Evaluators Often Disagree About Who Needs Disability Benefits

By Lisa Rapaport

February 03, 2017

(Reuters Health) - Medical experts who assess workers to see if they need disability benefits often don't reach the same conclusion, according to a review of research that questions the quality of these evaluations.

Private insurers and government programs in many countries worldwide use medical experts to evaluate workers who claim that illness or injury limits their ability to work. The experts decide whether the employee's health problems merit disability benefits designed to replace lost wages.

For the current study, researchers examined data in 23 studies conducted between 1992 and 2016 in 12 countries in Europe, North America, the Middle East and Northeast Africa.

In 63 percent of studies, medical experts reached only low to moderate agreement on workers' capacity to do their jobs, researchers report in The BMJ, online January 25.

"This problem seems to be universal," said senior study author Dr. Regina Kunz, a researcher at the University of Basel in Switzerland.

"What we found is the challenge to decide on the threshold when a health problem is 'severe enough' to qualify for disability benefits," Kunz added by email. "No gold standard exists as of today to determine this threshold."

For the current analysis, Kunz and colleagues examined data from 16 studies conducted in an insurance setting and seven done in research settings.

Studies done in the insurance setting were conducted with medical experts assessing claimants who were actual workers seeking disability benefits or actors portraying hypothetical cases.

Workers were seeking benefits for mental health problems in 38 percent of cases, physical injuries or illnesses in 25 percent of instances and a combination of both mental and physical issues in 38 percent of cases.

Only seven of the insurance studies, or 44 percent, were generalizable to real life evaluations, the study found. Another three insurance studies, or 19 percent, were rated as "probably generalizable."

Researchers saw an "excellent" level of reliability in results for just two insurance studies.

By contrast, five of the studies done in research settings, or 71 percent, had "excellent" reliability in results, the current analysis found.

Conclusions were particularly unreliable when medical experts assessed workers for subjective complaints or chronic health problems, or when they didn't use a standardized set of measurements or questions to determine if people needed disability benefits.

Taken together, the authors conclude, these results suggest that there might be greater need for strategies to improve agreement when patients present with subjective complaints and better understanding of factors that contribute to variability in evaluations of capacity to work.

One limitation of the current study is that the researchers looked at previous studies with wide variation in design, outcome measurements and size, the authors note. This made it difficult to draw statistically meaningful conclusions from the current analysis, they point out.

Mental health problems in particular can stymie evaluators, and are often exacerbated because people don't get adequate mental health care or vocational services, said Dr. Robert Drake, a health policy researcher at The Dartmouth Institute in Hanover, New Hampshire, who wasn't involved in the study.

"Many people are disabled temporarily and need help but get trapped in the disability system," Drake said by email. "Continuing reviews do not help. We need to have more sensible rules, and patients need better mental health and vocational services."

SOURCE: https://bit.ly/2kuezhN

BMJ 2017.