10 Chapter 1 GENERAL INTRODUCTION Case study The central construct of this thesis is the ‘Inability to Work Fulltime’, assessed as part of the work disability benefit assessment. To illustrate the meaning of this construct I present a case from practice. A worker has been sick-listed from his work for almost two years, has not fully returned to his work, and applies at the social security institute for work disability benefits. He experiences serious problems in starting activities and taking initiative, is continuously tired, and needs to rest during the day. He has been diagnosed with a depressive episode and is undergoing psychiatric treatment. An insurance physician from the social security institute assesses the physical and mental impairments that limit his capacity to work. An important aspect of this assessment is the inability to work fulltime. The question for the insurance physician is how many hours per day and week this worker is able to work, and whether he is able to sustain working activities for normal fulltime working hours. The insurance physician knows that depressed people often suffer a lack of interest and drive, sleeping disturbances and fatigue, as well as mood disturbances, all of which interfere with normal daily functioning and make it unlikely that the depressed sick-listed worker will be able to work fulltime. However, it is complicated to estimate the number of hours this person can work. When the insurance physician consults the Dutch professional guideline, he finds insufficient information to support him in the decision-making process for this specific case. Consequently, he bases his decision on his own expertise and the available information. He hopes that he can make the right decision, knowing that the outcome of the assessment may have significant personal, social, and financial consequences for the employee. This case illustrates the importance and relevance of the assessment of inability to work fulltime, as well as the complexity of the construct. With the studies in this thesis, we aim to expand the knowledge regarding the concept inability to work fulltime, and how to apply this knowledge when assessing work disability benefits. In the following sections we describe the background and context of the study, and explain the research gaps and challenges related to the concept inability to work fulltime. Finally, we present our objectives and an overview of the thesis. Background Being able to work is central to quality of life, and is associated with multifaceted psychological, social, and economic benefits. Many countries recognize the importance of work, and strive to have their citizens participating fully in society, as besides financial necessity, work participation
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