title: Medico-legal reasoning in disability assessment: a focus group and validation study.
abstract: BACKGROUND
  Decisions on disability pensions are based, among others, on medical reports. The way these medical assessments are performed is largely unclear. The aim of the study was to determine which grounds are used by social insurance physicians (SIPs) in these assessments and to determine if the identification of these grounds can help improve the quality of assessments in social insurance practice. The article describes a focus group study and a questionnaire study with SIPs in four different countries.
  
  
  METHODS
  Using focus group discussions of SIPs discussing the same case in Belgium, the Netherlands, Norway and Slovenia (N = 29) we determined the arguments and underlying grounds as used by the SIP's. We used a questionnaire study among other SIPs (N = 60) in the same countries to establish a first validation of these grounds.
  
  
  RESULTS
  Grounds in the focus groups were comparable between the countries studied. The grounds were also recognized by SIPs who had not participated in the focus groups. SIPs agreed most on grounds with regard to the claimant's health condition, and about the claimant's duty to explore rehabilitation and work resumption, but less on accepting permanent incapacity when all options for treatment were exhausted.
  
  
  CONCLUSIONS
  Grounds that SIPs use refer to a limited group of key elements of disability evaluation. SIPs interpret disability in social insurance according to the handicapped role and strive at making their evaluation fair trials. ICF is relevant with regard to the health condition and to the process of evaluation. Identification of grounds is a valuable instrument for controlling the quality of disability evaluation. The grounds also appear to be internationally comparable which may enhance scientific study in this area.
authors.affiliation: Department of Quality of Life, TNO, Hoofddorp, the Netherlands. wout.deboer@tno.nl
authors.forename: Wel
authors.initials: W
authors.lastname: de Boer
authors.forename: P
authors.initials: P
authors.lastname: Donceel
authors.forename: S
authors.initials: S
authors.lastname: Brage
authors.forename: M
authors.initials: M
authors.lastname: Rus
authors.forename: Jhbm
authors.initials: J
authors.lastname: Willems
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D001530:Belgium; D003431:Cross-Cultural Comparison; D003657:Decision Making; D006233:Persons with Disabilities / Q000145:classification* / Q000534:rehabilitation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence / Q000592:standards*; D017144:Focus Groups; D006801:Humans; D018868:Insurance, Disability / Q000331:legislation & jurisprudence*; D009426:Netherlands; D009664:Norway; D009787:Occupational Medicine / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards*; D010415:Pensions; D010820:Physicians / Q000331:legislation & jurisprudence / Q000592:standards; D017524:Slovenia; D012943:Social Security / Q000331:legislation & jurisprudence / Q000592:standards*; D014938:Work Capacity Evaluation