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- Review article Medical certification of system sickness benefit scheme (II): practical approaches for evaluating work disability
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Yangwoo Kim1
, Inah Kim2,* -
Annals of Occupational and Environmental Medicine [Epub ahead of print]
DOI: https://doi.org/10.35371/aoem.2025.37.e24
Published online: July 28, 2025
1Department of Occupational and Environmental Medicine, Hanyang University Hospital, Seoul, Korea
2Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, Korea
- *Corresponding author: Inah Kim Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea E-mail: inahkim@hanyang.ac.kr
• Received: April 7, 2025 • Revised: July 5, 2025 • Accepted: July 7, 2025
© 2025 Korean Society of Occupational & Environmental Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
- Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians’ decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea’s sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.
BACKGROUND
A sickness benefit system compensates workers who partly or wholly lose work abilities due to an illness or injury. Within this system, the medical certification framework evaluates the worker’s condition and determines the period of work disability during which sickness benefits are payable. In our previous study, we confirmed that the core objective of a sickness benefit medical certification system is to use these benefits to influence healthcare-seeking behaviors, promote timely medical interventions, improve treatment outcomes, and ultimately enable a suitable return-to-work.1 Achieving this goal requires supplementing work-disability evaluations with occupational health (OH) principles and conducting fitness-for-work (FFW) assessments.
This review focuses on the practical aspects of conducting work disability evaluations within the sickness benefit medical certification system. These practical considerations include (1) the physician’s role in issuing medical certificates for sickness benefit claims in clinical settings, (2) methods of assessing the duration of work disability based on each disease’s FFW profile, and (3) the use of guidelines that aid in appraising work disability. We further explored how these insights could inform Korea’s ongoing pilot projects and contribute to the nationwide implementation of a sickness benefit system.
METHODS
This study builds on previous research and reviews official documents, existing literature on international sickness certification systems, and reports from Korea’s sickness benefit pilot program.
RESULTS
Various terms describe a worker’s functional abilities, including “work ability” and “job capacity.” In this study, we used the phrase “work disability evaluation” to emphasize the assessment of the degree of reduced work ability. This concept broadly involves evaluating physical, mental, and social functional impairments and can therefore be viewed as a form of disability evaluation. Accordingly, many countries have adopted the World Health Organization International Classification of Functioning, Disability, and Health (ICF) to medically classify these impairments.2
Although criteria and implementation methods for evaluating work disabilities varies globally,3 yet common features exist. Evaluations are typically overseen by social insurance agencies that establish administrative rules for benefit claims to maintain consistency within the sickness benefit system.4 In some countries, contracted physicians conduct medical consultations who directly oversee these assessments.4
Work disability evaluations are not limited to sickness benefit schemes; they are essential for disability pension programs. In Europe, when a worker’s inability to work is assessed for <1 year, it typically falls under sickness benefits. Cases extending beyond 1 year often transition to disability pension programs. In most systems, primary care physicians and general practitioners are responsible for evaluating work-related disabilities, and OH specialists play a central role.5 In Korea, the National Pension Service evaluates Basic Livelihood Security recipients based on their medical conditions.6
Physicians are primarily responsible for the determination of work disability duration while issuing sickness benefit certifications. This is challenging as the main aim is to support timely return-to-work. Substantial variability in certified durations can undermine fairness, a concern raised by the Organisation for Economic Co-operation and Development (OECD).7 To address this, countries such as Sweden, France, and Ireland have introduced disease-specific guidelines to standardize work disability assessments and clarify medical certification procedures.8-10
Sweden operates its sickness benefit system through the Swedish Social Insurance Agency (Försäkringskassan), regulated by the Ministry of Health and Social Affairs.9 In Sweden, the medical certification form must be submitted to the Social Insurance Agency (Försäkringskassan) when sick leave lasts ≥7 days (Supplementary Fig. 1). In addition to providing a diagnosis, the form requires detailed documentation of workers’ current occupations and tasks to assess whether partial sick leave is feasible. It also includes detailed notes on any existing disability according to the ICF, future treatment plans, expected work ability, and factors to be considered when returning to work.
