Abstract
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.
Highlights
Individuals who are sick and unable to work may receive wage replacement benefits from an insurer
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 framework and definitions are limited with respect to comprehensive descriptions of work disability
Summary
Comparing the output of disability evaluation across Europe Despite the wide variation of social insurance systems across Europe and country- specific organization of disability evaluation and differences in structure and size of medical reports, we identified 4 core features of work disability for medical experts [6]: 1) the functional capacity of the claimant; 2) the socio-medical history, including the development and severity of the claimant’s health condition, his/her previous efforts to regain health and return to work, and his/her job and social career; 3) the individual prognosis of work disability; 4) the feasibility of interventions to promote recovery and return to work. The ICF definitions for body functions, structures, activity and participation, and environmental factors cover essential parts of the disability evaluation. Kirschneck et al translated concepts of disability evaluation to ICF categories by linking medical reports from claimants with low back pain and chronic widespread pain and compared them with the existing core set of these conditions [13]. The medical expert describes the claimant‘s health condition and functional limitations, socio-medical history, feasible interventions and prognosis and relates his/her findings to the requirements of the social insurance scheme. Before advancing with applied research around the optimal use of the ICF in disability evaluation, the professional community needs to specify its expectations: in what way should the ICF framework and the classification be used to express a claimant’s functional capacity? Competing interests The authors declare that they have no competing interests
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