior factual demonstration of acts and behaviors that denote an organizational constraint potentially harmful to the worker's psychophysical integrity, and therefore the demonstration of the reiteration of employer conduct, with persecutory intent, oriented towards such constraint.

The principle highlights how the Ministerial Decree of December 11, 2009, places these pathologies in List II, meaning among diseases whose occupational origin is considered to have limited probability. Consequently, no legal presumption operates in favor of the worker: the burden of proof lies entirely on the latter, who must demonstrate not only the existence of the disease but also the existence of specifically harassing employer conduct.

What must the worker prove?

In light of Ordinance no. 27444 of 2025, to have an occupational disease due to organizational constraint recognized, the worker must provide precise and consistent evidentiary elements. In particular, it is necessary to demonstrate:

• The existence of concrete employer acts and behaviors that fall outside the normal exercise of organizational and managerial power;
• The reiteration of such conduct over time, which must assume a systematic and persecutory character;
• The harassing intent or, in any case, the suitability of such behaviors to harm the employee's psychophysical integrity;
• The direct causal link between the employer's conduct suffered and the onset of the diagnosed psychic or psychosomatic pathology.

It is therefore not sufficient to complain about a simply stressful work environment or assignment to demanding tasks, provided these fall within the normal corporate dialectic and organization.

Conclusions and practical implications

The Court of Cassation ruling no. 27444/2025 reaffirms a principle of evidentiary rigor to protect the balance of the social insurance system. While on one hand it protects the worker from real abuse, on the other it prevents normal work tensions or corporate reorganizations from being automatically classified as pathogenic and compensable. For workers who believe they are victims of organizational constraint, it becomes essential to promptly collect detailed documentation and be assisted by legal professionals and occupational physicians to structure a solid defense based on irrefutable evidence.