The specification allows you to use extensions as well as mime types
In fact, it actually recommends that you use both mime-type and extension.
As for requiring the OS to recognize the mime-type, that doesn't really make sense since mime-types are Internet protocol file identifiers. It actually depends on the user agent (browser) support for the mime-type. Since this is a fairly new construct, I wouldn't be surprised if browsers only minimally "support" it by having a common mapping between mime types and extensions. I can't imagine that the browser attempts to stat all readable files to determine mime type (which in my experience is not even close to dependable anyway). accept
's intent seems to be more about changing how the file upload dialog looks, and I doubt any browser does that yet, although I could definitely be wrong considering how quick browser releases are nowadays.
If you're still concerned, you could test yourself in common browsers since it really seems like it should be per user agent rather than per OS.