Who qual­i­fies for dis­abil­ity? De­pends who’s as­sess­ing: study

The Hamilton Spectator - - LOCAL - JOANNA FRKETICH

Who qual­i­fies for work dis­abil­ity ben­e­fits will of­ten de­pend on which doc­tor is do­ing the as­sess­ment, Hamil­ton re­searchers con­clude.

In a study pub­lished Jan. 26 in the Bri­tish med­i­cal jour­nal BMJ, they found high dis­agree­ment among med­i­cal ex­perts as­sess­ing dis­abil­ity claims.

“If you have two pro­fes­sion­als and they as­sess the same in­di­vid­ual, they very of­ten do not agree on whether that per­son can re­turn to work or not,” said Ja­son Busse, an au­thor of the study who con­ducts re­search into in­surance medicine at McMaster Uni­ver­sity.

“You have this prob­lem where you’ve got large num­bers of in­di­vid­u­als be­ing re­ferred for these as­sess­ments and it’s quite in­flu­en­tial in their lives and the ev­i­dence sug­gests the re­sult of­ten de­pends on who does it.”

Call­ing the re­sults “dis­con­cert­ing,” the re­searchers from McMaster, Switzer­land and the Nether­lands warn ev­i­dence is lim­ited on the re­li­a­bil­ity of as­sess­ments.

“There is an ur­gent need for high qual­ity re­search, con­ducted in ac­tual in­surance set­tings, to ex­plore promis­ing strate­gies to im­prove agree­ment,” the study says.

Treat­ing physi­cians of­ten don’t do the as­sess­ments be­cause of con­cerns they aren’t ob­jec­tive enough about their pa­tients’ abil­i­ties, Busse told The Spec­ta­tor.

But he said there are also ques­tions about the in­de­pen­dence of med­i­cal pro­fes­sion­als hired by in­surance com­pa­nies.

“There is the pos­si­ble con­flict that arises when you know who is pay­ing you and you know their in­ter­est in the re­sult,” Busse said.

Re­searchers re­viewed 23 stud­ies done be­tween 1992 and 2016 in 12 coun­tries, look­ing pri­mar­ily at claims in­volv­ing men­tal health and mus­cu­loskele­tal dis­ease. They found dis­agree­ment among eval­u­a­tors about the claimant’s abil­ity to re­turn to work in nearly two-thirds of the stud­ies that took place in an in­surance set­ting.

“The find­ings are sig­nif­i­cant be­cause there is ev­i­dence that world­wide ap­prox­i­mately half of all dis­abil­ity claims are re­jected on the ba­sis of these in­de­pen­dent medi-

cal eval­u­a­tions,” said Busse. “We need to un­der­stand the sources of vari­abil­ity and look for op­por­tu­ni­ties to tar­get them.”

The study raises the prospect of us­ing a stan­dard­ized eval­u­a­tion.

But that idea was met with con­cern by Kather­ine Lip­pel, who holds the Canada Re­search Chair on Oc­cu­pa­tional Health and Safety Law at the Uni­ver­sity of Ot­tawa. She was not in­volved in the un­funded re­search.

“De­pend­ing on what you put in the form, you are go­ing to stan­dard­ize but not nec­es­sar­ily in a way that is go­ing to im­prove the eq­uity of your sys­tem,” Lip­pel said.

“I would be very wary of a sug­ges­tion that we could im­prove our poli­cies by mak­ing sure ev­ery­thing is stan­dard­ized … Train­ing physi­cians as to their role and more train­ing in med­i­cal school on oc­cu­pa­tional haz­ards, I’d put my money on that much more quickly than on a stan­dard­ized form.”

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