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