The National Coal Workers Autopsy Study (NCWAS) and Disaster Plan, a program developed to provide medical evidence in support of disability claims, conduct research on the epidemiology and pathogenesis of coal workers pneumoconiosis, and provide forensic assistance to the Mine Safety and Health Administration during mine accidents was examined. The NCWAS and disaster plan was a program mandated under Section 203(d) of the Federal Coal Mine Health and Safety Act of 1969 and administered by NIOSH. Over the period 1971 through 1984 approximately 4000 autopsies were performed on decedents from 27 states under the auspices of the program. The causes of death were found to be similar to that of the general United States male population. The largest number of deaths was due to circulatory system disorders, followed by cancer, miscellaneous causes, nonmalignant respiratory disease, and external causes. Accidental deaths occurred more frequently in younger than in older age groups. The data indicated that the risk of dying in a coal mine accident was similar to that of dying a violent death outside the mine. NIOSH procedures in the event of a major coal mine accident were discussed. Since 1971 the NIOSH disaster team has investigated 16 major mine accidents that caused 148 fatalities. Most of the accidents involved methane explosions. Ninety six victims were autopsied. Recommendations for improving the quality of coal mine fatality investigations were discussed and included increased autopsy rate of miners, standardized procedures for forensic investigation of mine accident victims, increased research in correlating blood and ambient methane mine levels, and increased proper medical care at the mine site.