The concept of inability to work fulltime in work disability benefit assessment

Inability to work fulltime - the inability to sustain full-time work activities - is an important item in the work disability benefit assessment. Research is scarse, while there is unclarity about the concept. With this dissertation we contribute to the conceptualization and operationalization of the concept in the context of work disability assessment.
We found that that inability to work fulltime is assessed in many European countries. From interviews with insurance-, occupational physicians, and representatives of patient organizations we learned that inability to work fulltime is considered a complex concept to operationalize, strongly individually determined and variable, depending not only on disease related factors. Analyses on register data of disability claim applicants showed that almost 40% of all applicants with residual work capacity were assessed with inability to work fulltime. Older age, female gender, higher education and multimorbidity was associated with a higher risk of being assessed with inability to work fulltime. Diagnoses resulting in energy deficit and impairments in cognition and functioning (e.g., blood-related diseases, respiratory diseases, nervous diseases and specific mental disorders) in general had stronger associations with inability to work fulltime. These findings can help insurance physicians to more easily identify those applicants at risk. Moreover, given our findings on the complexity and variable nature of the concept, we recommend that assessments should incorporate multiple methods over a longer period of time.