A recent study shows high disagreement among medical experts assessing disability claims
Claims for work disability benefits are accepted or rejected based on the assessment of a medical expert. However, each medical expert may have their own opinion, which may significantly affect the outcome of the case.
InsideHalton.com reported on a study published in BMJ which found considerable disagreement among medical experts assessing disability claims. “If you have two professionals and they assess the same individual, they very often do not agree on whether that person can return to work or not,” said Jason Busse, an insurance medicine researcher at McMaster University and co-author of the study.
Work disability claims are often assessed by experts other than the treating physicians, who are assumed to be too familiar with their patient to be objective. However, independent medical professionals hired by insurance companies may also be biased. “There is the possible conflict that arises when you know who is paying you and you know their interest in the result,” Busse said.
Researchers from McMaster, the Netherlands, and Switzerland reviewed 23 studies conducted between 1992 and 2016 in 12 countries. They looked primarily at claims involving mental health and musculoskeletal disease, and found that evaluators disagreed in nearly two thirds of the studies that were done in an insurance setting.
“[T]here is evidence that worldwide, approximately half of all disability claims are rejected on the basis of these independent medical evaluations,” Busse said. “We need to understand the sources of variability and look for opportunities to target them.”
The results of the study raise a possible need to standardize the evaluation process for disability assessments. However, Katherine Lippel, who holds the Canada Research Chair on Occupational Health and Safety Law at the University of Ottawa, has concerns about that idea.
“Depending on what you put in the form, you are going to standardize but not necessarily in a way that is going to improve the equity of your system,” Lippel said. “I would be very wary of a suggestion that we could improve our policies by making sure everything is standardized so the doctors have no discretion.”
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