Guidelines for Assessment of Work Disability: An International Survey

Abstract

Background: Assessments of long-term work disability are carried out by social insurance physicians (SIPs) and are little supported with evidence or instruments. Guidelines are hardly ever used in social insurance medicine. Developments in social insurance medicine might be slow as insurance is different from clinical medicine.

Aims: We explored the comparability of assessments in social insurance medicine in different countries and asked what guidelines were in official use.

Methods: Eighteen European countries were invited. A questionnaire on assessments practices was sent to national experts. A comparative table was presented to all contributors. Countries with guidelines were visited. Guidelines were categorised according to their purpose and their contents were compared. The results were presented to experts of the participating countries for validation.

Results: Fourteen countries participated. Functional capacity assessment was common. Guidelines for SIPs were reported to be officially in use in Germany, Ireland, the Netherlands and Switzerland. Twenty-two guidelines were medical and eleven were procedural. Medical guidelines mainly treated the same topics. Procedural guidelines were more variable.

Conclusion: Assessment of work disability is comparable between countries. Medical and procedural guidelines should be further developed and tested on their value in practice. The procedural guidelines need to be published in a clear and comparable manner. The legal security of claimants would be endorsed by this. Germany and the Netherlands are most experienced and could take the lead in international development.

Zusammenfassung

Hintergrund: Begutachtungen hinsichtlich des Leistungsvermögens bei verminderter Erwerbsfähigkeit werden durch Experten in der Rentenbegutachtung durchgeführt. Die Begutachtungspraxis ist in vielen Nationen noch wenig evidenzbasiert. Begutachtungsleitlinien nach den Kriterien der evidenzbasierten Medizin werden in der Sozialversicherung nur vereinzelt angewendet. Die wissenschaftliche Entwicklung auf dem Gebiet der Sozialversicherungsmedizin scheint langsam voranzugehen, da sich Versicherungsmedizin von klinischer Medizin unterscheidet.

Ziel: Wir haben die Begutachtungspraxis zur verminderten Erwerbsfähigkeit in verschiedenen Nationen einer vergleichenden Analyse unterzogen und untersucht, in welchen Nationen verbindliche Leitlinien Anwendung finden.

Methodik: Mittels eines standardisierten Fragebogens wurden Experten in der Rentenbegutachtung aus 18 europäischen Nationen zur Begutachtungspraxis befragt. Aus den Antworten wurde eine vergleichende Übersichtstabelle erstellt und anschließend an alle Mitwirkenden vorgelegt zur Prüfung. Des weiteren erfolgte eine Visitation der Nationen, die Leitlinien anwenden. Vorliegende Leitlinien wurden kategorisiert und ihr Inhalt verglichen. Die Ergebnisse wurden abschließend den Experten der teilnehmenden Nationen zur Prüfung und Kommentierung vorgelegt.

Resultate: 14 Nationen nahmen an unserer Studie teil. Die Bewertung der funktionellen Kapazität war innerhalb der verschiedenen Nationen gebräuchlich. Leitlinien zur Begutachtung setzten Sozialmediziner offiziell in Deutschland, Irland, der Schweiz und den Niederlanden ein. 22 Leitlinien waren medizinisch und 11 Leitlinien prozedural ausrichtet. Hierbei wiesen die prozeduralen Leitlinien mehr Variabilität auf.

Schlussfolgerung: Zwischen den verschiedenen Nationen sind die Begutachtungen bezüglich der verminderten Erwerbsfähigkeit vergleichbar. Medizinische und prozedurale Leitlinien sollten aber weiterentwickelt und auch in der Praxis auf ihre Validität untersucht werden. Die prozeduralen Leitlinien benötigen ferner eine Verbreitung in Form einer klaren und vergleichbaren Anwendungsweise. Dieses würde die Rechtssicherheit der Antragsteller stärken. Der Wissensstand und die Forschung sind in Deutschland und in den Niederlanden auf dem Gebiet der sozialmedizinischen Begutachtungen am weitesten entwickelt. Beide Nationen könnten in diesem Fachbereich eine führende Rolle einnehmen.

