Occupational diseases and the causal link: the Court of Cassation's position in Order no. 27410 of 2025

The recognition of an occupational disease represents a delicate stage in the worker's protection process. It is often believed that the inclusion of a pathology in the ministerial tables automatically guarantees the right to social security benefits. However, the jurisprudence of the Court of Cassation, with Order no. 27410 of October 14, 2025, has reaffirmed significant limits to this automatism, particularly when dealing with so-called "multifactorial" pathologies, i.e., those caused by a plurality of factors not exclusively related to work.

The specific case and the decision of the Supreme Court

The case originated from an appeal filed by the worker P. D. against the decision of the Court of Appeal of Lecce, which had denied compensation for lumbar spondylodiscopathy. The insured party, who had worked as a manual laborer, argued that the pathology was directly linked to his past work activity. However, the diagnostic and radiological investigations produced in court dated back to twenty years after the termination of the employment relationship.

The judges of legitimacy rejected the appeal, confirming that the excessive lapse of time between the end of the work activity and the diagnosis of the pathology interrupts the necessary chronological congruence. In this context, it is not possible to blindly apply the presumption of occupational origin, as the wear and tear of the spine can be attributed to degenerative dynamics linked to age or other non-work-related factors.

The principle of law of the Court of Cassation and the causal link

To fully understand the scope of this ruling, it is essential to analyze the principle of law expressed by the Supreme Court:

Regarding occupational diseases, the rule according to which the inclusion of the work process and the disease in the appropriate tables (provided that it arose within the maximum period of eligibility for compensation) determines the applicability of the presumption of the occupational etiology of the latter, with the consequent burden of proof to the contrary resting on INAIL, must be tempered in the case of a disease with a multifactorial etiology, for which the proof of the causal link must consist not of simple presumptions derived from theoretically possible technical hypotheses, but in the concrete and specific demonstration - at least on a probabilistic basis - of the suitability of the exposure to the risk to cause the morbid event.

This principle clarifies that the "legal presumption" (i.e., taking for granted that the disease derives from work if it is listed in the table) is not absolute. When a disease can have different causes (multifactorial), the worker cannot simply invoke the table, but must demonstrate, at least in terms of high scientific probability, that the exposure to the occupational risk was concretely capable of causing the damage.

Criteria for the recognition of multifactorial pathologies

The decision is part of a solid jurisprudential trend and outlines a series of essential criteria that trial judges must evaluate to ascertain the causal link in multifactorial diseases:

• Chronological congruence: the pathology must manifest itself within times compatible with the cessation of the work activity involving the risk.
• Specificity of exposure: it is necessary to demonstrate the actual intensity and duration of exposure to the risk factor during work shifts.
• Exclusion of prevailing concurrent causes: the worker's lifestyle and the presence of previous or degenerative pathologies linked to natural aging must be analyzed.

Conclusions

In conclusion, Order no. 27410 of 2025 represents an important reminder of the evidentiary rigor required in matters of occupational safety and social security. While the protection of the worker remains a cornerstone of our legal system, it cannot disregard a rigorous scientific verification of the cause-effect link. For workers and legal professionals, this provision underscores the importance of collecting medical documentation in a timely manner and not underestimating the time factor when requesting the protections provided by law.