Disability and the Limits of Knowledge. Uncertainties of Expert Practices in Insurance Companies

Disability is one of the most significant insurable risks in human life. Insuring disability, either statutorily or voluntarily, is not an easy task for insurance companies. Ability to work is more or less subjective, but insurance companies are expected to evaluate it objectively and unambiguously. Disability insurance as well as rehabilitation involves different kinds of expert knowledge. Disability is a construct of medical, legal and insurance institutions which are entangled with each other. Experts of these institutions try to prevent disability, define it and control its consequences in distinct ways. The interaction of these professions entails a lot of uncertain elements. Furthermore, as an increasing number of disability insurance applications and benefits are based on mental illnesses, the situation has become even more challenging than before.

This paper studies expert practices related to disability insurance and rehabilitation in Finland. The focus is on statutory disability insurance system. The main question is: how do different experts and institutions interact as they make decisions on disability insurance benefits and rehabilitation? The empirical material consists of interviews of medical, legal and other insurance experts, observation of institutional practices and technologies in insurance companies, and some key documents. The study shows how decisions on disability benefits and rehabilitation are a result of complex and case-specific negotiations between different professions and organizations, including (occupational) health care. Disability is not only a medical condition but thoroughly a social, political and judicial phenomenon. Hence, the ability to recognize the limits of expert knowledge and the related uncertainties has a crucial effect on the practices of insurance companies and the treatment of the insured.