136 Chapter 7 continue to participate more [8-10]. Gaining insight into the impact of inability to work fulltime as an outcome of work disability assessment and having paid employment after the assessment among workers and non-workers at the time of assessment and applicants with different diagnoses may help develop approaches to support applicants assessed with an inability to work fulltime. Within this context, the aim of this study was to examine the association between inability to work fulltime and paid employment one year after the disability benefit assessment in a nationwide register study of Dutch applicants who applied for disability benefits and were granted a partial disability benefit. The second aim was to study if the association is moderated by socio-demographic and disease-related factors. We conducted the analyses for applicants who had and did not have paid employment at the time of the work disability benefit assessment separately, as having paid employment at the time of the assessment is known to have an effect on labour participation in later years. METHODS Setting In the Netherlands, long-term disability benefits can be applied for under the Work and Income Act (WIA) Netherlands [11] after two years of sick leave by both employed and unemployed workers. The insurance physician of UWV evaluates the health situation of an applicant and first determines the residual work capacity based on several criteria. Applicants are assessed with no residual work capacity on specific conditions: (1) total work capacity loss within three months, (2) terminal disease with foreseeable total work capacity loss, (3) fluctuating work capacity, (4) hospitalization, or (5) lack of self-reliance due to severe mental or physical disorders [12]. If any of these apply, the insurance physician determines (permanent or non-permanent) full work disability. If applicants have residual work capacity, the insurance physician continues the assessment indicating potential limitations caused by their disease using the Functional Ability List (FAL) [13, 14]. Part of the assessment involves a conclusion about the (in)ability to work fulltime, reported as the number of hours the applicant can sustain working activities per day. Particularly energy deficit, fatigue and increased need for rest are primary indicators of inability to work fulltime [15]. Following the medical disability benefit assessment by the insurance physician, the earning capacity is evaluated by a labour expert of the UWV. The disability benefit amount is determined based on the income loss, comparing the pre-sick leave earnings of the applicant with the income that can be generated considering the assessed residual work capacity, with a threshold of 35% to be granted a partial disability benefit. Applicants may fall into four categories: 1) full and permanent work disability, (2) non-permanent but full work disability, (3)
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