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A prospective cohort study was conducted on workers claiming earnings-related compensation for low back pain. Information obtained at the time of the initial claim was linked to compensation status (still claiming or not claiming) 3 months later.To identify individual, psychosocial, and workplace risk factors associated with the transition from acute to chronic occupational back pain.Despite the magnitude of the economic and social costs associated with chronic occupational back pain, few prospective studies have investigated risk factors identifiable in the acute stage.At the time of the initial compensation claim, a self-administered questionnaire was used to gather information on a wide range of risk factors. Then 3 months later, chronicity was determined from claimants’ computerized records.The findings showed that 3 months after the initial assessment, 204 of the recruited 854 claimants (23.9%) still were receiving compensation payments. A combined multiple regression model of individual, psychosocial, and workplace risk factors demonstrated that severe leg pain (odds ratio [OR], 1.9), obesity (OR, 1.7), all three Oswestry Disability Index categories above minimal disability (OR, 3.1–4), a General Health Questionnaire score of at least 6 (OR, 1.9), unavailability of light duties on return to work (OR, 1.7), and a job requirement of lifting for three fourths of the day or more all were significant, independent determinants of chronicity (P < 0.05).Simple self-report measures of individual, psychosocial, and workplace factors administered when earnings-related compensation for back pain is claimed initially can identify individuals with increased odds for development of chronic occupational disability.