Optimizing the First Phase in the Assessment of Disability Claims Submitted to the National Insurance Institute

Background

Every year, hundreds of thousands of disability allowance claims are submitted to the National Insurance Institute (NII). Following each submission, an initial assessment takes place, whereby a physician on behalf of the NII determines the diagnoses relevant for reviewing the claim, adds medical information to the file, expands the set of benefits requested as needed, and decides on the medical specialties required for the hearing at the medical board, as well as the time to be devoted for each hearing, according to its complexity.

The NII has decided to take steps to shorten the time required to handle claims and to standardize the way they are managed in its various branches. To promote this aim, it contacted the Myers-JDC-Brookdale Institute requesting that it examine the initial assessment process in depth and suggest steps for its improvements.

Objective

Measure and analyze the work of the physicians responsible for the initial assessment process in the areas of general disability and work-related disability and leverage this information to enhance the efficiency and quality of their work.

Method

Analyzing administrative date from June-September and November-December 2022, provided by 22 NII branches. The analysis is based on descriptive statistics, data visualization, and data envelopment analysis (DEA) – a method used to measure relative efficiency.

Findings

Medium-high performance levels were found for all outcome measures. Nevertheless, the current situation does leave some room for improvement. Among other things, we found variance between the branches and several of the branches are significantly less t efficient and successful than the norm. Some branches are more efficient than others in terms of processes but perform less well in terms of outcome measures. Two branches were found to vary extremely from one another in specialization areas: one was very efficient and successful in the area of workplace-related disabilities and inefficient and unsuccessful in the general disability area, whereas the other excelled in the former area but performed less well in the latter. In addition, one branch was found to be mediocre in both areas.

Conclusion and Recommendations

We identified gaps between the branches and a potential for improvement to standardize the quality of service provided in NII branches countrywide. Here are some recommendations of managerial decisions that can be made based on the study, that are likely to have a direct effect on optimizing the initial phase of the assessments in the branches:

1. Change the division of work hours between the branches and the weekly deployment of the work hours for the initial assessments.
2. Examine the mix of doctors in the branches who are engaged in the initial assessments, based on training, authority, specialization, experience, etc.
3. Optimize communications and interrelations between branches, routing doctors, and administrators in order to minimize the number of times that the initial assessments need to be repeated.
4. Encourage the doctors engaged in the initial assessments to write a detailed and accurate summary of their decisions, including their rationales.