Intervention in work-related disability: The need for an integrated approach

This paper looks at work-related disability in the United States as it is currently addressed according to the policies and procedures of the Social Security Disability Administration and the Workers' Compensation system. These policies and procedures proceed from a medical model that emphasizes health impairment as the fundamental cause of work-related disability. Thus physicians' evaluations of work-related impairment are the primary basis for administrative disability determinations. Increasing litigation regarding disability determinations and experience with long-term work-related disability suggest that the guiding policies are flawed. Work-related disability is as much a problem of manpower policy as it is one of personal health, but most employers and compensation programs in the United States do not yet respond to it as such. Recommended is a shift from a medical to a socioeconomic frame of reference for work-related disability that would overtly recognize regional variations in the static and dynamic factors of the economy and that would promote return to work and rehabilitation. Political intervention will be necessary. Because cultural values and social relationships are part of the problem, new research is needed in correlates of work-related disability.