Sweden is recognized as a prime example of a country with a well-established social insurance network, and it treats Försäkringsmedicinskt beslutsstöd (“insurance medicine”) as a subfield of medicine. Training in the sickness benefit system and its medical certification framework are included in Swedish medical curricula. Nonetheless, concerns regarding fairness and the burden on general practitioners persisted, leading to the establishment of disease-specific guidelines in 2007. As of March 2025, there are 132 sets of such guidelines detailing the characteristics of each disease, recommended duration of work disability, and whether partial sick leave is applicable.11
In France, the National Health Insurance Fund (Caisse Nationale d’Assurance Maladie, CNAM) manages both the sickness benefit system and worker compensation insurance. To apply for sickness benefits, a worker must submit medical certification from a primary care physician or OH physician to both the CNAM and their employer. The disease-specific guidelines in France were developed by an independent committee and present occupational and clinical factors in a tabulated format.10 France provides fewer disease-specific guidelines and does not offer guidelines for cancer compared to Sweden.
Ireland implemented a sickness benefit system under the Department of Social Protection. The first disease-specific guidelines were published after expert consultations in 2015 and revised in 2019.8 Using the Delphi method, experts compiled the recommended duration of work disability for 40 frequently cited diagnoses and surgical procedures, factoring in the level of physical strain entailed by each job. The guidelines also provide an occupational classification system for gauging the physical demands.
In 2008, the United Kingdom mandated that any worker claiming >7 days of sick leave must submit a fit note to their employer, replacing the older sick note format with fit notes. Since 2022, physicians, nurses, and occupational therapists have been issuing these certifications.12,13 The Department for Work and Pensions oversees the UK sickness benefit system. It provides official guidance for healthcare professionals on how to complete a fit note as well as advisory materials for employers and employees. The fit note describes an individual’s medical condition, evaluates their FFW, and specifies any measures that the employer is expected to take (Supplementary Fig. 2). Fit-note statistics were published by the National Health Service. In contrast to Sweden, sick leave extends beyond 28 weeks of transition to disability evaluation, with reassessments conducted every 3 months.
The Korean pilot program implemented several models. In the model that evaluates work disability, a doctor issues a medical certificate that describes the type of work, job description, physical functions, and limitations in daily activities, in addition to the contents covered by a general medical certificate, such as basic demographic information and medical conditions, and records the period of work disability in detail (Supplementary Fig. 3).
There are examples of practical cases where work disability assessments have been conducted for various disease classifications. First, it compares musculoskeletal and respiratory diseases, which have relatively clear FFW guidelines, in contrast to cancer and mental and neurological conditions. Finally, it presents a specific example from the UK Fit Note, which extensively incorporates the FFW concept.
Musculoskeletal diseases
First, it is imperative to understand that Sweden's disease-specific guidelines determine the period of disability to work based on the disease, treatment, and the specific job duties of the affected individual. For adhesive capsulitis of the shoulder or bursitis of the shoulder, if acromioplasty is performed, it is recommended that work involving physical strain on the shoulder be suspended for a period of one month. In the absence of surgical intervention for rotator cuff syndrome or tears, no specific period of work disability is established, as it is not associated with professional activities. However, if rotator cuff reconstruction surgery is performed, the work disability period is typically 4–6 weeks for the nondominant hand, 2–3 months for the dominant hand, 3–6 months for medium-load work, and ≥6 months for high-load work, such as heavy object lifting.
France employs a comparable strategy using data as a fundamental element. In the context of office work, it is recommended that individuals use their nondominant hand for a period of 7 days, followed by their dominant hand for a duration of 10 days in the absence of surgical intervention. In cases wherein surgical intervention was performed, the designated periods were between 10 and 70 days. For tasks involving the handling of objects weighing <10 kg in a single instance or the repeated handling of objects weighing <5 kg, the applicable periods were 14–90 days for the dominant and nondominant hands and 28–120 days for the nondominant hand. For moderate work and above, irrespective of the dominant hand status, a duration of 42 days is recommended for individuals who have not undergone surgery, and 150 days for those who have. For high-risk work involving the handling of objects weighing ≥25 kg, it is recommended that individuals who have not undergone surgery be allowed a period of 60 days, whereas those who have undergone surgery should be allowed a period of 180 days. Table 1 compares the guidelines for shoulder disorders in Sweden and France, and highlights their characteristics.
