This study focuses on post-traumatic stress disorder in a follow up one to two years after the occupational accident. The aim was to estimate the prevalence of PTSD, changes in general health status and issues of compensation. The material was all serious accidents registered in the Danish National Register of Work Accidents during 1991. Seriousness was defined by type of injury, including all cases of amputations, bone fractures and extensive body lesions. Of 4745 possible, 3663 persons (77%) participated in a questionnaire study. The prevalence fulfilling the complete set of criteria of posttraumatic stress disorder as a chronic state was 2.8% (102 persons), of whom half had been given compensation. Among the most severe accidents the prevalence was 7.6%. In conclusion, in a large cohort of persons with moderate and severe occupational injuries this study demonstrated that post-traumatic stress disorder and lasting psychological distress should be a matter for concern in addition to the physical injury.