What is Disability, Really?

Bob Wilson

It is an issue we struggle with, and a difficult one to solve. Much of the activity in workers’ comp is centered around the concept of disability; what it is and how much it is worth for the individual who has been assigned with that designation. We even grade disability, giving it a numerical value with which we can then produce other mathematical calculations related to the previously mentioned value of its existence.

But here is the thing: Disability is a man-made legal construct, a creature of regulatory definition. It doesn’t actually exist outside of our creative imaginations. There are certainly people who by those definitions are fully disabled, but our use of the term is far too broad. Our challenge is that the concept of disability has been forever and inexorably tied to the reality of impairment. While impairment is quite real, the way we use the notion of disability often clouds the true picture of a person’s ability and ultimate contributory value in society.

I was speaking about this with a friend just a few days ago, and it is an issue we’ve broached before in this blog. Yesterday’s excellent column from Peter Rousmaniere, “What’s the problem with impairment ratings?,“ was a reminder that we should not easily dismiss this issue.

In his article, Rousmaniere cites an example from Dr. Chris Brigham’s Book, Living Abled and Healthy. That example is:

If your ring finger is amputated, you get a 100% rating for your finger, a 10% rating for your hand, and a 5% impairment rating for a whole person.

Rousmaniere correctly notes that the “whole person and her impairment are abstractions on paper.”

The problem for workers’ comp, and to a greater extent society in general, is that the percentages assigned to that loss have no basis in reality when comparing it to actual earning capacity. As the CEO of an internet-based information services provider, the amputation of my ring finger would have absolutely no impact on my continuing income or ability to perform my job. If I were a concert pianist or a surgeon, however, the loss of just one finger could be catastrophic. The rating system we currently use is seriously flawed, as it is a mechanism to compensate for lost earning potential that in many cases simply does not exist.

That is not to say there should not be consideration for what Rousmaniere refers to as “non-economic fallout” from an injury. As in the example he used, a person with a severe shoulder impairment may still be able to work but can no longer hold their grandchild; we must be cognizant of the impact of impairment beyond economic factors. Our system today, however, does not really consider that either.

It is no secret that I have grown to detest the word “disability.” It is unfortunately for many a self-fulfilling prophecy. We take people with a level of physical or mental impairment, and we declare them disabled. In so doing we condemn some of them to a future defined by restrictions and limitations. We categorize them by what they can no longer do and ignore the abilities they may still possess.

For some injured workers it becomes an integral part of their narrative in a larger story of general victimization. The sad thing is they are right. Our system assigned them that designation and role. They are disabled because we told them they were.

It’s official and everything.

Impairment is the physical reality. Disability is ultimately how the impaired person chooses to accept and deal with that reality. I’ve met many inspiring people over the years who have suffered significant impairment, but they are not disabled by our lackluster definition. They live full and functional lives, sometimes with accommodations, but they have not let the reality of their physical condition define who or what they are.

Our system of defining, declaring and compensating for blanket disability is flawed. We should be figuring out a better method that considers lifestyle impact as well as lost earnings potential. Whatever we end up with, we should not be so easily willing to label people as something they are not.

Defining an abled person as disabled may ultimately be the biggest injury with which they are inflicted.

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