Key words

work disability - evaluation - guidelines - international

Schlüsselwörter

Erwerbsunfähigkeit - Begutachtung - Leitlinien - international

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Appendix A

Assessment of long term incapacity for work in European countries

Country	Belgium	Czech Republic	Finland (Tyel) Private scheme
aspects the claimants are assessed on.	– new or aggravating health problem that causes work cessation – loss of earning capacity of over 2/3 with regard to suitable reference jobs. – duration of benefit	– reduced ability to participate in gainful activity in percentage (at least 33% for partial disability, at least 66% for full disability). – possibility of rtw actions – permanence of this incapacity.	– illness, defect or injury that causes a decrease in earning or prevents claimant from working for over 40% (or over 60% partial disability) – treatment and – vocational/non-vocational rehabilitation. – prognosis of at least a year of incapacity.

Country:	Finland (Kela) Public scheme	France	Germany
aspects the claimants are assessed on.	– is it an illness, defect or injury that causes a decrease in earning or prevents claimant from working. – possibility of treatment and rehabilitation first – prognosis of permanent incapacity.	– health condition – loss of functional capacity of 2/3 or over. – loss of earning capacity of 2/3 or over	rehabilitation (medical and rtw) is investigated. prognosis aetiology work incapacity in working hours (complete: 0–3 h/partial: 3–6 h/none: 6–8 h), what disabilities does the client have. work intensity, work organisation.

Country	Hungary	Ireland	Italy
aspects the claimants are assessed on.	– functional capacity – earning capacity prognosis	– health condition – capacity for all types of work – permanence of this incapacity	– health condition (afflicted by a mental or physical infirmity). – degree of restriction or loss of working capacity of or over 2/3 in any of the activities one had an aptitude for, or absolutely and permanently unable to perform any gainful activity – prognosis (disability must be permanent).

Country	The Netherlands	Norway	Slovakia
aspects the claimants are assessed on.	– disease or handicap that reduce – functional capacity in max. 56 items that causes – loss of earning capacity between 35% and 80% or over 80% – rehabilitation and – rtw activities in preceding two years of sick leave – actual possibilities for treatment and rtw – prognosis	– permanent disease, injury or impairment as cause of the loss of function that is the main cause of the loss of over 50% of earning capacity – adequate treatment and vocational rehabilitation with regard to age, capacities, education and possibilities for work. – effort to rtw	health condition prognosis notably impairments (in percentage from 41% upwards) loss of earning capacity (between 41–70% and 71 upwards).

Country	Slovenia	Sweden	Switzerland
aspects the claimants are assessed on.	change of health condition that reduces claimant's possibilities for getting or keeping one's job or getting promoted in one's career. three categories of invalidity.	loss of earning capacity (25%, 50%, 75%, 100%) prognosis	health condition capacity prognosis rehabilitation

Appendix B

Officially prescribed guidelines for evaluation of work disability in Germany, Ireland, the Netherlands and Switzerland

Germany:

Deutsche Rentenversicherung Leitlinien zur sozialmedizinischen Leistungsbeurteilung bei koronarer Herzkrankheit [guideline for the socio-medical assessment of coronary heart disease] 2005 http://www.drv.de

Deutsche Rentenversicherung Leitlinien zur sozialmedizinischen Beurteilung der Leistungsfähigkeit bei Mama-Karzinom [guideline for the socio-medical assessment of Breast Cancer] 2006 http://www.drv.de

Deutsche Rentenversicherung Leitlinien zur sozialmedizinischen Beurteilung der Leistungsfähigkeit bei Bandscheiden und Bandscheibenassoziierten Erkrankungen [guideline for the socio-medical assessment of Herniating intervertebral disc] 2005 http://www.drv.de

Deutsche Rentenversicherung Leitlinien zur sozialmedizinischen Leistungsbeurteilung bei chronisch obstruktiven Lungenkrankheiten (COPD) und Asthma Bronchiale [guideline for the socio-medical assessment of Chronic Obstructive Pulmonary Disease and Bronchial Asthma] 2005 http://www.drv.de

Deutsche Rentenversicherung Leitlinien für die sozialmedizinische Beurteilung von Menschen mit psychischen Störungen [guideline for the socio-medical assessment of people with mental disorders] 2006 http://www.drv.de

