WORK DISABILITY EVALUATION IN SLOVENIA EVA KOSTA, MSc, MD The Institute of Pension and Disability Insurance of Slovenia Board of Medical Assessors

DEFINITION OF DISABILITY DISABILITY OCCURS IF THE INSURED PERSON'S POSSIBILITY TO GET OR RETAIN THEIR JOB OR GET PROMOTED HAS DIMINISHED DUE TO THE CHANGES IN THEIR HEALTH CONDITION WHICH CANNOT BE REMOVED WITH TREATMENT OR MEDICAL REHABILITATION MEASURES.

TREATING DOCTOR’S APPLICATION TO THE INSURANCE PROVIDER FOR DISABILITY EVALUATION DUE TO CHRONIC HEALTH CHANGES OR INJURY CONSEQUENCES TREATING DOCTOR’S APPLICATION TO THE INSURANCE PROVIDER FOR DISABILITY EVALUATION DUE TO CHRONIC HEALTH CHANGES OR INJURY CONSEQUENCES RELEVANT MEDICAL DOCUMENTATION (SPECIALIST REPORTS AND RESULTS OF DIAGNOSTIC PROCEDURES) RELEVANT MEDICAL DOCUMENTATION (SPECIALIST REPORTS AND RESULTS OF DIAGNOSTIC PROCEDURES) ONE YEAR AFTER ONSET OF SICK LEAVE ONE YEAR AFTER ONSET OF SICK LEAVE CLAIMANT’S DOCTOR’S OPINION ON CATEGORY OF DISABILITY CLAIMANT’S DOCTOR’S OPINION ON CATEGORY OF DISABILITY

LOST CAPACITIY FOR GAINFUL WORK = I. CATEGORY OF DISABILITY DECISION BASED MAINLY ON HEALTH CONDITION

RESIDUAL WORK CAPACITIY = II. OR III. CATEGORY DECISION BASED ON HEALTH STATE AND WORK CIRCUMSTANCES DECISION BASED ON HEALTH STATE AND WORK CIRCUMSTANCES ABILITY FOR WORK WITH RESTRICTIONS (LIFTING, FREQUENT BENDING, WORKING FULL TIME) BASED ON MATCHING CONSEQUENCES OF CLAIMANT’S HEALTH PROBLEMS AND WORK CONDITIONS ABILITY FOR WORK WITH RESTRICTIONS (LIFTING, FREQUENT BENDING, WORKING FULL TIME) BASED ON MATCHING CONSEQUENCES OF CLAIMANT’S HEALTH PROBLEMS AND WORK CONDITIONS

HEALTH PROBLEM: CATEGORY BACK SURGERY ADMINISTRATIVE WORK NO DISABILITY ADMINISTRATIVE WORK- III., II.CATEGORY, STRAINED POSITIONS; NEW WORK SITE/JOB, RESTRICTIONS RESTRICTIONS PHYSICAL WORK– AND/OR LIFTING, BENDING OCCUPATIONAL REHABILITATION

PRELIMINARY PROCEDURE – INSURANCE OFFICER - CHECKS THE INSURANCE STATUS OF THE CLAIMANT - COLLECTS WORKING DOCUMENTATION: DATA ON CLAIMANT’S OCCUPATION AND PRESENT OR LAST PERFORMED WORK DATA ON CLAIMANT’S OCCUPATION AND PRESENT OR LAST PERFORMED WORK THE (LAST) EMPLOYER THE (LAST) EMPLOYER THE CLAIMANT THE CLAIMANT THE EMPLOYMENT AGENCY (FOR THE UNEMPLOYED) THE EMPLOYMENT AGENCY (FOR THE UNEMPLOYED) - CONTACTS EMPLOYER AND/OR CLAIMANT TO CLARIFY POSSIBLE CONTRADICTIONS - CONTACTS EMPLOYER AND/OR CLAIMANT TO CLARIFY POSSIBLE CONTRADICTIONS

WORK DATA GENERAL INFORMATION (FIELD OF ACTIVITY, NUMBER OF EMPLOYED ETC) GENERAL INFORMATION (FIELD OF ACTIVITY, NUMBER OF EMPLOYED ETC) NAME OF CLIAMANT’S WORKPLACE, DATE OF EMPLOYMENT, NAME OF CLIAMANT’S WORKPLACE, DATE OF EMPLOYMENT, EMPLOYER’S AND CLAIMANT’S DESCRIPTION OF PRESENT (OR LAST) WORKPLACE, TYPE AND INTENSITY OF VARIOUS PHYSICAL AND MENTAL FUNCTIONS REQUIRED AT WORK EMPLOYER’S AND CLAIMANT’S DESCRIPTION OF PRESENT (OR LAST) WORKPLACE, TYPE AND INTENSITY OF VARIOUS PHYSICAL AND MENTAL FUNCTIONS REQUIRED AT WORK POSSIBILITIES FOR MORE APPROPRIATE WORKPLACES, POSSIBILITIES FOR MORE APPROPRIATE WORKPLACES, CLAIMANT’S, EDUCATION, WORKING HISTORY, EXPECTATIONS CLAIMANT’S, EDUCATION, WORKING HISTORY, EXPECTATIONS DATE OR DATES OF REGISTRATION WITH THE EMPLOYMENT AGENCY DATE OR DATES OF REGISTRATION WITH THE EMPLOYMENT AGENCY

