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Original article

Vol. 145 No. 3334 (2015)

Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders

  • Stefan Schandelmaier
  • Andrea Leibold
  • Katrin Fischer
  • Ralph Mager
  • Ulrike Hoffmann-Richter
  • Monica Susanne Bachmann
  • Sarah Kedzia
  • Jason Walter Busse
  • Gordon Henry Guyatt
  • Joerg Jeger
  • Renato Marelli
  • Wout Ernst Lodewijk De Boer
  • Regina Kunz
DOI
https://doi.org/10.4414/smw.2015.14160
Cite this as:
Swiss Med Wkly. 2015;145:w14160
Published
09.08.2015

Summary

QUESTIONS: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process.

METHODS: We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation.

RESULTS: Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts’ findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts’ delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable.

CONCLUSIONS: Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

References

  1. Riemer-Kafka G. Medical expertises. [An interdisciplinary guidance on medical and legal issues.] Versicherungsmedizinische Gutachten. Ein interdisziplinärer juristisch-medizinischer Leitfaden. 2nd ed. Universität Luzern: Stämpfli Verlag, AG Bern; 2012.
  2. Federal Social Insurance Office, Switzerland [Bundesamt für Sozialversicherungen]. Swiss statistics about social security [Statistiken zur Sozialen Sicherheit: IV-Statistik 2013]. 2014. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/news/publikationen.Document.178872.pdf
  3. Federal Social Insurance Office, Switzerland [Bundesamt für Sozialversicherungen]. Informations about essential changes and revisions within the disability insurance. [Informationen zu den wichtigsten Änderungen und Revisionen in der Invalidenversicherung]. 2014. Available from: http://www.bsv.admin.ch/themen/iv/00021/03189/?lang=de
  4. Swiss Federal Court [Schweizerisches Bundesgericht]. Verdict BGE 130 V 352 [Internet]. 2004. Available from: http://www.bger.ch
  5. Swiss Federal Court [Schweizerisches Bundesgericht]. Verdict 9C_243/2010. 2011. Available from: http://www.bger.ch
  6. Griffith LE, Cook DJ, Guyatt GH, Charles CA. Comparison of open and closed questionnaire formats in obtaining demographic information from Canadian general internists. J Clin Epidemiol. 1999;52(10):997–1005.
  7. SIM (Swiss Insurance Medicine). Guidance for evaluating work capacity following injury or illness [Leitlinie zur Beurteilung der Arbeitsunfähigkeit nach Unfällen und bei Krankheit]. 2013. Available from: http://www.swiss-insurance-medicine.ch/de/leitlinie-zur-beurteilung-der-arbeitsunfaehigkeit.html
  8. Bennett C, Khangura S, Brehaut JC, Graham ID, Moher D, Potter BK, et al. Reporting guidelines for survey research: an analysis of published guidance and reporting practices. PLoS Med. 2010;8:e1001069.
  9. Ebrahim S, Sava H, Kunz R, Busse JW. Ethics and legalities associated with independent medical evaluations. CMAJ Can Med Assoc J J Assoc Medicale Can. 2014;186(4):248–9.
  10. Spanjer J, Krol B, Brouwer S, Groothoff JW. Sources of variation in work disability assessment. Work. 2010;37(4):405–11.
  11. Anner J, Kunz R, Boer W. Reporting about disability evaluation in European countries. Disabil Rehabil. 2014;36:848–54.
  12. Busse JW, Bruun-Meyer SE, Ebrahim S, Kunz R. A 45-year-old woman referred for an independent medical evaluation by her insurer. Can Med Assoc J. 2014;186(16):E627–30.
  13. Colomb E, Dittmann V, Ebner G, Hermelink U, Hoffmann-Richter U, Kopp E, et al. Qualitätsleitlinien für psychiatrische Gutachten in der Eidgenössischen Invalidenversicherung [Internet]. Swiss Society of Psychiatry and Psychotherapy; 2012. Available from: http://www.psychiatrie.ch
  14. The legal basis in medical practice. A practical guide. [Rechtliche Grundlagen im medizinischen Alltag. Ein Leitfaden für die Praxis.]. 2nd rev. Swiss Medical Association; Swiss Academy of Medical Sciences.; 2013.