Deutsche Rentenversicherung Leitlinien zur sozialmedizinischen Leistungsbeurteilung bei chronisch entzündlichen Darmkrankheiten [guideline for the socio-medical assessment of chronic inflammatory bowel disease] 2005 http://www.drv.de

Deutsche Rentenversicherung Das ärztliche Gutachten für die gesetzliche Rentenversicherung; Hinweise zur Begutachtung [Medical guideline for the assessment], 2001 http://www.drv.de

Ireland:

Medical assessments no year http://www.welfare.ie/

The Netherlands

Gezondheidsraad Verzekeringsgeneeskundig protocol Angststoornissen [Guideline for social insurance physicians: Anxiety Disorders] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol HNP [Guideline for social insurance physicians: Herniating intervertebral disc] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Depressie [Guideline for social insurance physicians: Depressive Disorder] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Borstkanker [Guideline for social insurance physicians: Breast cancer] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Chronisch Vermoeidheidssyndroom [Guideline for social insurance physicians: Chronic Fatigue Syndrome] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Burn out [Guideline for social insurance physicians: Burn out] 2007 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol CVA [Guideline for social insurance physicians: Stroke] 2007 www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Whiplash Associated Disorders [Guideline for social insurance physicians: whiplash associated disorders] 2008 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Aspecifieke rugklachten [Guideline for social insurance physicians: Non Specific Lumbar Disorder for Social Insurance Physicians] 2008 http://www.gr.nl

Gezondheidsraad Verzekeringsgeneeskundig protocol Hartinfarct [Guideline for social insurance physicians: Myocardial Infarction] 2008 http://www.gr.nl

NVVG Verzekeringsgeneeskundig protocol Chronisch Hartfalen [Guideline for social insurance physicians: Chronic Heart Failure ] 2007 http://www.nvvg.nl

NVVG Verzekeringsgeneeskundig protocol arthrose van heup en knie [Arthritis Hip and Knee] 2007 http://www.nvvg.nl

NVVG Verzekeringsgeneeskundig protocol Reumatoide Artritis [Guideline for social insurance physicians: Rheumatoid Arthritis] 2007 http://www.nvvg.nl

NVVG Verzekeringsgeneeskundig protocol COPD [Guideline for social insurance physicians: Chronic Obstructive Lung Disease] 2007 http://www.nvvg.nl

NVVG Verzekeringsgeneeskundig protocol Schizofrenie en aanverwante stoornissen [Guideline for social insurance physicians: Schizophrenia and associated disorders] 2007 http://www.nvvg.nl

NVVG Verzekeringsgeneeskundig protocol chronische schouderklachten [Guideline for social insurance physicians: Chronic Shoulder Disorders] 2007 http://www.nvvg.nl

NVVG Richtlijn Medisch Arbeidsongeschiktheidscriterium [Guideline for social insurance physicians: medical criterion of incapacity for work], 1996 http://www.nvvg.nl

NVVG Standaard Geen duurzaam benutbare mogelijkheden [Guideline for social insurance physicians: permanent full disability] 1996 http://www.nvvg.nl

NVVG Standaard Communicatie met behandelaars [Guideline for social insurance physicians: communication with treating physicians] 1996 http://www.nvvg.nl

NVVG Standaard onderzoeksmethoden [Guideline for social insurance physicians: assessment methods] 2000 http://www.nvvg.nl

NVVG Rapportageprotocol [Guideline for social insurance physicians: report protocol social insurance medicine] 1999 http://www.nvvg.nl

NVVG Standaard urenbeperking [Guideline for social insurance physicians: restriction of working hours] 2000, http://www.nvvg.nl

NVVG Standaard professionele herbeoordeling [Guideline for social insurance physicians: professional criteria for reassessment] 2000 http://www.nvvg.nl

NVVG Standaard toegenomen arbeidsongeschiktheid door dezelfde oorzaak [Guideline for social insurance physicians: increased disability by the same cause] no year http://www.nvvg.nl

NVVG Gedragscode verzekeringsarts [code of conduct Social Insurance Physician] http://www.nvvg.nl

Switzerland:

Riemer Kafka G. (ed). Versicherungsmedizinische Gutachten [Evaluation in insurance medicine] Stampfli verlag AG Bern 2007

Correspondence