Abstract
Purpose: It has been argued that social security disability assessments should directly assess claimants’ work capacity, rather than relying on proxies such as on functioning. However, there is little academic discussion of how such assessments could be conducted.Method: The article presents an account of different models of direct disability assessments based on case studies of the Netherlands, Germany, Denmark, Norway, the United States of America, Canada, Australia, and New Zealand, utilising over 150 documents and 40 expert interviews.Results: Three models of direct work disability assessments can be observed: (i) structured assessment, which measures the functional demands of jobs across the national economy and compares these to claimants’ functional capacities; (ii) demonstrated assessment, which looks at claimants’ actual experiences in the labour market and infers a lack of work capacity from the failure of a concerned rehabilitation attempt; and (iii) expert assessment, based on the judgement of skilled professionals.Conclusions: Direct disability assessment within social security is not just theoretically desirable, but can be implemented in practice. We have shown that there are three distinct ways that this can be done, each with different strengths and weaknesses. Further research is needed to clarify the costs, validity/legitimacy, and consequences of these different models.Implications for rehabilitationIt has recently been argued that social security disability assessments should directly assess work capacity rather than simply assessing functioning – but we have no understanding about how this can be done in practice.Based on case studies of nine countries, we show that direct disability assessment can be implemented, and argue that there are three different ways of doing it.These are “demonstrated assessment” (using claimants’ experiences in the labour market), “structured assessment” (matching functional requirements to workplace demands), and “expert assessment” (the judgement of skilled professionals).While it is possible to implement a direct assessment of work capacity for social security benefits, further research is necessary to understand how best to maximise validity, legitimacy, and cost-effectiveness.
Highlights
Disability assessment is at the heart of social security: it divides the 40 million people claiming disability benefits across the OECD from the 25 million claiming unemployment benefits [1]
We aim to provide an account of how work capacity can be directly assessed in social security disability assessments, based on comparative case studies of nine high-income countries
We chose cases that our initial information suggested would be most relevant. This includes the country that two international experts and Bickenbach et al all suggested as best practice, three other countries that Bickenbach et al suggest are currently closest to the direct disability approach, three other European countries that have sometimes been suggested as having elements of good practice (Denmark, Norway, and Germany), and two countries that have undertaken recent reforms that were attracting attention in the United Kingdom (Australia and New Zealand)
Summary
Disability assessment is at the heart of social security: it divides the 40 million people claiming disability benefits across the OECD from the 25 million claiming unemployment benefits [1] The history of such assessments can be seen as a gradual – and still incomplete – transition from impairment-based assessments to functioning-based assessments [2,3]. While elements of the impairment-based approach are still common, these have been supplemented or replaced by a focus on functional capacities This is because impairments are a poor proxy for an individual’s capacity to work: functioning is not reducible to impairment as modern models of disability, such as the International Classification of Functioning, Disability and Health (ICF) make clear [4].
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