Abstract:Disability assessment is a complex and multifaceted process of exploration and evaluation, which in terms of legal evidence can be of far-reaching consequence for the claimant, the statutory pension insurance and finally for society as well. In the article the specifics of the assignment, the assessment situation, and the process of evaluation are described. Based upon an analysis of the so far only little research activities, the future need for research is subdivided into 4 thematic groups: 1 Operationalizat… Show more
“…Insurer’s typically consider medical evaluations as the best evidence for informing whether or not to award disability benefits [ 14 ]. However, for any evaluation process to be valid, it must first demonstrate reliability (although reliable evaluations can still be invalid).…”
Section: Discussionmentioning
confidence: 99%
“…However, anecdotal evidence suggests that many evaluation reports are of poor quality [ 8 ] and that different experts attending the same claimants often disagree regarding their ability to work (Fig. 1 ) [ 9 – 14 ]. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…A key criticism of disability evaluations is the failure of medical experts’ to clearly relate how claimants’ impaired health affects their ability to engage in competitive employment [ 14 – 18 ]. Rather, experts refer to their implicit professional expertise [ 11 , 12 , 19 , 20 ].…”
BackgroundWork capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants’ functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits.Methods/DesignWe will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants’ functional limitations. Our primary outcome measure is the evaluation of claimant’s work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process.DiscussionWe hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.
“…Insurer’s typically consider medical evaluations as the best evidence for informing whether or not to award disability benefits [ 14 ]. However, for any evaluation process to be valid, it must first demonstrate reliability (although reliable evaluations can still be invalid).…”
Section: Discussionmentioning
confidence: 99%
“…However, anecdotal evidence suggests that many evaluation reports are of poor quality [ 8 ] and that different experts attending the same claimants often disagree regarding their ability to work (Fig. 1 ) [ 9 – 14 ]. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…A key criticism of disability evaluations is the failure of medical experts’ to clearly relate how claimants’ impaired health affects their ability to engage in competitive employment [ 14 – 18 ]. Rather, experts refer to their implicit professional expertise [ 11 , 12 , 19 , 20 ].…”
BackgroundWork capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants’ functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits.Methods/DesignWe will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants’ functional limitations. Our primary outcome measure is the evaluation of claimant’s work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process.DiscussionWe hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.
“…Professional guidances on disability evaluation advise the medical expert to draft a holistic picture of the claimant [9,20,21]. …”
Section: Discussionmentioning
confidence: 99%
“…One way to settle this matter is to analyse the reports of disability evaluation in different countries. Different countries have different ways to organise disability evaluation, but the reports seem to share essential characteristics: Reports describe a claimant’s (in-) capacities and relate these to his health condition (rather than to a non-medical cause) [3,5], and his efforts to recover and return to work [4,6-9]. …”
BackgroundIndividuals who are sick and unable to work may receive wage replacement benefits from an insurer. For these provisions, a disability evaluation is required. This disability evaluation is criticised for lack of standardisation and transparency. The International Classification of Functioning, Disability and Health (ICF) was developed to express the situation of people with disability. We discuss potential benefits of the ICF to structure and phrase disability evaluation in the field of social insurance. We describe core features of disability evaluation of the ICF across countries. We address how and to what extent the ICF may be applied in disability evaluation.DiscussionThe medical reports in disability evaluation contain the following core features: health condition, functional capacity, socio-medical history, feasibility of interventions and prognosis of work disability. Reports also address consistency, causal relations according to legal requirements, and ability to work. The ICF consists of a conceptual framework of functioning, disability and health, definitions referring to functioning, disability and health, and a hierarchical classification of these definitions. The ICF component ’activities and participation’ is suited to capture functional capacity. Interventions can be described as environmental factors but these would need an additional qualifier to indicate feasibility. The components ‘participation’ and ‘environmental factors’ are suited to capture work requirements. The socio-medical history, the prognosis, and legal requirements are problematic to capture with both the ICF framework and classification.SummaryThe ICF framework reflects modern thinking in disability evaluation. It allows for the medical expert to describe work disability as a bio-psycho-social concept, and what components are of importance in disability evaluation for the medical expert. The ICF definitions for body functions, structures, activity and participation, and environmental factors cover essential parts of disability evaluation. The ICF framework and definitions are however limited with respect to comprehensive descriptions of work disability.
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