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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.

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