Perceived fairness of claimants undergoing a work disability evaluation: Development and validation of the Basel Fairness Questionnaire.

Regine Lohss,Regina Kunz,Wout De Boer,Brigitte Walter Meyer,Monica Bachmann,Katrin Fischer,Timm Rosburg,Melita J Giummarra

doi:10.1371/journal.pone.0238930

Abstract

There are currently no tools for assessing claimants' perceived fairness in work disability evaluations. In our study, we describe the development and validation of a questionnaire for this purpose. In cooperation with subject-matter experts of Swiss insurance medicine, we developed the 30-item Basel Fairness Questionnaire (BFQ). Claimants anonymously answered the questionnaire immediately after their disability evaluation, still unaware about its outcome. For each item, there were four response options, ranging from "strongly disagree" to "strongly agree". The construct validity of the BFQ was assessed by running a principal component analysis (PCA). In 4% of the questionnaires, the claimants' perception on the disability evaluation was negative (below the median of the scale). The PCA of the items responses followed by an orthogonal rotation revealed four factors, namely (1) Interviewing Skills, (2) Rapport, (3) Transparency, and (4) Case Familiarity, explaining 63.5% of the total variance. The ratings presumably have some positive bias by sample selection and response bias. The PCA factors corresponded to dimensions that subject-matter experts had beforehand identified as relevant. However, all item ratings were highly intercorrelated, which suggests that the presumed underlying dimensions are not independent. The BFQ represents the first self-administered instrument for measuring claimants' perceived fairness of work disability evaluations, allowing the assessment of informational, procedural, and interactive justice from the perspective of claimants. In cooperation with Swiss assessment centres, we plan to implement a refined version of the BFQ as feedback instrument in work disability evaluations.

Highlights

In most European countries, individuals with social security coverage who consider themselves as unable to work because of poor health can file a claim for disability benefits
Mono- and bidisciplinary evaluations are directly assigned to medical experts, whereas a random procedure allocates multidisciplinary medical evaluations to assessment centres, which need to be licenced by the Swiss Federal Social Insurance Office (“Bundesamt für Sozialversicherung”)
We aimed to develop and to validate a questionnaire that measures to what degree claimants for disability benefits perceive their evaluation by the medical expert as fair

Summary

Introduction

In most European countries, individuals with social security coverage who consider themselves as unable to work because of poor health can file a claim for disability benefits. The DI offices seek to establish the claimant’s degree of work incapacity, as critical variable determining the amount of work disability benefits. To this end, DI offices commission mono-, bi-, or multidisciplinary medical evaluations, depending on the complexity of the claimant’s medical history. Mono- and bidisciplinary evaluations are directly assigned to medical experts, whereas a random procedure allocates multidisciplinary medical evaluations to assessment centres, which need to be licenced by the Swiss Federal Social Insurance Office (“Bundesamt für Sozialversicherung”). We describe the development and validation of a questionnaire for this purpose

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Conclusion