Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context

Abstract

Purpose: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists.

Materials and methods: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis.

Results: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to.

Conclusions: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits.

Implications for rehabilitation

• The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome.

• What is considered fair differs between assessing professionals and persons being assessed.

• Professionals may influence the perceptions of fairness through their way of communication.

• Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

Keywords:

• Work ability
• work disability
• sickness insurance
• return to work; assessment
• Sweden

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The study was funded by a research grant from the SSIA; however, the funding agency had no role in study design, data analysis, data interpretation, writing of the report, or the decision to submit for publication. The authors had full access to all the data in the study and had the final responsibility for the decision to submit for publication.