Work Disability Evaluation

  • Sören BrageEmail author
  • Ása Dóra Konráðsdóttir
  • Gert Lindenger
Part of the Handbooks in Health, Work, and Disability book series (SHHDW)


In this chapter, we describe how the evaluation of work disability is carried out in social insurance institutions in Europe. Work disability evaluation is necessary in two different situations with different aims. One is to find the best return-to-work process for employees who are absent from work due to health problems. The other is to decide on claims for short- and long-term benefits, like sickness benefits or disability benefits. In vocational rehabilitation, the emphasis lies on return-to-work processes, while the social insurance institutions traditionally have focused on the eligibility of claims. A comparison between these two aims is done. For both aims, the ICF can provide social security with a consistent framework for description and assessment of functional abilities. It can also provide a taxonomy that can improve interprofessional communication in evaluation procedures in social insurance institutions.

We describe a generic EUMASS Core Set for the assessment of functional abilities in disability claims, and how it has been developed and tested. With examples from Sweden, Iceland, and Norway, we also describe how ICF has been implemented at various levels in social insurance and in vocational rehabilitation.


Work Ability Work Disability Disability Benefit Disability Evaluation Insurance Physician 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    World Health Organization. ICF-international classification of functioning, disability, and health. Genève: World Health Organization; 2001.Google Scholar
  2. 2.
    Brage S, Donceel P, Falez F. Development of ICF core set for disability evaluation in social security. Disabil Rehabil. 2008;30:1392–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Anner J, Brage S, Donceel P, Falez F, Freudenstein R, Oancea C, de Boer WEL. Validation of the EUMASS Core Set for medical evaluation of work disability. Disabil Rehabil. 2013;35:2147–56.PubMedCrossRefGoogle Scholar
  4. 4.
    Timner K. Die Bedeutung der ICF für die sozialmedizinische Beurteilung in der gesetzlichen Rentenversicherung. Der Medizinische Sachverständiger. 2008;104:15–7.Google Scholar
  5. 5.
    Morgell R, Backlund LG, Arrelöv B, Strender L-E, Nilson GH. Health problems and disability in long-term sickness absence: ICF coding of medical certificates. BMC Public Health. 2011;11:860.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Escorpizo R, Stucki G. Disability evaluation, social security, and the international classification of functioning, disability, and health. J Occup Environ Med. 2013;55:644–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Nordenfelt L. The concept of work ability. Brussels: P.I.E. Peter Lang; 2008.Google Scholar
  8. 8.
    OECD. Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries. Paris: OECD; 2010.Google Scholar
  9. 9.
    Mabbet D, Bolderson H, Hvinden B. Definitions of disability in Europe: a comparative analysis. Uxbridge: Brunel University; 2002.Google Scholar
  10. 10.
    de Boer WEL, Besseling JJM, Willems JHBM. Organisation of disability evaluation in 15 countries. Pratiques et organisation des soins. 2007;38:205–17.Google Scholar
  11. 11.
    EUMASS. Social security medicine in Europe: professional sick leave: the role and functions of professionals in managing sick leave in different European countries. 2011. At:
  12. 12.
    Brage S. Legers oppgaver ved søknad om uførepensjon i fem europeiske land [Physician work tasks in applications for disability benefits in five European countries] (in Norwegian). Arbeid og Velferd. 2010;4:70–80.Google Scholar
  13. 13.
    Anner J, Schwegler U, Kunz R, Trezzini B, de Boer WEL. Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not. BMC Public Health. 2012;12:470.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Harrington M. An independent review of the work capability assessment – year two. London: The Stationery Office; 2011.Google Scholar
  15. 15.
    Medical Services. Training & development revised WCA handbook. ESA (LCW/LCWRA) Amendment Regulations; 2011.Google Scholar
  16. 16.
    Boer de WEL. Quality of evaluation of work disability. Ph.D. thesis, University of Amsterdam; 2010.Google Scholar
  17. 17.
    Ptyushkin P, Vidmar G, Burger H, Marinček C, Escorpizo R. The International Classification of Functioning, Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users’ perspective. Disabil Rehabil. 2011;33(2):130–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Solli HM. Justice, objectivity and disability assessment within social insurance medicine. An ethical and scientific-philosophical analysis of three disability models, seen in a historical perspective (in Norwegian). Ph.D. thesis, Michael. 2007;4(3):195–520.Google Scholar
  19. 19.
    Schwegler U, Anner J, Boldt C, Glässel A, Lay V, de Boer WEL, Stucki G, Trezzini B. Aspects of functioning and environmental factors in medical work capacity evaluations of persons with chronic widespread pain and low back pain can be represented by a combination of applicable ICF Core Sets. BMC Public Health. 2012;12:1088.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Gjesdal S, Bratberg E. Diagnosis and duration of sickness absence as predictors for disability pension: results from a three-year, multi-register based and prospective study. Scand J Public Health. 2003;31:246–54.PubMedCrossRefGoogle Scholar
  21. 21.
    Krohne K, Brage S. New rules meet established sickness certification practice: a focus-group study on the introduction of functional assessments in Norwegian primary care. Scand J Prim Health Care. 2007;25:172–7.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Larson J. Metoder för bedömning av arbetsförmåga inom sjukförsäkringen – slutrapport [Methods for assessment of job capacity in social insurance – a final report (in Swedish)]. Stockholm: Försäkringskassan; 2013.Google Scholar
