Disability Rate: How is it Determined?

According to the World Health Organization, we can consider as a handicap any restriction or hindrance to the normal exercise of an activity by a person. This incapacity , characterized by excess or insufficiency of a current activity considered normal, may be temporary or permanent , reversible or be the direct consequence of a physical impairment.

As you can see, the term is very broad, since each person has specific circumstances. The degree of disability is used precisely to define as objectively as possible to what extent the disability affects a person’s autonomy and to provide them with the necessary tools and aids.

What is the disability rate and who determines it?

The disability rate is the value of the disability expressed as a percentage . It responds to unified technical criteria established by Social Security and assesses both the handicaps that a person presents as the complementary social factors (family, professional, educational and cultural environment) which can hinder their social integration.

In order to determine a person’s degree of disability , a physical, psychological and sensory assessment is carried out by a medical consultant from the Primary Health Insurance Fund (CPAM). Other factors of a diverse nature are also studied by a multidisciplinary team made up of a doctor, a psychologist and a social worker.

The last responsible for certification of the disability rate are the Primary Health Insurance Fund and the Departmental Disability Centers ( MDPH ). They will also be the ones who will determine the periodic review of this disability rate in case they deem it appropriate in anticipation of possible changes, although the minimum from the first diagnosis and from the review to assess the improvement or aggravation of disability is never less than two years .

From a legal standpoint, the invalidity recognition procedure was simplified by the decree published on October 5, 2018 in the Official Journal.

How is the disability rate determined?

In general terms, the disability rate is determined according to the law “by an analysis of the interactions between three dimensions”: impairment (impairment of functions), disability (limitation of activity linked to an impairment) and disadvantage ( limitation of the performance of a normal social role).

The rate is not precise but is determined as a “range” comprising the degrees of disability mild, moderate, significant and major . The last two rates represent handicaps greater than 50%.

The disability rate fundamentally assesses how different disabilities influence individuals’ personal autonomy. It is clear that expectations of personal autonomy vary throughout the life cycle, for both disabled and non-disabled people , but in the former it is essential to ensure quality of life.

When we speak of autonomy , we are referring to all aspects of life, both the most personal (home and close environment), educational, communicative and work and, above all, in terms of accessibility .

One of the methods for determining the disability rate is the guide scale for the assessment of impairments and disabilities of disabled people , the last update of which was in November 2017. It is a measurement tool that assesses the degree of disability. a person’s independence from certain routine activities of daily living (ADLs), the time spent in these activities and whether they need help. This guide is coupled with the Barthel index and assesses several areas:

  • Eat
  • Move between the chair and the bed
  • Personal cleanliness
  • Toilet use
  • Bath or shower
  • Getting around – walking on a smooth surface or in a wheelchair –
  • Going up and down stairs
  • Dressing and undressing
  • Stool control
  • Urine control

Beyond these ten ADLs, other mobility related revisions were added later , such as getting on and off the toilet and chair, getting on and off the shower, walking 50 meters on level ground, going up and down stairs or moving the wheelchair.

The Barthel index , as well as its subsequent modifications and interpretations, is a simple measure to apply with a high degree of reliability and validity and which makes it possible to detect changes and trends in disability and to be compatible with other assessments.

However, it is not based on a specific conceptual model. In other words: there is no theoretical model that justifies the choice of certain activities of daily living and not others, and it is not used to make a complete assessment of a person’s degree of disability. because it has to take into account many other factors.

Determining the disability rate is therefore a much more complex process in which two assessments are always carried out  : that of “activity limitations” (it would be a bit like the Barthel index) and that of “complementary social factors”. 

When a person reaches 25% in “activity limitations”, the score is added to that of the factors that may limit his full and effective participation in society on an equal basis with others. A disability is considered to be when a person reaches a rate equal to or greater than 33% , after which he automatically obtains his disability certificate .