Ireland's disease-specific guidelines initially included a separate job classification table that rendered them useful for musculoskeletal disorders. The intensity and level of skills required for different occupations were classified into three categories. Occupations involving high work intensity and skill levels, such as carpentry and meat processing, were placed in the highest category. In contrast, occupations with low work intensity and skill levels, such as retail assistance and janitorial work, were placed in the lowest category. The guidelines delineate a three-tiered classification system for lower back pain, with the classification determined by the severity of pain, presence or absence of discectomy, and the occurrence of spinal fusion. The recommended work disability period was set to a minimum of one week and a maximum of 16 weeks, with the duration contingent upon work intensity. These guidelines stipulate that the period of work disability may be extended to cases in which severe complications are anticipated.
Respiratory diseases
The determination of a prolonged period of work disability is not necessary in cases where the severity of respiratory diseases is not substantial. In Sweden, a period of disability to work that extends for a minimum of 2 weeks is diagnosed in cases where the severity of the condition reaches a certain threshold. Individuals with these conditions should refrain from work that involves minimal physical exertion. In Ireland, the period of disability to work is only calculated in cases of acute exacerbation of asthma, and sick leave is recommended for a maximum of one week, regardless of physical strain. Guidelines in France recommend a period of 5–7 days of sick leave for acute respiratory infections, explaining that this may be extended in cases accompanied by asthma, and 1–2 weeks in cases of tonsillectomy. Table 2 shows work disabilities related to respiratory diseases according to each disease-specific guideline.
Mental disorders
In many European countries, mental disorders consistently account for the largest proportion of sickness benefit claims, posing ongoing medical and socioeconomic challenges.14-16 According to Sweden’s disease-specific guidelines, mild mental disorders generally do not warrant periods of work disabilities. For instance, anxiety-related disorders, such as social phobia, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder, are typically not associated with work disability periods. Post-traumatic stress disorder (PTSD) does not justify a work disability period unless it is accompanied by another illness; in such cases, leaves over 3 months may be authorized. For eating disorders such as anorexia and bulimia, no disability period is recommended for mild cases, although severe cases warrant >6 months. In conditions such as schizophrenia, that severely impact daily and social functioning, the recommendation is for a work disability period exceeding a year, alongside an evaluation for permanent disability.
Ireland’s guidelines include a broader range of mental disorders, with more detailed criteria. For depression, they distinguished between single and recurrent episodes: single episodes ranged from 2 to 20 weeks depending on severity, whereas recurrent episodes ranged from 2 to 24 weeks, and incorporated risk assessments for suicidal ideation. Bipolar disorder and panic disorder cover 6–28 weeks, depending on their severity. The PTSD periods in Ireland range from 10 to 20 weeks, which are generally shorter than those in Sweden, whereas obsessive-compulsive disorder and eating disorders can range from 4 to 28 weeks, which is longer than in Sweden. Substance use disorders can start within a minimum of 2 weeks, extending up to 18 weeks at the physician’s discretion. Phobias were further subdivided according to severity and job requirements as follows: agoraphobia, 2–20 weeks; social phobia, 2–14 weeks; and specific phobias, 2–10 weeks.
France’s guidelines simply set a 2-week recommendation for depression and does not address other mental disorders in detail. Table 2 compares the guidelines for depression in Sweden, Ireland, and France and highlights the characteristic features of each country’s disease-specific guidelines.
Cancers
Sweden's cancer-specific policy separates recommended and maximum duration of work disability based on degree of metastasis and treatment modality. Cancers with metastasis might require leaves longer than 1 year, whereas non-metastatic cancers are separated based on the primary site. Post-surgical leave is generally of 4–6 weeks but extended to 4 months in case of complications. Chemotherapy varies from 9 months for colon cancer to 2 months for breast cancer. Radiotherapy for cancer of the prostate can be as long as 8 weeks, and treatment of non-metastatic melanoma can take between 3 days and 1 month. Notably, cancer is not covered in Ireland or France.
Neurological diseases
Sweden’s guidelines categorize neurological diseases into acute and chronic conditions, with initial recommendations often suggesting 1–2 weeks of work disability for diagnostic evaluations or recommending partial sick leave. For instance, new-onset multiple sclerosis typically warrants 2 weeks, whereas disease progression can justify up to 12 weeks of work disability. Chronic conditions, such as Parkinson’s disease, call for partial sick leave, with transitions to disability evaluation if the condition worsens. Similar to their approach toward cancer, Ireland and France do not provide guidelines for neurological diseases.
