title: Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.
abstract: OBJECTIVE
  In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process.
  
  
  METHODS
  We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation.
  
  
  RESULTS
  Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable.
  
  
  CONCLUSIONS
  Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.
authors: Swiss Academy of Insurance Medicine, University of Basel Hospital, Basel, Switzerland; Institute for Clinical Epidemiology and Biostatistics, University of Basel Hospital, Basel, Switzerland.
authors: Stefan
authors: S
authors: Schandelmaier
authors: School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland.
authors: Andrea
authors: A
authors: Leibold
authors: School of Applied Psychology, University of Applied Sciences Northwestern Switzerland, Olten, Switzerland.
authors: Katrin
authors: K
authors: Fischer
authors: University Psychiatric Hospital Basel, Basel, Switzerland.
authors: Ralph
authors: R
authors: Mager
authors: Department of Insurance Psychiatry, Suva, Swiss Accident Insurance Fund, Lucerne, Switzerland.
authors: Ulrike
authors: U
authors: Hoffmann-Richter
authors: Swiss Academy of Insurance Medicine, University of Basel Hospital, Basel, Switzerland.
authors: Monica Susanne
authors: MS
authors: Bachmann
authors: Swiss Academy of Insurance Medicine, University of Basel Hospital, Basel, Switzerland.
authors: Sarah
authors: S
authors: Kedzia
authors: Department of Anaesthesia, McMaster University, Hamilton, Canada; CLARITY Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster Universit.
authors: Jason Walter
authors: JW
authors: Busse
authors: CLARITY Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors: Gordon Henry
authors: GH
authors: Guyatt
authors: Institute of Medical Disability Evaluations of Central Switzerland, Lucerne, Switzerland.
authors: Joerg
authors: J
authors: Jeger
authors: Institute of Medical Disability Evaluations of Central Switzerland, Lucerne, Switzerland.
authors: Renato
authors: R
authors: Marelli
authors: Swiss Academy of Insurance Medicine, University of Basel Hospital, Basel, Switzerland.
authors: Wout Ernst Lodewijk
authors: WE
authors: De Boer
authors: Swiss Academy of Insurance Medicine, University of Basel Hospital, Basel, Switzerland.
authors: Regina
authors: R
authors: Kunz
mesh_terms: D000328:Adult; D001290:Attitude; D004608:Eligibility Determination / Q000592:standards*; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000592:standards*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013557:Switzerland; D014938:Work Capacity Evaluation