Open Access Open Badges Research article

Medico-legal reasoning in disability assessment: A focus group and validation study

WEL de Boer1*, P Donceel2, S Brage3, M Rus4 and JHBM Willems5

Author Affiliations

1 Department of Quality of Life, TNO, Hoofddorp, the Netherlands

2 Section of Occupational, Environmental and Insurance Medicine, Department of Public Health, Katholieke Universiteit Leuven, Leuven, Belgium

3 Department of General Practice and Community Medicine Faculty of Medicine, University of Oslo, Oslo, Norway

4 Department of assessment, Pension and invalidity insurance of Slovenia, Ljubljana, Slovenia

5 Coronel Institute, Amsterdam University, Amsterdam, the Netherlands

For all author emails, please log on.

BMC Public Health 2008, 8:335  doi:10.1186/1471-2458-8-335

Published: 25 September 2008



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.


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.


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.


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.