Examples from the UK Fit Note
The UK Fit Note includes practical examples published by the Department of Work and Pensions. Four representative scenarios are outlined.
(1) Cystic fibrosis in a publishing employee: After contracting a common cold, the workers’ fit notes advised adjusting of the workplace rules. It recommended 10 days of remote work to minimize secondary infections. If no symptoms of bacterial infection are observed after 10 days, the employee may return to the office.
(2) Multiple sclerosis (MS) in an unemployed individual: When symptoms of MS persist, individuals must avoid lifting heavy objects. However, the cognitive function was unaffected. The fit note flagged the need for workplace and positional changes with a 3-month validity.
(3) Suicidal accountant: Chronic insomnia and depression led the individual to disclose explicit suicide plans to his wife in the morning. The fit note mandated urgent psychiatric intervention, indicating that depression rendered the person unfit for work. The note was valid for 4 weeks.
(4) Office worker with interpersonal conflict: Despite experiencing considerable stress, no mental disorder was diagnosed and the worker was deemed capable of continuing. The fit note advises contacting the company’s human resources department and union representatives for support, and recommends follow-up if stress persists.
DISCUSSION
In this review, we examined the concept of work disability evaluation and its application to sickness benefit schemes in various countries, including published disease-specific guidelines aimed at ensuring consistency and fairness. We also discussed case examples involving mental disorders, cancer, and neurological diseases, as well as concrete scenarios using UK fit notes. Building on these examples, we review the literature on the recurring challenges in medical certification systems, ultimately deriving insights into South Korea.
When physicians perform work disability evaluations for sickness benefits, they often encounter complex issues such as conflicts with patients, limited time and resources, ambiguity surrounding certain illnesses, and difficulties inherent in evaluating work disability.12,14,17 Particularly, for general practitioners handling extended sick leave or ambiguous symptoms, such as stress and chronic pain, studies have consistently reported significant burdens.18 Additional complexities arise from the administrative aspects of sickness benefit certification, communication with employers, and inadequate guidelines or training support.19
A nationwide Swedish survey indicated that physicians who regard sickness certification as a problematic work environment issue are mainly concentrated in primary care, psychiatry, and orthopedics. The chief complaints included a lack of time, conflicts with patients, and complex psychosocial needs.20 In another Swedish study involving 14,210 physicians from multiple specialties, 67% regularly performed sickness certifications. Hospital practitioners reported substantial burdens among the specialties of primary care, rheumatology, neurology, psychiatry, and orthopedics. The authors concluded that, although prior discourse focused mainly on primary care, specialists struggled with similar difficulties in conducting work disability evaluations.21
Qualitative studies have analyzed sickness certification documents, highlighting clinicians’ narratives.22-24 For instance, a physician may feel powerless when a patient requests sick leave for social issues, such as workplace stress or conflict with superiors.25
Across Europe, primary care physicians often assume the main role of issuing sickness benefit certificates and report numerous challenges, ranging from navigating patient conflicts to reconciling professional ethics.26 Although these perspectives are individual clinicians’ experiences, the root causes often lie in the broader social structures linking patients, employers, and governmental agencies. Korea is likely to encounter similar problems during early adoption of a sickness benefit system. However, Korea’s higher proportion of medical specialists than primary care physicians may alleviate concerns regarding diagnostic difficulties.
Sickness certification decisions depend on more factors other than on the sole basis of the type of disease. They are influenced by patients’ history of sick leaves, socioeconomic status, employment arrangements, doctor–patient relationships, and institutional contexts.27-30 During the decision-making process, physicians must reconcile the mandates of insurance oversight authorities, potential conflicts with patient requests, and their own professional integrity, sometimes resorting to informal strategies to navigate the administrative criteria.31 Studies have also suggested that physicians’ training skills, professional identity, psychological pressure, and the capacity to manage conflicts with patients significantly affect their certification practices.32
Issues related to social equity persist even in countries with extensive experience in sickness benefit systems and work disability evaluations. Considering that Korean healthcare offers easy access to medical facilities, but requires relatively shorter consultation times, these aspects must be addressed while implementing a national sickness benefit scheme. Ongoing government oversight and support are warranted to enable physicians to conduct medical certifications and work disability evaluations with efficiency and accuracy.