  23. 23.
    Nilsing E, Söderberg E, Öberg B. Sickness certificates in Sweden: did the new guidelines improve their quality? BMC Public Health. 2012;12:907.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Østerås 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 Pract. 2009;10:31.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Frank AO, Sawney P. Vocational rehabilitation. J R Soc Med. 2003;96:522–4.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Chamberlain MA, Moser VF, Ekholm KS, O’Connor RJ, Herceg M, Ekholm J. Vocational rehabilitation: an educational review. J Rehabil Med. 2009;41:856–69.PubMedCrossRefGoogle Scholar
  27. 27.
    Escorpizo R, Finger ME, Glässel A, Cieza A. An international expert survey on functioning in vocational rehabilitation using the international classification of functioning, disability and health. J Occup Rehabil. 2010;20:502–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Finger ME, Escorpizo R, Glässel A, Gmünder HP, Lückenkemper M, Chan C, Fritz J, Studer U, Ekholm J, Kostanjsek N, Stucki G, Cieza A. ICF Core Set for vocational rehabilitation: results of an international consensus conference. Disabil Rehabil. 2012;34(5):429–38.PubMedCrossRefGoogle Scholar
  29. 29.
    Waddell G, Burton AK, Kendall NAS. Vocational rehabilitation – what works, for whom, and when? Report for the Vocational Rehabilitation Task Group. London: TSO; 2008.Google Scholar
  30. 30.
    Konráðsdóttir ÁD. Work ability assessment – description and evaluation of a new tool in vocational rehabilitation and in disability claims. Master thesis, University of Bifröst; 2011.Google Scholar
  31. 31.
    Spanjer J. The disability assessment structured interview. Its reliability and validity in work disability assessment. Ph.D. thesis, University of Groningen; 2010.Google Scholar
  32. 32.
    Department of Work and Pensions. Transformation of the personal capability assessment. Report. London: DWP; 2006.Google Scholar
  33. 33.
    Litchfield P. An independent review of the work capability assessment – year four. London: The Stationery Office; 2013.Google Scholar
  34. 34.
    Linden M, Baron S, Muschalla B. Relationship between work-related attitudes, performance and capacities according to the ICF in patients with mental disorders. Psychopathology. 2010;43(4):262–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Madans JH, Loeb ME, Altman BM. Measuring disability and monitoring the UN convention on the rights of persons with disabilities: the work of the Washington Group on Disability Statistics. BMC Public Health. 2011;11 Suppl 4:54.CrossRefGoogle Scholar
  36. 36.
    Cieza A, Ewert T, Üstün B, Chatterji S, Kostanjsek N, Stucki G. Development of ICF core sets for patients with chronic conditions. J Rehabil Med Suppl. 2004;44:9–11.Google Scholar
  37. 37.
    Rondinelli RD, editor. Guides to the evaluation of permanent impairment. 6th ed. Chicago: AMA Press; 2008.Google Scholar
  38. 38.
    Nordenfelt L. On health, disability and activity: comments on some basic notions in the ICF. Disabil Rehabil. 2006;28:1461–5.PubMedCrossRefGoogle Scholar
  39. 39.
    World Health Organization. ICF-checklist. 2007. Available at:
  40. 40.
    Lindenger G. “Medical Conditions for Work” – how to assess work capacity using the international classification of functioning in Sweden. 15 Mar 2012. Available from:
  41. 41.
    SOU. Gränslandet mellan sjukdom och arbete [The borderland between sickness and work (in Swedish)]. SOU 2009:89. Stockholm; 2009.Google Scholar
  42. 42.
    Löfgren A, Hagberg J, Arrelöv B, Ponzer S. Frequency and nature of problems associated with sickness certification tasks: a cross sectional questionnaire study of 5455 physicians. Scand J Prim Health Care. 2007;25:178–85.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Nilsing E, Söderberg E, Normelli H, Öberg B. Description of functioning in sickness certificates. Scand J Public Health. 2011;39:508–16.PubMedCrossRefGoogle Scholar
  44. 44.
    OECD. Transforming disability into ability. Policies to promote work and income security for disabled people. Paris: OECD; 2003.Google Scholar
  45. 45.
    Dekkers-Sánchez PM, Wind H, Sluiter JK, Frings-Dresen MHW. What promotes sustained return to work of employees on long-term sick leave? Perspectives of vocational rehabilitation professionals. Scand J Work Environ Health. 2011;37(6):481–93.PubMedCrossRefGoogle Scholar
  46. 46.
    Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med. 2008;44:329–42.PubMedGoogle Scholar
  47. 47.
    Brage S, Fleten N, Knudsrød OG, Reiso H, Ryen A. Norsk Funksjonsskjema – et nytt instrument ved sykmelding og uførhetsvurdering. Tidsskr Nor Laegeforen. 2004;124:2472–4.PubMedGoogle Scholar
  48. 48.
    Østerås N, Gulbrandsen P, Garratt A, Benth JS, Natvig B, Brage S. A randomised comparison of a four- and a five-point scale version of the Norwegian Function Assessment Scale. Health Qual Life Outcomes. 2008;6:14.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Østerås N, Brage S, Garratt A, Benth JS, Natvig B, Gulbrandsen P. Functional ability in a population: normative survey data and reliability for the ICF based Norwegian Function Assessment Scale. BMC Public Health. 2007;7:278.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Strupstad J, Ihlebaek C, Øyeflaten I, Espnes GA. Arbeidsrettet rehabilitering i Norge [Vocational rehabilitation in Norway (in Norwegian)]. Utposten. 2011;3:26–32.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Sören Brage
    • 1
    Email author
  • Ása Dóra Konráðsdóttir
    • 2
  • Gert Lindenger
    • 3
  1. 1.Research UnitDirectorate for Labour and WelfareOsloNorway
  2. 2.VIRK Rehabilitation FundReykjavikIceland
  3. 3.Main OfficeSwedish Social Insurance AgencyStockholmSweden

Personalised recommendations