title: The actions of the social insurance agency regarding long-term sickness absentees before and after a medical assessment--a study of 384 case files.
abstract: OBJECTIVE
  The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension.
  
  
  METHODS
  For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001-2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data.
  
  
  RESULTS
  Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work.
  
  
  CONCLUSIONS
  Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions.
  
  
  CONCLUSIONS
  Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.
authors.affiliation: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Marklund
authors.forename: Göran
authors.initials: G
authors.lastname: Lundh
authors.forename: Klas
authors.initials: K
authors.lastname: Gustafsson
authors.forename: Jürgen
authors.initials: J
authors.lastname: Linder
authors.forename: Pia
authors.initials: P
authors.lastname: Svedberg
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions; D012050:Rehabilitation, Vocational; D012189:Retrospective Studies; D062707:Return to Work; D018582:Sick Leave; D012947:Social Work; D013548:Sweden; D014938:Work Capacity Evaluation; D055815:Young Adult
keywords: Case files; return to work; sick leave; social insurance; social insurance officers; social work; vocational rehabilitation; welfare administration