A Cochrane Database of Systematic Reviews analysis of five studies comparing self-certification (in which patients declare their own absence) with physician-issued certification found no clear or consistent benefits in terms of the number of lost workdays, frequency of absence, or associated costs. While self-certification may simplify administrative procedures, the overall evidence regarding its effect on reducing sick leave days or costs remains unclear.33 Another example stems from interrupted time-series analysis in Helsinki, Finland, in which a multifaceted intervention designed to strengthen musculoskeletal care and sick leave guidelines correlated with a gradual decline in sick leave days. The quasi-experimental study design prevented definitive causal attribution, but suggested possible benefits for cost reduction and return-to-work.34
A qualitative Swedish study reported that, following intensified oversight by the Swedish Social Insurance Agency (Försäkringskassan), physicians used various “unofficial tactics” to boost the acceptance rate of work disability certifications, such as slightly revising diagnoses to appear more objective or modifying the description of symptoms.35 A national Finnish survey of 2,472 physicians revealed that 61% of them encountered difficulties in sickness benefit certification, partly because delays in medical or rehabilitative services left patients unnecessarily off work for extended periods. These burdens were most acute among primary care physicians and psychiatrists, many of whom believed that the establishment of national guidelines or supportive infrastructure was essential.36
Multiple studies in Sweden have investigated the utility of disease-specific guidelines for sickness benefits.37-40 By instituting formal recommendations for work disability durations and administrative procedures, the Swedish government aimed to improve communication between healthcare providers and insurance examiners, as well as to enhance fairness among beneficiaries. A nationwide cross-sectional survey of these guidelines introduced in 2007 found that approximately half of the physicians used them monthly or more often. Such guidelines were most frequently adopted by general practitioners, many of whom reported that they helped clarify illnesses and the need for sick leave. Conversely, some respondents noted that the guidelines are complex and not easily tailored to individual patient characteristics, highlighting the need for further education and systematic support.41
In Korea’s pilot sickness benefit system projects, disease-specific guidelines have been developed through dedicated research contracts. By referring to work disability periods and decision-making factors in the Swedish, French, and Irish guidelines, these newly created guidelines incorporated disease characteristics, clinical considerations, and occupational factors. They further proposed recommended durations for healthy workers with no specific illnesses or occupational risk factors. Throughout the development process, which spanned 3 years and covered approximately 160 different medical conditions, clinical experts and academic societies provided extensive consultations and reviews. Considering that European countries have long emphasized and recommended guidelines within their own sickness benefit schemes, establishing disease-specific guidelines was deemed essential for the successful introduction of Korea’s program; however, disease-specific guidelines must be framed not simply as administrative tools but rather as practical resources that help physicians accurately evaluate work disability.
Tables 1 and 2 present the characteristics of the Korean disease-specific guidelines, using shoulder disorders and depressive episodes as examples. The most distinctive feature of the Korean disease-specific guidelines is that they introduce the concept of a “referent worker” to compare periods of inability to work. While guidelines in other countries vaguely define office workers, the Korean guidelines specify a standard worker as a worker in their 30s or 40s with no underlying conditions and who does not perform work that affects their illness. Continuous updates and educational programs are vital. Therefore, these guidelines remain clinically relevant and do not merely serve a bureaucratic function.
CONCLUSIONS
Although the specific format of work disability evaluation may vary within national institutional framework, the overarching goal is to facilitate appropriate and timely return-to-work. Korea’s sickness benefit system shares this mission with other countries. To reduce inefficiencies and establish a successful scheme, it is essential to examine international experiences in work disability evaluations. Disease-specific guidelines providing concrete recommendations on the duration of work disability and approaches to functional assessment are likely to play major roles in the medical certification system for Korea’s sickness benefit programs.
However, evaluating work disability and determining the period of work inability based solely on illness severity is insufficient. A comprehensive assessment of the patient's occupational, social, and economic characteristics is necessary for an accurate evaluation. Therefore, it is common to adopt the broader concept of a workability assessment. However, the existing guidelines referenced by primary care physicians and general practitioners who first issue medical certificates mainly outline the work-related factors that should be taken into account. In cases where an employee is unable to work for a long period, active assessments and workplace return interventions are performed, such as establishing a workplace return plan together with the employer. Accordingly, expertise in occupational medicine is central for successful integration and implementation of sickness benefit systems. Along with the introduction of the system, it is time to strengthen the relevant competencies of occupational and environmental medicine specialists and develop educational programs and reference materials that can support the clinical judgments made by physicians in other specialties.
