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To examine the hypothesized effect of health anxiety on subsequent disability pension award. Mental disorders are consistently underrecognized in general health care, leading to underestimation of its effects on related social security expenditures. According to medicolegal diagnoses for disability pension award, there are almost no awards of disability benefits for health anxiety or hypochondriasis. There are no empirical longitudinal population-based studies on occupational disability in health anxiety or the extreme of hypochondriasis.Using a historical cohort design, we utilized a unique link between a large epidemiological cohort study (n = 6819) and a comprehensive national database of disability benefits to examine the effect of health anxiety on subsequent disability pension award (n = 277) during 1.0 to 6.6 years of follow-up. The data sources were merged after informed consent, using the national personal identification number.Health anxiety was a strong predictor of disability pension award, exceeding the effect of general anxiety, and comparable to the effect of depression. This effect was partly accounted for by adjustment for income and level of education, and comorbid mental, psychosomatic, or physical conditions. The effect was not limited to high symptom levels, but followed a dose-response association. Despite the robust effect in this prospective study, health anxiety or hypochondriasis was not recognized as medicolegal diagnosis for any awards of disability pension, and was not accounted for by other mental disorders.Health anxiety is a strong, independent, and yet underrecognized risk factor for disability pension award.