27 Jan Approval of Medical Disability Claims Vary By the Examiner
MedicalResearch.com Interview with:
Prof. Dr. Regina Kunz
Professorin für Versicherungsmedizin
Evidence-based Insurance Medicine I Departement Klinische Forschung
MedicalResearch.com: What is the background for this study?
Response: Many workers seek wage replacement benefits due to a disabling illness or injury. Public and private insurance systems provide wage replacement benefits for such employees, as long as eligibility criteria are met. Insurers often arrange for evaluation of eligibility by medical professionals, but there are concerns regarding low quality evaluations and poor reliability between medical experts assessing the same claimant. In order to better understand this situation, we performed a systematic review of reproducibility studies on the inter-rater agreement in evaluation of disability.
We carried out a systematic review of 23 studies, conducted between 1992-2016, from 12 countries in Europe, North America, Australia, the Middle East, and Northeast Asia. The studies include those carried out in an insurance setting, with medical experts assessing claimants for work disability benefits, and in a research setting, where evaluation of patients took place outside of actual assessments, for example, for rehabilitation.
MedicalResearch.com: What are the main findings?
Response: Despite their widespread use, medical evaluations of work disability show high variability and often low reliability. Use of standardised and validated instruments to guide the process could improve reliability. Promising targets include formal training in evaluation of capacity to work, use of standardised instruments to guide disability evaluations, and addressing the conflict of interest that arises when insurers select their own experts.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There is an urgent need for high quality research, conducted in actual insurance settings, to explore promising strategies to improve agreement in evaluation of capacity to work.
MedicalResearch.com: Is there anything else you would like to add?
Response: Dr. Busse acts as a consultant to Prisma Health Canada, a private incorporated company funded by employers and insurers that consults on and manages long term disability claims. The Evidence-based Insurance Medicine Unit at the University Hospital in Basel is funded in part by donations from public insurance companies and a consortium of private insurance companies (Dr. Kunz). After the manuscript was finalised, Dr. Kunz took a part time position at the Swiss National Accident Insurance Fund, Suva. Drs. Kunz, Barth, Busse, de Boer, and Hoving were initiators of Cochrane Insurance Medicine.
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Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j14 (Published 25 January 2017)Cite this as: BMJ 2017;356:j14
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