Abbreviations
CNAM
Caisse Nationale d’Assurance Maladie
FFW
fitness-for-work
ICF
International Classification of Functioning, Disability, and Health
MS
multiple sclerosis
OECD
Organisation for Economic Co-operation and Development
OH
occupational health
PTSD
post-traumatic stress disorder
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Competing interests
Inah Kim, contributing editor of the Annals of Occupational and Environmental Medicine, was not involved in the editorial evaluation or decision to publish this article. The remaining author has declared no conflicts of interest.
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Author contributions
Conceptualization: Kim Y, Kim I. Data curation: Kim Y. Formal analysis: Kim Y. Writing -original draft: Kim Y. Writing - review & editing: Kim I.
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Acknowledgments
The authors thank the National Health Insurance Service (NHIS) and the Ministry of Health and Welfare (MoHW) for cooperating our research and providing the data used in this study. Additionally, authors thank researchers who has participated the development of the medical certification schemes for the Korean Sickness Benefit Pilot program; Choi, Won-Jun (Gachon University), Kang, Chung Won (Hanil General Hospital), Kang, Mo-Yoel (The Catholic University of Korea), Kim, Eun Kyoung (Korea Workers’ Compensation & Walfare Service Ansan Hospital, Ansan), Kim, Yong-kyu (Korea Workers’ Compensation & Walfare Service Incheon Hospital, Incheon), Lee, Dong-Wook (Inha University Hospital), Min, Jeehee (Hanyang University Hospital), and Youn, Kanwoo (Wonjin Green Hospital).
NOTES
SUPPLEMENTARY MATERIAL
Supplementary Fig. 1.
The application form of sickness benefits medical certification in Sweden (1) (A), (2) (B), (3) (C), and (4) (D).
Supplementary Fig. 2.
The Med 3 form for fit notes in the United Kingdom.
Supplementary Fig. 3.
The medical certificate form in the Korean Pilot Program of the sickness benefit (1) (A) and (2) (B).
Table 1.
Comparison of disease-specific sickness benefit guidelines for shoulder diseases in Sweden, France, and Korea
Table 2.
Comparison of disease-specific sickness benefit guidelines for respiratory diseases in Sweden, France, Ireland and Korea
Table 3.
Comparison of disease-specific sickness benefit guidelines for depressive episodes in Sweden, Ireland, France, and Korea
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XML DownloadMedical certification of system sickness benefit scheme (II): practical approaches for evaluating work disability
Medical certification of system sickness benefit scheme (II): practical approaches for evaluating work disability
| Main category | Sweden | France | Korea |
|---|---|---|---|
| Recommended period of work disability | Acromioplasty (adhesive capsulitis/bursitis): 1 month | Office work | Labor‑intensity matrix (low/medium/high) |
| Rotator‑cuff reconstruction among office workers: 4–6 weeks (non‑dominant hand), 2–3 months (dominant hand) | – No surgery: 7 days/10 days (dominant/non‑dominant) | Adhesive capsulitis | |
| Rotator‑cuff reconstruction among manual workers: 3–6 months (medium‑load work), ≥6 months (high‑load work ≥25 kg) | – Post‑surgery: 10 days/70 days. | – No surgery: 0/14/28 days | |
| Light handling | – Post‑surgery | ||
| – No surgery: 14 days/90 days | 0/28/56 days | ||
| – Post‑surgery: 28 days/120 days. | Impingement, biceps‑tendinitis, calcific tendinitis | ||
| Moderate work | – No surgery: 0/14/28 days | ||
| – No surgery: 42 days | – Post‑surgery: 0/28/56 days | ||
| – Post‑surgery: 150 days | Rotator‑cuff tear | ||
| High‑risk | – No surgery: 0/14/28 days | ||
| – No surgery: 60 days | –Reconstruction‑surgery: 28/56/84 days | ||
| – Post‑surgery: 180 days | – Arthroscopic repair: 28/42/56 days | ||
| Symptoms/prognosis/treatment | Duration tailored to surgery type, dominance, and load class | Explicit day‑based schedules linked to hand dominance, load, and surgery status | Acute pain limits ROM; chronic cases show strength loss. Conservative care (exercise, NSAIDs, injections); surgery where indicated. |
