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Introduction
The caseworkers in public insurance systems have a key role in deciding on
both benefit entitlement and the need for any support measures. Although
much of the caseworker’s job is regulated by law and process documents,
they still have considerable discretion in terms of making decisions.
Although the impact of different policies regulating the generosity of public
insurance, as well as the effect of various support programs, has received
much attention in the empirical literature, the role of the caseworker is a
field which has seen very little research. The few studies that exist are
restricted to unemployment insurance (UI). Behncke et al (2010a) studied
the effect of the relationship between caseworkers and unemployed
individuals on unemployment duration. Using Swiss data, they concluded
that a more demanding and less cooperative relationship with the individual
increased return to work. With the same data, Behncke et al (2010b) found
that similarities between caseworkers and individuals regarding gender,
age, education, and nationality increased return to work. Using Swedish
data, Lagerström (2011) found that the probability of being employed one
year after becoming unemployed was 13 percent higher for an individual
assigned a caseworker among the 30 percent most successful caseworkers
than it was for one assigned a caseworker among the 30 percent least
successful .
This paper focuses on caseworkers in the public sickness insurance (SI)
system in Sweden. Making assessments of working ability and benefit
entitlement is sometimes a complicated process and considerable
caseworker autonomy is necessary. As in many countries, the
caseworker´s role in Sweden is a dual one, involving both a help
component and a monitoring component. The help component is
represented by the opportunity to assess the need for rehabilitation and
to coordinate any rehabilitation measures needed, and the monitoring
component by legally regulated eligibility checks. With the discretion
allowed them, caseworkers can weigh these two potentially conflicting roles
differently, which in turn may affect the individual´s chances of returning
to work.
From research on SI we know that the benefit level (Johansson & Palme,
2005; Hesselius & Persson, 2007), and the degree of control (Hägglund,
2012; Hesselius et al, 2013; Johansson & Lindahl, 2012) affect the sickness
absence level. In correspondence with the findings for UI, results show that
the more generous the terms of the insurance are, that is, higher benefit
levels and less control, the higher the sickness absence level becomes,
and vice versa. Furthermore, studies of various active programs designed
to help those on sick leave get back to work, for instance, rehabilitation
or multi-sectoral co-operation, are discouraging. In an overview, Johansson
et al (2010) conclude that there is only limited evidence of vocational
rehabilitation and multi-sectoral co-operation increasing return to work. In
a recent evaluation of a large-scale rehabilitation program in Sweden (the
Rehabilitation Guarantee), Hägglund et al (2012) found that multimodal
rehabilitation among patients with pain in the shoulders, back, and neck
increased sickness absence in the years following the program. Also,
cognitive behavioral therapy among patients with psychiatric disorders had
no impact on subsequent sickness absence.