Although annual United States occupational injury fatalities range between 7,000 and 10,400, consistent rules to determine which deaths are “occupational” do not exist. Fifty-seven North Carolina county medical examiners (MEs), responsible for more than 50% of all medical examiner cases in 1990, received our questionnaire. Fifty-three (93%) responded, classifying 22 scenarios as on-the-job deaths and indicating usual classification practices and information sources. Agreement varied among the scenarios, but those involving transportation and nonpaid workers elicited particularly inconsistent responses. Fifty-six percent of medical examiners have a general rule for determining on-the-job status, but deaths associated with motor vehicles, farming, and occupations other than the decedent's usual job were classified most inconsistently. The lack of standard definitions of “job,” “work,” and “on-the-job” is apparent in classification decisions. Certain work situations need special consideration.