BACKGROUND:Workers' compensation claims data are routinely used to identify and describe work-related injury for public health surveillance and research, yet the proportion of work-related injuries covered by workers' compensation, especially in the agricultural industry, is unknown. METHODS:Using data from the Iowa Trauma Registry, we determined the sensitivity and specificity of the use of workers' compensation as a payer source to ascertain work-related injuries requiring acute care comparing agriculture with other rural industries. RESULTS:The sensitivity of workers' compensation as a payer source to identify work-related agricultural injuries was 18.5%, suggesting that the large majority of occupational agricultural injuries would not be accurately identified through workers' compensation records. For rural nonagricultural, rural occupational injuries, the sensitivity was higher (64.2%). Work-related agricultural injuries were most frequently covered by private insurance (39.6%) and public insurance (21.4%), while rural nonagricultural injuries were most frequently covered by workers' compensation (65.2%). CONCLUSIONS:Workers' compensation claims data will not include the majority of work-related agricultural injuries.