Abstract
In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.
Highlights
Western societies have established social insurance systems to cover loss of income in workers who are unable to work owing to poor health
QUESTIONS: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism
We focused on medical evaluations directed at determining work capacity among patients presenting with mental illness
Summary
Western societies have established social insurance systems to cover loss of income in workers who are unable to work owing to poor health. Insurers commission medical evaluations of work capacity when confronted with disputable claims. Increasing restrictions in social insurance eligibility arising from attempts to address rising debts in disability insurance [2,3,4] have fuelled controversy among independent medical experts and criticism and discontent with the claim process from patients and the legal community. This controversy and expression of dissatisfaction has been prominent in evaluations of disability arising from psychiatric conditions
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