The Pike River Royal Commission has been told health and safety breaches were made repeatedly at the mine, with no improvements to its systems.
The commission heard on Friday from Kathleen Callaghan from the University of Auckland's Human Factors Group.
Dr Callaghan said given that factors that made the tragedy more likely were identified well before the first explosion on 19 November, it was an "accident waiting to happen."
She told the commission her research found more than 500 health and safety incidents were reported at the mine, with many issues coming up again and again.
She says nothing appears to have been done to change the behaviour and that when relatively minor issues are allowed to reoccur, that can lead to major problems.
Much of the detail around those breaches has been suppressed as some of the witnesses may give evidence later.
Dr Callaghan said the Pike River disaster proves the country has failed to learn from previous accidents.
"For the purposes of trying to prevent a similar event in any industry in New Zealand happening again, we need to interrogate the strengths and weaknesses at all levels of the system. And unless we clearly define the problem, any intervention is unlikely to be as efficacious and efficient as it could be."
She says it should be looked at as workplace accident that happened in a mine, not simply as a mining accident.