  15. Federal Social Insurance Office, Switzerland [Bundesamt für Sozialversicherungen]. Conduct of interdisciplinary evaluations of work capacity for the allocation of disability benefits [Durchführung von polydisziplinären Gutachten zur Beurteilung von Leistungsansprüchen in der Invalidenversicherung]. 2012. Available from: http://www.news.admin.ch/NSBSubscriber/message/attachments/26524.pdf
  16. Swiss Society of Rheumatology [Schweizerische Gesellschaft für Rheumatologie]. Guidance of the Swiss Society of Rheumatology for evaluating work capacity following injury [Leitlinien der SGR zur Begutachtung rheumatologischer Krankheiten und Unfallfolgen]. Schweiz Ärzteztg. 2007;88(17):735–42.
  17. Camerer C, Johnson EJ. The Process-Performance Paradox in Expert Judgment: How Can Experts Know So Much and Predict So Badly? In: Toward a General Theory of Expertise: Prospects and Limits, K Anders Ericsson and Jacqui Smith (Eds). New York: Cambridge University Press; p. 195–217.
  18. Giegerenzer G, Hertwig R. Heuristics: The Foundations of Adaptive Behavior. New York: Oxford University Press; 2011.
  19. Shanteau J. How much information does an expert use? Is it relevant? Acta Psychol (Amst). 1992;81(1):75–86.
  20. Ontario Medical Association. Medical Care and Practice Committee. Position in support of timely return to work programs and the role of the primary care physician [position paper]. Toronto; 1994.
  21. Kurtz S, Silverman J, Draper J. Teaching & Learning Communication Skills in Medicine. Radcliffe Medical Press; 1999.
  22. Boer WE de, Wind H, Dijk FJ van, Willems HH. Interviews for the assessment of long-term incapacity for work: a study on adherence to protocols and principles. BMC Public Health. 2009;9(1):169.
  23. Osteras N, Gulbrandsen P, Kann IC, Brage S. Structured functional assessments in general practice increased the use of part-time sick leave: a cluster randomised controlled trial. Scand J Public Health. 2010;38:192–9.
  24. Osteras N, Gulbrandsen P, Benth JS, Hofoss D, Brage S. Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial. BMC Fam Pr. 2009;10:31.
  25. Speroff T, Sinnott PL, Marx B, Owen RR, Jackson JC, Greevy R, et al. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial. J Trauma Stress. 2012;25(6):607–15.
  26. Jeger J. Issue of fact or law? Challenges in discriminating medical and legal issues in the context of work capacity evaluation. A comment from the medical perspective [Tatfrage oder Rechtsfrage? Abgrenzungsprobleme zwischen Medizin und Recht bei der Beurteilung der Arbeitsfähigkeit in der Invalidenversicherung. Ein Diskussionsbeitrag aus der Sicht eines Mediziners (Teil 2)]. Schweiz Z Für Sozialversicherung Berufliche Vorsorge. 2011;6:580–611.
  27. Swiss Federal Court [Schweizerisches Bundesgericht]. Verdict 9C_850/2013 des Schweizerischen Bundesgerichtes vom 12.06.2014. Available from: http://www.bger.ch. 2014.
  28. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. N Engl J Med. 2008;358(3):252–60.
  29. Adler DA, Irish J, McLaughlin TJ, Perissinotto C, Chang H, Hood M, et al. The work impact of dysthymia in a primary care population. Gen Hosp Psychiatry. 2004;26(4):269–76.
  30. Jeger J. Die Entwicklung der FOERSTER-Kriterien und ihre Übernahme in die bundesgerichtliche Rechtsprechung: Geschichte einer Evidenz. Jusletter. 2011 Mai; Available from: http://www.jusletter.ch
  31. Dickmann JR, Broocks A. Psychiatric expert opinion in case of early retirement – how reliable?. Fortschr Neurol Psychiatr. 2007;75:397–401.
  32. Clark WL, Haldeman S, Johnson P, Morris J, Schulenberger C, Trauner D, et al. Back impairment and disability determination. Another attempt at objective, reliable rating. Spine Phila Pa 1976. 1988;13(3):332–41.

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