Analysis of the Medical Expertise System in Bulgaria: Structural Deficits, Financial Sustainability and Strategic Path towards the ICF Model

This article examines the state of and challenges facing the system for medical expertise determining permanent disability in Bulgaria (the TELC system). Despite recent steps towards fairer calculation of percentages, the introduction of lifetime TELC status for more diseases, digitalisation and the elimination of delays with legislative changes from 2023–2024, the system continues to suffer from serious structural deficits rooted in the strictly medical approach to disability assessment. The article analyses the increasing number of disability decisions and their impact on the long-term financial sustainability of the funds of the National Social Security Institute (NSSI). Special attention is paid to the discrepancy between medical diagnoses and real functional possibilities for integration into the labour market. The author argues that the strategic modernisation of the system requires a paradigm shift from a medical model to the WHO International Classification of Functioning, Disability and Health (ICF) framework. The results show that adopting a biopsychosocial approach would not only increase social justice but would also optimise public spending by more accurately targeting support and rehabilitation services.