Measuring Functional Capacity and Work Requirements Summary of a Workshop (1999) / Chapter Skim
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5 The Use of Functional Capacity Measures in Public and Private Programs in the United states and in Other Countries
5 The Use of Functional Capacity Measures in Public and Private Programs in the United states and in Other Countries
Pages 59-73
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From page 59... ...
Proposals under consideration would give functional evaluation a larger role in the disability decisionmaking process. As used in this context, functional evaluation is a process that estimates the ability of an impaired person to perform work.
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From page 60... ...
Functional capacity limitations, or more properly re ma~n~ng capacity, arising from physical or mental impairments when compared to functional demands of work, drives private disability decisionmaking within the contractual definition of work disability. A worker's capacity, limitations, and restrictions are all relevant to the initial disability determination.
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From page 61... ...
Claims payers use the medical functional assessments in comparison to assessments of functional requirements of a job or occupation. These latter evaluations of work demands are increasingly purchased from professionals who look at a person's assessed functional capacity and search for jobs they could do.
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From page 62... ...
The increasing numbers of jobs that can be performed in a person's home add new dimensions to matching functional capacity with work demands. In closing, it is important to emphasize that how to develop the best functional evaluations and when and how to use them in deciding work disability are important questions, but answering these questions alone is only a small step.
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From page 63... ...
Employment and job placement, including getting support from the business community, need more attention in today's work disability management process. Finally, public disability programs consist almost exclusively of cash benefits.
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From page 64... ...
64 I Cal · .
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From page 65... ...
Yet the growth in the prevalence of the Dutch working age population receiving disability transfers in the 1970s far exceeded that of the other countries. Policy changes in the 1980s slowed this growth, and dramatic policy changes in the early l990s have turned it around.
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From page 66... ...
But circle A can also increase. If medical innovations prolong life but do not offset ensuing impairments and functional limitations, then circle A would increase, as, for instance, it did in the case of advancements in medical care for severe spinal .
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From page 67... ...
However, if a person was declared to be partially disabled, even if only at the 15 percent level, but was not currently employed, the person received a full disability benefit unless the government could show otherwise. Hence while the Netherlands had an elaborate system of trying to assign a share of disability to each individual, the overriding importance of labor market considerations effectively meant that very few people actually got partial benefits.
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From page 68... ...
the scarring effect of the system itself. If a person invests in trying to get on the program, the rational way to do so is to do everything possible to diminish the possibilities of being judged capable of performing any substantial gainful activity.
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From page 69... ...
It is not means-tested or taxed so that disabled people who are employed can receive this benefit. Children under five and those whose disability arises at 65 years of age and over are only eligible for "Attendance Allowance," the care component of the Disability Living Allowance.
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From page 70... ...
The initial assessment for Disability Living Allowance is based on a complex and detailed self-reported form focusing on questions about needs for care and mobility. A "professional" (often the physician)
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From page 71... ...
Hopefully they will result in an assessment process that has the following features: holistic assessing an individual's education, skills, and experience; take account of the local labor market and chances of finding employ ment; replace the All Work Test with an assessment of "employability"; consider what a disabled person could achieve given appropriate ac commodations, not his or her functional limitations according to an able-bodied norm; allow for a continuum of disability, from able to work full-time to un able to take any employment; assess the impact of impairments in a work setting by experts in voca tional rehabilitation, not necessarily doctors; introduce an individual action plan based on the assessment and other information; redesign benefits to provide income security based on the activities agreed to in an individual's plan, not predetermined rules; involve disabled peoples' organizations in developing the assessment process; and where appropriate, acknowledge and involve the disabled person as an expert in his or her disability in the assessment process.
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From page 72... ...
However, there are still many similarities in the challenges both countries face in reviewing disability benefits, and some similar themes emerge in the thinking about the assessment process. There is a great deal of gray in this area and the redesign efforts in the United Kingdom and in the United States are grappling with reducing it.
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From page 73... ...
The contractual obligation involves assessment to decide if the individual meets the test of disability that is in the insurance contract so that the person can get earnings replacement benefits. The purpose of a subsequent assessment, which was quite different criteria, is to determine what additional services this person should have along with assuring that the person is getting appropriate medical care to help him or her get back to work.
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