6
completion. The proportion of cases where the SIA decides contrary to the doctor’s
recommendation is, however, small. During 2006 the request for sick pay was rejected in
1.5 percent of the inflow (Försäkringskassan, 2007). The percentage of rejections
increased to 1.7 percent in 2008 and the proportion of revocations of sickness benefit is
stable at 1 percent.
When there are doubts about the right to benefits and the need for rehabilitation, the
caseworkers are obligated to refer the sick absent individual to an assessment meeting.
The available assessment meetings are Sassam
5
and AM
6
. Both are mandatory and failure
to participate could lead to withdrawal of benefits. The purpose of Sassam and AM is
twofold: first, by reviewing medical certificates and other documentations, the SIA
confirms whether the working capacity is reduced due to illness. The evaluation could also
uncover the need for vocational rehabilitation, which then leads to the second purpose,
which is to initiate different types of vocational rehabilitations.
2.2
Disability Insurance
The criteria for receiving DB depend on the age of the individual. For individuals 30 years
and older, an individual is entitled to benefits if the working ability is assessed as being
reduced by at least 25 percent for at least 1 year. Benefits could be granted either fully or
partially (25, 50, or 75 percent). Before 1 July 2008, DB could be either permanent or
time limited up to 3 years. With the new rules, only permanent DB are allowed. For
individuals below 30 years of age, only time-restricted DB are granted. A benefit period
could be no longer than three years. When a benefit period expires it could be renewed
after a new assessment of the working capacity.
Disability benefits can be obtained in either of two ways. The individual can apply for
benefits and the caseworker can, even without the individual’s consent, initiate an
exchange from sickness benefits to DB. The granting of DB starts with the caseworker
preparing a portfolio with the necessary documentation together with an assessment of
what the outcome should be. A specialist at the SIA then checks the documentation and
whether further information is needed. The specialist presents a report to a second
caseworker who makes the decision and denotes a decision maker in the following. If
eligible, (s)he furthermore decides on the degree of the working disability (0, 1/4, ½, ¾,
or full) and on the benefit level (based on the suggestion in the portfolio from the
5
Sassam is an in-person meeting where the sick individual and the SIA have a structural discussion
(based on a so-called SASSAS-map) of the situation. This structural discussion concerns questions
dealing with benefit eligibility, i.e., medical diagnoses, working ability, and working tasks. It also
involves questions not directly associated with the right to benefits, for instance social status and
work motivation. The results from the assessment are used to decide on the eligibility and on how
the sick leave will progress.
6
The AM is a formalized meeting between the sick individual, the SIA, and at least one additional
part, usually the doctor or the employer. If the sick individual is unemployed, representatives from
the employment agency could participate. The purpose of the meeting is to evaluate the working
capacity and the possibility to return to the existing or alternative work tasks at the employer. If
necessary, appropriate vocational rehabilitation measures are decided upon. An AM meeting should
be foregone by a Sassam investigation. The purpose of the AM is to reduce sick-spell length and
increase the possibility to return to work. In contrast to Sassam, AM is legislated in law (see
proposition 2002/03:89).