| Functional impairment | Targets loss of shoulder strength/mobility; heavier work extends restrictions | Dominance‑specific functional limits documented; higher loads assume greater impairment | Impaired overhead reach and lifting; severity graded by labor intensity and dominant‑side involvement |
| Activity limitations | Heavy lifting or sustained shoulder use restricted up to ≥6 months post‑reconstruction | Graduated limits from office tasks to ≥25 kg handling | Presented by clinical and occupational factors |
| Rehabilitation and return-to-work | Progressive loading; earlier return for non‑dominant or low‑load roles | Stepwise re‑introduction of dominant‑hand tasks; longer convalescence after surgery and high‑load work | Present a return-to-work evaluation through the concept of a referent worker |
| Main category | Sweden | Ireland | France | Korea |
|---|---|---|---|---|
| Relevant diseases | Upper-respiratory-tract infections, sinusitis, tonsillitis, chronic-obstructive-pulmonary-disease (COPD), asthma, etc. | Acute respiratory infections and asthma | Acute respiratory infections | Asthma, COPD, pneumonia, acute/chronic bronchitis, upper-respiratory-tract infections |
| Recommended period of work disability | Generally no sick leave for mild cases; if symptoms worsen, 1–3 weeks are recommended. | 1–2 weeks | Tonsillectomy: 1–2 weeks | Bronchitis and upper-respiratory infections: 0 days; other conditions: 3–14 days, depending on symptom severity |
| Lower-respiratory infection: 5–7 days | ||||
| Symptoms/prognosis/treatment | Detailed instructions provided | Not specified | Not specified | Detailed instructions provided. |
| Functional impairment | Reduced exercise capacity; limitations for voice-dependent tasks | Not specified | Not specified | Reduced exercise capacity; limitations for voice-dependent tasks |
| Activity limitations | In the case of a high degree of severity, difficulties may arise in daily life. | Not specified | Not specified | Detailed guidance on tasks that heavily burden the respiratory system (dust, fumes, high physical demand) |
| Rehabilitation and return-to-work | Encourage early return-to-work or partial leave for mild cases with low severity | Not specified | Not specified | Present a return-to-work evaluation through the concept of a referent worker |
| Main category | Sweden | Ireland | France | Korea |
|---|---|---|---|---|
| Relevant diagnosis code | F32 | F32, F33 (Recurrent Depressive Episodes) | Not specified | F32, F33 (Recurrent Depressive Episodes) |
| Recommended period of work disability | Partial sick leave for up to 3 months for mild symptoms, full-day sick leave or partial sick leave for up to 6 months for moderate or more severe symptoms | For a single episode of depression, the recommended duration is 2 weeks for mild, 8 weeks for moderate, 16 weeks for severe, and 20 weeks for the most severe symptoms. | Regardless of the type of work, 14 days | If duration is 3 months or more, or accompanied by symptoms such as suicidal thoughts or need for inpatient treatment, a consultant doctor conducts an evaluation. |
| Symptoms/prognosis/treatment | Detailed instructions provided | General description of a single depressive episode’s medical characteristics | Explanation of the risk of increasing severity due to prolonged inactivity | Detailed instructions provided |
| Functional impairment | Influence on cognitive function | Not specified | Not specified | Not specified |
| Activity limitations | In the case of a high degree of severity, difficulties may arise in daily life. | Not specified | Not specified | Presented by clinical and occupational factors |
| Rehabilitation and return-to-work | Encourage early return-to-work or partial leave for mild cases with low severity | Emphasizes the importance of returning to work | If symptoms do not improve, partial sick leave is possible | Present a return-to-work evaluation through the concept of a referent worker |
Table 1. Comparison of disease-specific sickness benefit guidelines for shoulder diseases in Sweden, France, and Korea
ROM: range of motion; NSAID: non-steroidal anti-inflammatory drug.
Table 2. Comparison of disease-specific sickness benefit guidelines for respiratory diseases in Sweden, France, Ireland and Korea
Table 3. Comparison of disease-specific sickness benefit guidelines for depressive episodes in Sweden, Ireland, France, and Korea
