Country good practice

case study:
Belgium

Marc de Graaf
Prevent
 Disability Case Managers:
Making the case for work health
promotion

Prof. Marc De Greef

Executive Director
Musculoskeletal disorders
 Most prevalent cause of work-related illness in
Belgium
 Represent 40% of all working days lost
 Estimation of the total cost to Belgian society:
 Back disorders: 1.6 billion euro
 Rheumatoid arthritis : 1.2 billion euro
An early intervention is needed
 Healthy people become ill, stay away from the
workplace and after some time ….
 Become long term benefit recipients with little chance
of returning to work
 Return to work after a long-term of absenteeism?*
• between three and six months : < 50%
• more than 1 year : +/- 20%
• more than 2 years : +/- 10%
• An early intervention affects the success rate of
RTW-programmes.
*Eurofound, “Employment and disability – Back to work strategies”, 2004
 Different stakeholders in RTW process
General Insurance doctor
practitioner Public
health
insurance
doctor
Organizations
focused on Employee Rehabilitation
integration

Occupational
Direct chief HRM physicians

Trade union Prevention

Employer
representatives advisor
Bottlenecks
 Employer and the employee are both responsible for the
reintegration process
 No other actor is officially responsible for reintegration of the
employee
 If an employee is motivated to return to work, he/she will
play a key role when negotiating between different actors
 An individual employee who becomes ill has no or little
knowledge about:
 The legislation applying to reintegration

 The network of actors and the different positions of these

actors with regard to reintegration
 Disability Case Manager
General Insurance doctor
practitioner Public
health
insurance
doctor
Organizations
focused on DCM + Employee Rehabilitation
integration

Occupational doctor
Direct chief HRM

Trade union Prevention

Employer
representative advisor
Role of the DCM
 The intermediary between the employer and the employee
 A networker, who
 optimises communication with and between all legally
involved actors;
 contacts specialised organisations for specific actions
(ergonomic adaptations, psychological assistance, … )
 A coordinator and evaluator of the process of reintegration
 An advisor with regard to reintegration (legislation,
concrete actions, …)
Skills and knowledge of DCM
Workplace level:
Understanding of
employer,
employee, legal
and regulatory
systems

Self-management
Advisory level: level:
Communication, Disability Case Manager:
Network of
networking and Coach of RTW process
support, coping
influencing skills strategies

Clinical level:
Bringing together
workplace
demands and
functional abilities
of the worker
 Multi-Dimensional Framework
Workplace System
Awareness-raising actions focusing on the advantages which come
from investing in people at work are needed. Workplaces should
integrate RTW in OSH; Trade Unions should recognize
RTW in their strategies; RTW should
Should include require proactive action
Should be
occupational
Health Care System

encouraged to

Legislative & Insurance System

approaches and
implement an
interventions; should
A systematic approach integrated approach of
acknowledge OSH and
for effective, safe, the different policies.
prevention at the
sustainable RTW Action must be taken to
workplace; should play
clarify responsibilities.
a role in the
Collection of
identification of workers
data needs to be
who need a nudge in
improved.
the right direction
Workers should not have financial
disadvantages related to RTW;
should be partner in RTW process and
All dimensions must be should be supported by their workplace.
part of the approach to
strengthen the possibilities
for a safe, sustainable RTW
Personal System

• Source: Based on “Moving Towards a Robust, Comprehensive Return to Work System”,

Judy Geary, IFDM 2006 & “Intro_DM Introduction in DM in Belgium”, Prevent, 2008
The first graduated DCM’s
Thank you for your attention!

Prof. Marc De Greef

Executive Director