PRELIMINARY PROCEDURE – INSURANCE DOCTOR STUDIES THE MEDICAL AND WORKING DOCUMENTATION; ASKS TREATING DOCTOR FOR ADDITIONAL SPECIALIST OR DIAGNOSTIC FINDINGS, GETS ADDITIONAL INFORMATION FROM INSURANCEOFFICER, FOR CLARIFICATIONS ON WORK DATA STUDIES THE MEDICAL AND WORKING DOCUMENTATION; ASKS TREATING DOCTOR FOR ADDITIONAL SPECIALIST OR DIAGNOSTIC FINDINGS, GETS ADDITIONAL INFORMATION FROM INSURANCEOFFICER, FOR CLARIFICATIONS ON WORK DATA GIVES PRELIMINARY OPINION ON INVALIDITY CATEGORY GIVES PRELIMINARY OPINION ON INVALIDITY CATEGORY ALLOCATES CLAIMANT FOR PRESENTATION TO ASSESSMENT BOARD SESSION WITH SPECIALISTS OF ADEQUATE FIELDS ALLOCATES CLAIMANT FOR PRESENTATION TO ASSESSMENT BOARD SESSION WITH SPECIALISTS OF ADEQUATE FIELDS

ASSESSMENT BOARD SESSION  TWO OR MORE MEMBERS, USUALLY MEDICAL DOCTORS OF DIFFERENT SPECIALTIES DEPENDING ON THE CLAIMANT’S HEATH PROBLEMS OR INJURIES, ONE (OR MORE) MEDICAL DOCTORS AND A LABOR ONE (OR MORE) MEDICAL DOCTORS AND A LABOR EXPERT IN CASES REQUIRING SPECIAL EXPERTISE most often sufficient working information obtained during the preliminary procedure by insurance officer

ASSESSMENT BY THE BOARD CONSENSUAL OPINION ON THE CATEGORY OF INVALIDITY, BASED ON CONSENSUAL OPINION ON THE CATEGORY OF INVALIDITY, BASED ON MEDICAL RECORDS, MEDICAL RECORDS, DATA CONCERNING THE WORKPLACE, DATA CONCERNING THE WORKPLACE, REHABILITATION TEAM REPORT IN CASES OF OCCUPATIONAL REHABILITATION REHABILITATION TEAM REPORT IN CASES OF OCCUPATIONAL REHABILITATION INTERVIEW WITH THE CLAIMANT AND A SHORT EXAMINATION INTERVIEW WITH THE REPRESENTATIVE OF THE EMPLOYER (WHEN POSSIBLE) EXPLANATION OF THE OPINION IN UNDERSTANDABLE LANGUAGE

BOARD DECISIONS BASED ON KNOWLEDGE AND EXPERIENCE; BOARD DECISIONS BASED ON KNOWLEDGE AND EXPERIENCE; SET OF GUIDELINES BY DISABILITY ASSESSMENT EXPERTS, SUBJECT TO ONGOING UPDATING; SET OF GUIDELINES BY DISABILITY ASSESSMENT EXPERTS, SUBJECT TO ONGOING UPDATING; ETHICAL CODE; ETHICAL CODE; CONSENSUAL OPINION OF AT LEAST TWO BOARD MEMBERS, TAKING INTO CONSIDERATION PRELIMINARY OPINION AND TREATING DOCTOR’S OPINION; CONSENSUAL OPINION OF AT LEAST TWO BOARD MEMBERS, TAKING INTO CONSIDERATION PRELIMINARY OPINION AND TREATING DOCTOR’S OPINION; REVISIONS OF I.CATEGORY AND OTHER RANDOMLY SELECTED CASES BY SECOND DEGREE ASSESSMENT BOARD; REVISIONS OF I.CATEGORY AND OTHER RANDOMLY SELECTED CASES BY SECOND DEGREE ASSESSMENT BOARD; POSSIBILITY OF REASSESSMENT BY APPEAL BOARD IN CASES OF COMPLAINT POSSIBILITY OF REASSESSMENT BY APPEAL BOARD IN CASES OF COMPLAINT

FINAL DECISIONS REST ON INDIVIDUAL OPINIONS ABOUT INDIVIDUAL PERSONS; FINAL DECISIONS REST ON INDIVIDUAL OPINIONS ABOUT INDIVIDUAL PERSONS; THE ABOVE SAFETY MEASURES HELP TOWARDS ACHIEVING OBJECTIVITY TO A CERTAIN EXTENT THE ABOVE SAFETY MEASURES HELP TOWARDS ACHIEVING OBJECTIVITY TO A CERTAIN EXTENT NEED OF POSTGRADUATE SPECIALTY TRAINING PROGRAM FOR BETTER EVIDENCE BASED DISABILITY EVALUATION NEED OF POSTGRADUATE SPECIALTY TRAINING PROGRAM FOR BETTER EVIDENCE BASED DISABILITY EVALUATION