65 Inability to work fulltime, prevalence and associated factors an applicant can work per day graded in steps of 2 h. Insurance physicians adhere to a guideline with regards to assessing inability to work fulltime; ‘Endurance capacity in work’ [35]. This guideline describes three indications for inability to work fulltime: 1. a lack of energy, resulting in the need for extra daily recovery (hours of rest) consistent with the findings of the insurance physicians and with the nature and severity of the disease, 2. when an increasing number of working hours cause (worsening of) disease symptoms, and 3. reduced availability for work because of necessary treatment. After the medical disability assessment by an insurance physician and assessment of earning capacity by a labor expert of the UWV, individuals can either have a full and permanent work disability, a non-permanent but full work disability, or a permanent and partial work disability. Individuals in the latter group have residual earnings capacity. Individuals with residual capacity are incentivized to continue in paid (part-time) employment at their current employer or enroll in a new, more appropriate (part-time) job, in accordance to their residual work capacity. The income in the original work before sick leave is compared with the income in the work they can perform according to their residual work capacity. The income loss determines the amount of the disability benefit, with a threshold of 35% loss of income. Students, self-employed workers, pensioners and individuals disabled since childhood are not entitled to a WIAdisability benefit. Instead, individuals disabled since childhood can apply for a WAJONG-disability benefit when they turn eighteen (Disablement Assistance Act for Handicapped Young Persons) [36]. Design and Sample The study is a cross-sectional register based cohort study among applicants for a long term disability benefit according to the WIA [33], in a year cohort (January 1st to December 31st 2016). The data was provided by the UWV and derived from the register forms completed by the insurance physicians and labor experts at the time of assessment, and anonymized by UWV. For this study, we only included applicants in the analyses with residual work capacity and with complete data on all variables. Approval by a Medical Ethical Committee was not necessary under Dutch law. Measures Socio-demographic data included gender (male/female), age, and educational level. For educational level, three classes were differentiated based on the highest level of completed education: low (primary school, lower vocational education, lower secondary school), middle (intermediate vocational education, upper secondary school), and high (upper vocational education, university). Insurance physicians use the Dutch Classification of Occupational Health and Social Insurance (CAS) to categorize diagnoses, derived from the 4
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