Assessment of work ability
If a person’s work ability is at risk or impaired, the situation may arise where the person’s work ability is assessed more closely. In the earnings-related pension system, work ability is assessed when a person applies for vocational rehabilitation, disability pension or years-of-service pension.
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Assessment is a matter of overall consideration
Assessing work ability covers a wide range because mere assessment of an individual’s physical and mental functional capacity is not enough. In addition, compatibility between the individual and the work must be assessed, and consideration must be given to what the person’s work ability would be in another type of work. Persons who cannot cope with their own work may be able to work in another job.
As defined in the legislation on earnings-related pensions, the assessment of work ability is based on overall consideration. This takes into account the applicant’s whole life history, age, education, work experience and social factors, as well as the restrictions resulting from an illness, injury or impairment and any work ability that may still remain.
If the applicant’s functional capacity is not sufficient for their previous occupation and duties, and it has been determined that there is a risk of disability even at the general level within the next few years, continued employment can be supported through the means of vocational rehabilitation. Vocational rehabilitation offered by pension providers always takes precedence over a disability pension.
Various definitions of disability
Both vocational rehabilitation and disability pensions are based on the law. In addition to pension providers, both Kela and traffic and accident insurance institutions grant vocational rehabilitation and disability pensions. Different laws give different definitions of what disability means and what ensues from it.
When assessing work ability and disability, work ability is mirrored against the definitions of the law and the person’s ability to continue working. Disability thus is not a diagnosis; it is a legal concept defined by law.
The Acts on earnings-related pensions have three different definitions of disability: partial disability; total disability; and occupational disability separately for people over 60 years of age.
- A person whose work ability has decreased by at least two-fifths is considered to have partial disability.
- A person whose work ability has decreased by at least three-fifths is considered to have total disability.
- The work ability of a person over the age of 60 is assessed in relation to the person’s latest job, in addition to which the length of employment and coping with work are taken into account.
In addition, the assessment of disability in the public sector differs from that in the private sector since disability is compared to the person’s own work and occupation.
The Seafarers’ Pensions Act, the Workers’ Compensation Act, the National Pensions Act, and the Health Insurance Act also have their own definitions of disability.
Disabled according to the Health Insurance Act or the Earnings-related Pension Acts?
The widest differences in the definition of disability are found between the Health Insurance Act and the Earnings-related Pension Acts.
In the Health Insurance Act, the definition of disability is occupational. When people fall ill and are unable to cope with their own work, they are entitled to sickness allowance from Kela for 300 days. They are then considered to be occupationally disabled.
If the illness is so serious or lasts for so long (more than a year without interruption) that applying for a pension becomes timely, the disability will be assessed in accordance with the Employment Pensions Acts. In this case, the person’s ability to work is generally compared against any work that he or she can reasonably be expected to do. The assessment of work ability may therefore change, even if the state of health remains unchanged. This is because the underlying legislation has changed.
Medical adviser’s role in the assessment of work ability
The work ability assessment made by the earnings-related pension provider is always based on the application for a disability pension and the related opinions. The decision on work ability should be based on medical findings. Therefore, the assessment on work ability is made on the basis of documents. The decision is made by a group of experts appointed by the pension provider, one of whom is the medical adviser.
The medical adviser makes an overall assessment of the decline in the applicant’s work ability and the applicant’s remaining ability to earn a living through work. The assessors review the opinions of various attending physicians, medical records, and other documents about the applicant’s illness and medical history. The medical adviser evaluates this information against the benefit criteria defined by law. In connection with an application for a disability pension, the threat of disability and the possibilities of influencing it by means of vocational rehabilitation are also assessed.
The medical adviser assesses the applicant’s ability to continue working from the perspectives of medical and social insurance legislation. The medical adviser participates in preparing the decision as one expert among lawyers, rehabilitation experts, pension adjudicators and other specialists.
The case of an individual applicant is also compared to previous applications and decisions. This is an attempt to ensure that the decisions are the same for everyone in the same situation. Pension providers also monitor the decisions made by appeal bodies.
Differences between an attending physician and a medical adviser
It is the duty of the attending physician to provide the pension provider with the information necessary for the pension decision. Attending physician
- examines the patient
- assesses the patient’s functional capacity
- makes a diagnosis
- arranges the necessary care and draws up a rehabilitation plan
- monitors the patient’s recovery
- draws up a statement in which the physician describes the patient’s situation and coping at work.
The medical adviser assesses whether the attending physician’s description meets the criteria required by law for awarding a disability pension. Medical adviser
- reviews the opinions of the attending physicians
- ensures that the patient is properly examined and treated
- ensures that all applicants are treated equally and fairly
- assesses the type of work for which the applicant’s remaining work ability is sufficient or insufficient
- assesses, in the framework of the general assessment of work ability, whether the applicant is at risk of becoming disabled within the next few years and whether this risk can be affected by means of vocational rehabilitation
- provides medical grounds for the decision on disability.
Source: Finnish Medical Association
Almost all medical advisers have a degree in some medical specialization and have typically worked as attending physicians for a fairly long time before becoming a medical adviser. Many medical advisers work as attending physicians at the same time, but they may not take part in the handling of their own patients’ benefits or participate in any way in treating applicants for benefits.
In addition to their medical expertise, medical advisers must be familiar with the legislation on social benefits and the criteria laid down by law.
Both the attending physician and the medical adviser are bound by the same medical ethics and responsibilities. They both perform their statutory duties.