Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not

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.

Assessing work ability – a cross-sectional study of interrater agreement between disability claimants, treating physicians, and medical experts

“…In the last decade, the International Classification of Functioning, Disability and Health (ICF) has been used to improve the assessment of disability, but even the use of this classification does not necessarily result in a reliable standardized evaluation of disability (26). Thus, there is an urgent need for validated instruments with which to assess work ability.…”

Arbeitsfähigkeitsbeschreibung bei psychischen Erkrankungen

“…Eine Arbeitsunfähigkeitsfeststellung kann nicht aufgrund einer Erkrankungssymptomatik allein erfolgen. Sie muss im Hinblick darauf erfolgen, ob die derzeit ausgeübte Tätigkeit krankheitsbedingt nicht oder nur mit der Gefahr, die Krankheit zu verschlimmern, ausgeübt werden kann [GBA, 2014;Foster und Pinals, 2014;Linden et al, 2015] [Anner et al, 2012].…”

“…Arbeitsfähigkeit ist in der bisherigen wissenschaftlichen Literatur unterschiedlich detailliert und auch inhaltlich heterogen definiert worden [MacDonald-Wilson et al, 2001;Lederer et al, 2014;Anner et al, 2012]. Dies ist unter anderem darauf zurückzuführen, dass Arbeitsfähigkeit in unterschiedlichsten Kontexten untersucht worden ist, z.B.…”

“…Arbeits fähigkeit ist vom Grundsatz her ein relatives Konzept: Arbeits fähigkeit ist keine der Person innewohnende Eigenschaft, sondern entsteht aus der Wechselwirkung von Person, Erkrankung und Arbeitsanforderungen [Lederer et al, 2014]. Auch mit der Einführung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) [WHO, 2001] [Linden et al, 2015;Anner et al, 2012].…”

Decision Support in Evaluating the Impacts of Mental Disorders on Work Ability

“…Psychiatric guidelines to the valuation of the impacts of mental disorders on work ability are sparse and inconclusive. Critics across Europe have pointed out the lack of quality and transparency of disability evaluation [1]. The financial impacts of work disability caused by mental disorders are significant, and thus it is essential to have a systematic process for evaluating the work ability of a person and to be able to determine the best treatment to restore and maintain it.…”