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An accident at work is a sudden occupation-related event induced by an external agent resulting in trauma or death. The analysis covered 3215 records of proceedings in cases of accidents at work sent for certification to the Department of Forensic Medicine, Poznan University of Medical Sciences, from all over the country in the years 1989-2003. Of this number 19 most interesting cases with two or more opinions and varied final conclusions were selected. Medical certifications are issued by experts of various institutions, mostly of forensic medicine departments of medical universities, but also by independent experts. The fact that final conclusions drawn by different experts differ although based on the same records of proceedings indicates the need for setting uniform criteria for medical certification. The cases described in this paper may also serve as a strong argument for organizing more frequent conferences addressing this issue and for considering a possible introduction of specialization in medical certification.