Excluded from sickness insurance: rejected sickness cash benefit claims after 180 days of sick leave in the Swedish rehabilitation chain

Abstract

Abstract Purpose—to study factors predicting rejection of prolonged sickness cash benefit claims among persons on compensated sick leave for 180 days. Methods—all 246 872 claims for employed persons on sick leave recorded in the Swedish official statistics register between 2018.01.01 − 2021.06.30 were analysed. Claim outcomes were evaluated using logistic regression with odds-ratios recalculated to relative risks (RR) with 95-per cent confidence intervals (CI), adjusted for sociodemographic, work and health related factors. Results—Overall 46 611 (23 per cent) of the claims were rejected with slightly lower rates among women (0.98; 0.97 − 0.99). Musculoskeletal diseases had the highest rates (RR 1.41; CI 1.35 − 1.47) followed by injuries (1.32; 1.27 − 1.36) and symptoms (1.29; 1.26 − 1.33). Mental disorders also had above average rates (1.13; 1.10 − 1.17). The lowest rates were found among pregnancy related diagnoses (0.22; 0.20 − 0.26) and neoplasms (0.30; 0.30 − 0.31). Higher rates were also found among immigrants (1.19; 1.18 − 1.21), those with only primary education (1.05; 1.04 − 1.07) and blue collar workers (RR:s around 1.06). The regional variation was substantial (RR-range 0.48 − 1.82). Rejection rates declined substantially from 2021 due to changes in sickness insurance regulations. Conclusions—High rejection rates were found for complex diagnoses and among groups with precarious positions at the labour market. Systematic unexplained differences in rates were identified between geographic regions.