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PubMed2001

Employer interference with ERISA rights and benefits. DiFederico v. Rolm Company.

DiFederico v. Rolm Company, 201 F.3d 200 (3rd Cir. 2000): A former employee who contended she was terminated because her employer wanted to avoid the cost associated with long-term disability obligations had to prove that her employer had a specific intent to violate Section 510 of ERISA. Section 510 prohibits an employer from interfering with her attainment of rights or benefits associated with an employee benefit plan. Proving specific intent requires proof that the employer made a conscious decision to interfere, and when there is no direct evidence of that intent, courts apply a shifting burden analysis like the one used in employment discrimination cases. After the former employee makes an initial circumstantial showing that she was terminated for a reason that violated Section 510 and the employer articulates a legitimate reason for its action, the former employee must prove that the employer's reason was pretextual.

Persons with Disabilities↗
PubMed1997

Injury severity assessment for car occupants in frontal impacts, using disability scaling.

Injury classification and assessment is one of the most important fields of injury prevention. At present, injury assessment focuses primarily on the risk of fatalities, in spite of the fact that most people who are injured survive the trauma. The net result of a fatality-based approach is that safety and vehicle engineers must make decisions with an incomplete, and sometimes misleading, picture of the traffic safety problem. By applying disability scaling reflecting long-term consequences to injury data, the most significant disabling injuries can be identified. The priorities change with the level of disability used in the scaling. In this study, the risk of permanent medical disability due to different injuries was derived and linked to abbreviated injury scale (AIS) values for 24,087 different injured body regions. This material is based on insurance data. To study how the importance of different bodily injuries changes with different severity assessments in a realistic real-world injury distribution, Swedish insurance industry disability scaling was applied to 3066 cases of belted Volvo drivers involved in frontal collisions. Crash severity was included in the study by using equivalent barrier speed (EBS). When lower levels of disability are included, injuries to the neck and the extremities become the most important, while brain and skull injuries become the most prominent at higher levels of disability. The results presented in this article should be regarded as a contribution to the development of a suitable disability scaling method. The results can also be utilized to further injury research and vehicle design aimed at reducing injuries which have the most important long-term disability consequences.

Accidents, Traffic↗
PubMed2006

Gambling problems and health functioning in individuals receiving disability.

PURPOSE: This study evaluated the rates and correlates of disordered gambling, with a focus on gambling behavior among participants receiving disability. METHOD: The sample consisted of 723 patients seeking free or reduced-cost dental care. Participants completed the South Oaks Gambling Screen (SOGS), Short Form-12 Health Survey, Second Edition (SF-12v2), and questions assessing demographic characteristics and frequency and intensity of current gambling behaviors. RESULTS: Results indicate a significantly higher prevalence of disordered gambling among participants receiving disability (26%) than in the remainder of the sample (14%; p < 0.001). Of the 135 individuals receiving disability, disordered gambling was associated with decreased physical and mental health functioning. CONCLUSIONS: These data indicate that individuals receiving disability have high rates of disordered gambling, and gambling behavior in this population is associated with poorer health functioning. Results suggest that disordered gamblers who receive disability have an increased need for interventions to reduce gambling and associated problems.

Adult↗
PubMed2004

Health services use and health care expenditures for children with disabilities.

OBJECTIVE: To examine health care utilization and expenditure patterns for children with disabilities. METHODS: Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13,792 children younger than 18 years. The overall response rate was 65.5%. RESULTS: Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999-2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures (2669 dollars vs 676 dollars) and higher out-of-pocket expenditures (297 dollars vs 189 dollars). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. CONCLUSIONS: The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Adolescent↗
PubMed1996

[Disability, the risk of disability and changes in work capacity-- unacceptable conditions for insurance in occupational injuries and diseases].

According to Croatian legislation disability, risk of disability and altered work capacity are prerequisites for recognition of job injuries, occupational diseases, and, consequently, of the worker's special rights. That is also valid for all areas of insurance. The legislation, if applied, would make it impossible for a great number of insured workers to realize their particular rights based on work related health damage, especially in the field of health insurance and reinsurance of health care costs. Health insurance boards, along with insurance companies, manage by evading the condition of disability, risk of disability and altered work capacity. This has been proved on a sample of 63 cases of job injuries and one occupational disease registered in the Occupational safety unit of the Clinical Hospital in Split from May 1994 to May 1995. In all cases the medical doctor of choice, the authorized health insurance board and the authorized insurance company enabled the insured (workers injured at work or having occupational disease, the employer) to make use of their specific insurance rights without waiting for the fulfillment of the prescribed condition of disability, risk of disability and altered work capacity. The authors consider such behaviour to be inadmissible in a state based on the rule of law. If the condition of disability, risk of disability and altered work capacity is unsuitable, as indeed it is, a solution should be sought for in changing the regulations. The simplest way of doing it is to invert the defining and taking over decrees in the Law on Pension and Disability Insurance and the Law on Health Insurance.

Accidents, Occupational↗
PubMed2003

[Could sick leaves be reduced by augmenting the knowledge of the general practitioner?].

