The arrears continue to rise: an employee who is ill for a long time and who applies for a WIA benefit, is now on average only examined after four months. Until then, they will be in uncertainty: will I soon be entitled to disability benefit, or will I be expected to fully work?
Employees of the UWV, which carry out these inspections, mainly see the pile of files growing. At the end of 2017, 14,000 people were waiting for their first medical assessment for schemes such as the WIA and Wajong. At the end of last year, that number had more than doubled: more than 29,600 people.
That pile and waiting time will continue to grow for a while, foresees Maarten Camps, chairman of the board of the UWV. This is due to the persistent shortage of insurance doctors. They assess the extent to which a person is able to work. They thus guard the gateway to the benefit.
The profession is relatively old: many insurance doctors are retiring. And the influx of young doctors is lagging behind. Basic physicians prefer to choose a more exciting specialism, such as a surgeon or cardiologist.
But the need for medical assessments continues to grow. The workforce is aging – and as people age, the risk of disability increases. “Last year we saw the number of WIA applications rise by 9 percent,” says Camps. “That is worrying. We couldn’t handle the demand for reviews at the time, and that demand will continue to grow.”
Still, the problem comes as no surprise. The sector has been warning about impending shortages since at least 2010.
How could the problem become so persistent?
“Because the number of insurance doctors is shrinking, we as UWV are fishing in an ever smaller pond. Another factor: around 2010 we were able to recruit limited new insurance doctors for several years due to budget cuts. Since then, we have been making maximum efforts to recruit doctors.”
Is the profession of insurance physician attractive enough? As the largest employer, the UWV can influence this.
“I totally agree. That is why we are experimenting with a new working method at two locations, in Heerlen and Tilburg. In the traditional model, the insurance doctor does everything. At those two locations, the doctor works in a team with other experts – a psychologist, a psychiatrist, a physiotherapist. They do the assessment together. This way you use the time of the insurance doctor more efficiently. The doctor can do more assessments and the work becomes more interesting.”
Why does it get more fun then?
“Because you work in a team, with different disciplines – and the insurance doctor makes the final decision. Just like in the hospital: there too all kinds of support staff relieve the specialist, but he remains responsible. We are now slowly expanding this method; because it’s a big change, we want to do this carefully.”
This does not mean that the shortages will have disappeared, says Camps. Together with Minister Karien van Gennip (Social Affairs, CDA), he is now looking at other far-reaching changes, also in legislation, that can reduce the pressure on insurance doctors.
At the same time, there are political plans that could increase the workload of the UWV. Such as the mandatory occupational disability scheme for self-employed entrepreneurs that is included in the coalition agreement. There are also plans to entitle more people to the WIA. At present, you will only receive benefits if you suffer at least a 35 percent loss of income due to your illness. Trade unions, employers and a majority in the House of Representatives want to lower that limit to 15 percent. As a result, more people are entering the WIA.
Also read: Tax authorities and UWV foresee problems with the implementation of self-employed insurance
Can the UWV handle that extra work?
“Not at this moment. For us, the highest priority is to clear the backlog. Then people’s long-term uncertainty about their entitlement to benefits will also disappear.
“Then there is a much broader discussion about the hardness, explainability and feasibility of the WIA. But that is something for the longer term. We would not be able to handle an expansion of our group of disabled people. And that scheme for the self-employed: we assume that it will only come into effect once we have cleared the backlog.”
You ask the ministry to introduce this only once the backlog is gone?
“Yes, and I see that the ministry sees that too, and that it is looking for the space to do it this way.”
Camps cannot yet estimate when the UWV has lost its arrears. That depends on how far-reaching Minister Van Gennip wants to intervene. For example, it may decide to re-examine people in the WIA much less often. Van Gennip promised to announce before the summer how she intends to tackle the problems.
Anyone waiting for the first WIA assessment will already receive a benefit. Until recently, you risked recovery if it turned out that you were not entitled to benefits. Why did you stop reclaiming?
“We saw the number of recoveries increase. And people also had to wait longer, so it was about increasing amounts. This led to harrowing cases: people had to pay back money that they no longer had. They just lived off that. We have decided with the minister not to reclaim that money.”
This leniency does not apply to people who do not receive WIA benefits, but who are still entitled to unemployment benefits. They are not allowed to keep their WIA advance. Instead, they will receive unemployment benefits retroactively for the months that they had to wait for a medical examination. Disadvantage: in this way they lose many accrued unemployment benefits in one fell swoop. When those are gone, the assistance remains.
Why can’t they keep the advance?
“We want to help the group that can get into financial problems because they have to wait so long. The moment someone does not receive a WIA and is not entitled to unemployment benefits, in many cases you fall back on social assistance. You cannot apply for this assistance with retroactive effect over the months that you have waited for an assessment. That is why we do not have that group repaid: otherwise they would have no income for those months. You can get unemployment benefits retroactively.
“The most important thing is that these people get back to work. That is why we ensure that they already receive support with this, while they are still waiting for their assessment.”
Unemployment benefit rights are expensive for people who are just not entitled to the WIA. Unemployment among them is high. Wouldn’t it be fairer if they too could keep the advance?
“You could build a case for that. But we also work with tax money. You always have to make a decision. What is fair for the people who get that tax money and for those who pay it? Ultimately, the minister has to make that decision.”
A version of this article also appeared in NRC in the morning of April 21, 2022