Conceptual Framework: Disability Evaluation and Vocational Rehabilitation

Abstract

Disability represents a major challenge that societies worldwide have to address and poses a burden at different levels: individual, societal, and economic. Disability can substantially and significantly impact work participation of individuals and hence may result in work disability. Assessment of disability in the context of work and employment is essential to guide and facilitate appropriate and adequate return-to-work (RTW) strategies and help ensure that the individual remains to be at work. Disability evaluation is crucial to determine a claimant’s eligibility for disability benefits as well as to establish appropriate levels of benefits. Disability evaluation also provides necessary information whether assignment to an RTW program is required before receiving disability benefits. Because the key information in disability evaluation refers to functioning and disability, standards for functioning assessment are instrumental in ensuring comparability, transparency, and fairness in disability evaluation. The internationally accepted standard for reporting information on functioning and disability is the International Classification of Functioning, Disability and Health (ICF) which could contribute to a transparent illustration of how impairments affect a claimant’s work activities, work participation, and work disability and identify the role of contextual factors in the process. The ICF can also be used to promote standardized reporting of work disability.

Glossary

Disability Evaluation

The assessment of the extent of a person’s work disability is among the key features of disability evaluation (DE). DE is instrumental to assign persons with disabilities (i.e., claimants) to the most appropriate return-to-work (RTW) programs, medical rehabilitation, and/or provision of assistive devices. DE is also crucial to determine claimants’ eligibility for disability benefits, to establish appropriate levels of benefits, and provides the necessary information whether assignment to an RTW program is required before receiving disability benefits.

Eligibility Determination for Benefits

DE in the context of eligibility determination for benefits is the “determination of the degree of a person’s physical, mental, or emotional [disability]. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for Social Security and workers’ compensation benefits.”

Functioning Assessments

Functioning assessments (FA) are core elements of DE across countries [2] and provide useful information for evaluating work disability. FA in the context of DE address the claimant’s ability to perform activities relevant for executing physical or cognitive work tasks such as lifting or focusing attention. There are differences in FA depending on whether the sole purpose for the DE is determining eligibility for benefits or also, respectively, exclusively considering RTW. Toward facilitating RTW, FA in DE focuses on the appraisal of the claimant’s functional performance. Assessments of functional limitations or abilities and influencing contextual factors such as the claimant’s living conditions or the situation on the job market are the basis for selecting appropriate RTW programs to enhance the claimant’s functioning at work and, finally, work participation. FA in DE toward eligibility determination for disability benefits are geared toward an objective statement on the claimant’s functional capacity in a standardized environment without considering the influence of contextual factors. The assessments provide key information for the determination of the relationship between impairments and functional limitations and, thus, for establishing a claimant’s work disability.

Return-to-Work Programs and Vocational Rehabilitation

Return-to-work (RTW) programs can be understood interchangeably with the term vocational rehabilitation (VR). Escorpizo et al. [19] defined VR as “a multi-professional evidence-based approach that is provided in different settings, services, and activities to working age individuals with health-related impairments, limitations, or restrictions with work functioning, and whose primary aim is to optimize work participation.” An RTW program is in principle VR of those who have previously worked with the ultimate goal of undertaking work duties long term. RTW programs encompass services such as job counseling, job placement, job matching, job coaching, skills development and retraining, provision of products and technology, work conditioning, or workplace modification.

Work Disability

In the context of RTW, work disability is defined as a claimant’s inability to work due to an illness or injury in the light of influencing contextual factors.

In the context of eligibility determination for disability benefits, work disability is seen as a legal concept with varying definitions among social security laws of different countries. However, work disability usually refers to a person’s inability to work due to an illness or injury without considering the influence of contextual factors.