BACKGROUND: Musculoskeletal disorders account for about 50 % of the cost of sick leaves in Norway. The aim of the study was to evaluate whether it is possible cut down the length of such sick leaves by augmenting the knowledge of these disorders among general practitioners (GPs). MATERIAL AND METHODS: Among GPs in a region of 50 000 inhabitants in Buskerud county, 24 joined a continuous medical education programme on musculoskeletal disorders and received financial compensation for the extra time spent on an extended clinical examination of patients whose sick leave had exceeded 16 days. 41 GPs that did not wish to attend the programme joined the study as a control group. Patients were included over one year and there was a one-year follow-up period. RESULTS: The GPs in the programme had a total of 753 patients who were included in the study; the GPs in the control group had 964. There were no differences between these patient groups with regard to sex, age, occupation and diagnosis, in length of sick leaves, or more permanent disability benefits. Among patients on sick leave of more than one year, 55% had not been referred to a specialist. INTERPRETATION: Augmenting the skills of GPs and giving them incentives to conduct more thorough clinical examinations does not reduce length of sick leaves caused by musculoskeletal disorders.

Adult↗
PubMed1992

[Expert assessment of hearing loss within the scope of the social compensation law and the law regarding severely handicapped patients].

Special problems are described concerning expert opinions on hearing disability and hearing loss with regard to the German Social Rights for Compensation and the laws for handicapped persons. In some aspects there are similarities to the rights of accident insurance, but disability programs question only the degree of handicap present and not the source of the hearing loss. The expert opinion on the subject's ability to work in his or any other profession must only determine the patient's ability to hear and the tasks needed to fulfill the profession. Special attention is given to the problems arising from tinnitus.

Deafness↗
PubMed1997

[Disability pension after a factory close-down--eight years after].

A follow-up study of 97 persons who were granted a disability pension in 1987 or 1988 after closure of a shipyard showed 82 alive in 1995. The predominant diagnoses were musculoskeletal complaints, heart disease and psychiatric disorders. The 82 who were still alive were in good health and satisfied with their pension. However, if the factory had not been closed down, many of them could probably have continued in work. For many of them, and especially the youngest, the first year on disability pension was difficult. Based on today's more restricted rules, we have estimated that 25% of the applications for disablement benefit would have been refused.

Adult↗
PubMed2007

Long-term absenteeism due to sickness in Sweden. How long does it take and what happens after?

In this paper, we analyze exits from long-term sickness spells in Sweden. Using data for more than 2,500 people, the aim is to analyze the transition to different states: return to work, full disability pension, partial disability pension, and other exits from the labor force. Given the complexity of the exit decision, which encompasses both the individual's choice, the medical evaluation and the decision of the insurance adjudicator, we consider the outcome as being the result of two aspects of the exit process: one that governs the duration of a spell prior to the decision to exit, and another that governs the type of exit. Therefore, the analysis is done in two steps: first, we analyze the duration of the sickness spells, and then we analyze the process that governs the type of exit. The results indicate that both individual characteristics and push factors, such as regional unemployment, are important for both components of the decision process.

Absenteeism↗
PubMed2005

Extension of the expiration date for several body system listings. Final rule.

We use the Listing of Impairments (the listings) at the third step of the sequential evaluation process when we evaluate your claim for benefits based on disability under title II and title XVI of the Social Security Act (the Act). This final rule extends until July 3, 2006, the date on which listings for four body systems will no longer be effective and extends until July 2, 2007, the date on which the listings for eight body systems will no longer be effective. Other than extending the date during which the listings will be effective, we have made no revisions to the listings; they remain the same as they now appear in the Code of Federal Regulations. This extension will ensure that we continue to have the medical evaluation criteria in the listings to adjudicate disability claims in these body systems at step three of the sequential evaluation process.

Eligibility Determination↗
PubMed1988

[Recommendation for standardized selection of sociomedical (insurance medical) assessment of work disability].

Two study populations were examined, one for obtaining a frequency distribution of incapacity for work periods, the other for tracing the qualitative aspects of incapacity for work cases. Quantitative appraisal showed that 16% of all cases accounted for 49% of total incapacity time. Qualitative (microanalytic) appraisal of these 16% traced but a few disease groups responsible, amply dealt with in literature on chronic conditions. A shortcoming of apparently rather minor relevance in the individual case, has moreover been found to be systematic: prolonged incapacity for work periods inadequately explained by the diagnoses given on the incapacity certificate. Not least for this reason, appraisal by the insurance medical examination service should occur after three months at the latest. The criteria for initial selection are outlined in terms of three months incapacity for work, frequent recurrence of incapacity periods, and a catalogue of a few diagnostic groups.

Disability Evaluation↗
PubMed1999

[Applications for disability benefits before and after the 1991 restrictions].

In 1991, the eligibility criteria for disability benefits were restricted in Norway. Some effects are described in the present evaluation. Based on documents, first time applicants in 1990 and in 1993 in two counties were analysed according to social and medical variables. "Social security careers" before application are described, and proposals from physicians and the local social security office are compared with the decisions made by the county social security administration. Over a three-month period, applications decreased from 2.2 per 1,000 inhabitants in 1990 to 1.4 in 1993, a 39% decrease. About the same decrease was observed in all social and diagnostic groups. The proportion on vocational rehabilitation before application increased from 19% to 23% (p = 0.02). The certifying physicians proposed refusals in 9% and 8% in the two samples, and the local social security office did so in 12% and 13%. The refusal rate increased from 8% in 1990 to 21% in 1993. Refusals were mostly given to women, the middle-aged, those living alone, those with short education, and applicants with medically unclear conditions. It is pointed out that the restrictions on disability benefits in 1991 had the greatest impact on applicants with few resources.

Adult↗