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## Principal activities

### Medical Assessment Service

From the beginning of 2010 the CSSA Medical Assessment Service (MAS) had to adapt to two fundamental changes: assessing disability under the new legislation and assessing state of health as part of objections proceedings. After some initial problems, the MAS successfully coped with these duties during 2010.

In 2010, the CSSA MAS drew up a total of 471,124 assessments for the purposes of the provision of social security benefits and services conditional on long-term adverse health. That figure includes second-instance assessments in cases of appeals (objections proceedings and appeals in administrative proceedings in sickness insurance matters). 190,286 assessments (40.39% of the total number) were performed for the purposes of benefits provided by the CSSA and 280,838 (59.61% of the total number) for other social security organisations. The average number of assessments drawn up in 2010 per assessing doctor was 1,227.7, which was an increase of 363.2 (42.01%) from 2009.

170,375 assessments were carried out for disability purposes in 2010 (36.17% of the total number). Of that number, 66,371 assessments were drawn up as part of disability ascertainment assessments (14.09% of the total number) and 104,004 assessments as part of inspection assessments (22.08% of the total number).

Compared to 2009 there was a relative fall in the share of both disability ascertainment and inspection assessments in the total number of assessments. In absolute terms, there was a fall in the number of disability ascertainment inspections from 78,076 to 66,371 (i.e. 14.99%). The number of inspection assessments also fell from 106,414 in 2009 to 104,004 (a 2.27% reduction). In total, disability assessments make up 36.17% of all assessments.

The CSSA MAS also drew up 11,348 assessments for extension of the sickness benefit payment period after the expiry of the support period.

The activities of the CSSA MAS related to assessing temporary incapacity to work were somewhat impeded by the transition to the new NEM programme bringing together all sickness insurance-related data. The switch from isolated local databases to a nationwide single set of records was a fundamental change. The software situation was therefore reflected in the number of performed inspections: there were 135,053 in 2010, 51,084 fewer than in 2009. This is partly an upshot of measures designed to ensure that inspections of sick leave assessment are effective and efficient. This is also apparent from the fact that the number of assessments for terminating sick leave by a decision was 479 lower in 2010 than in 2009. 574 such assessments were drawn up in 2010 (compared to 1,053 in 2009). However, the lower number of cases of sick leave terminated by an administrative decision is primarily a consequence of the change in the legislation that provides for significant penalties for attending doctors that extend temporary incapacity to work without good reason. A total of 103 assessments was drawn up in the context of appeals against cases of sick leave being terminated by a decision (i.e. 17.9%), of which 29 were upheld (3 of the decisions were changed by the CSSA itself).

As part of its methodological and inspection work the CSSA MAS carried out 325 reviews of assessment files in 2010. In addition to planned inspections, it performed a further 2,789 reviews of assessment files for the purposes of expert assessment for other CSSA departments based on submissions from citizens and institutions, e.g. the Ministry of Labour and Social Affairs and the ombudsman.

The CSSA MAS was also responsible for assessment activities in connection with the application of EU social security law and bilateral treaties. These activities were no longer statistically monitored in 2010, however.

The main prerequisite for carrying on the profession of a doctor in the CSSA MAS is specialisation in assessment medicine. 10 doctors were certified in 2010.