Independent medical evaluations are often used to adjudicate disability claims. But different doctors assessing the same patient often disagree on whether the patient is disabled or not. This problem can be mitigated by applying standardized procedures, says an international study led by researchers at the University of Basel and the University Hospital Basel in Switzerland. The results have just been published in the scientific journal BMJ.
The findings from a team of researchers from Switzerland, the Netherlands and Canada are based on a systematic review of 23 studies by scientists and insurance companies across 12 countries. The earlier studies had analyzed the extent to which healthcare providers agreed when assessing patients’ capacity to work in situations where this could validate disability claims.
Half of the claims were rejected
“Globally, around half of all disability claims were denied based on independent medical evaluations. However, our review of the studies found that experts are frequently in disagreement on whether an individual is incapable of working,” says Regina Kunz, Professor of Insurance Medicine at the University of Basel and Head of Evidence-based Insurance Medicine at the University Hospital Basel.
Medical evaluations are often used to assess a person’s capacity to work and have far-reaching consequences for employees, whose ability to work can be restricted by illness or accident.
Lack of standards
The reason medical professionals tend to offer varying assessments can likely be traced back to the lack of standards. “We found evidence that structured evaluation processes could improve the reliability of assessments,” said Regina Kunz.
“Any assessment cannot be valid unless it is reliable – that is, if it is incapable of measuring what it is supposed to measure,” adds co-author Jason W. Busse of McMaster University in Hamilton, Canada. “Our findings are troubling because disability claimants need valid assessments – on the one hand, to avoid delays in wage replacement benefits, and on the other to prevent prolonged disability by ensuring they receive the appropriate care.”
As a result, researchers determined that tools and structured approaches needed to be developed and tested in order to improve the assessment of incapacity to work.
Professor Kunz’s research team succeeded in developing and evaluating a new method – function-oriented assessment – for people with mental disorders as part of a study funded by the Swiss National Science Foundation, the Swiss Federal Social Insurance Office (BSV) and the Swiss National Accident Insurance Fund (Suva). The results will be presented in the near future.
Jürgen Barth, Wout E.L. de Boer, Jason W. Busse, Jan L. Hoving, Sarah Kedzia, Rachel Couban, Katrin Fischer, David von Allmen; Jerry Spanjer, Regina Kunz
Inter’rater agreement of disability evaluation: A systematic review of reproducibility studies
BMJ (2017), doi: 10.1136/bmj.j14