When every attempt to contribute becomes self-incrimination

Think of Shmulik, a successful software engineer. For twenty years, he developed complex systems, managed teams, and solved problems that no one else could solve. Until the day he got sick. A severe chronic illness. For whole days, he cannot get out of bed. He is unable to concentrate for more than ten minutes at a time. Even sitting for a long time is an impossible task. An occupational physician examined him and reached an unequivocal conclusion: total loss of work capacity. Permanently.

His insurance company accepted the claim. Now he receives a monthly allowance of 75 percent of his salary. And no, this is not a mistake. In most loss of work capacity policies, compensation is limited to about 75% of the insured salary. Why? To provide a financial safety net without creating an incentive where it is more profitable not to work. Therefore, at least on paper, even those recognized as having lost their full capacity are still allowed to work and earn an amount not exceeding the difference — 25% in Shmulik's case. Subject to the terms of their policy, of course.

And the Equal Rights for People with Disabilities Law, for its part, does not assume that someone who has lost the ability to earn a living has ceased to be valuable. On the contrary. The law requires employers to consider reasonable accommodations, as long as they do not impose an unreasonable burden, and the state even participates in financing the accommodations in many cases.

Beyond the sad story, so far the matter sounds quite logical. The engineer is no longer able to work eight hours a day. Not even four. But once or twice a week, he has two good hours. And in those two hours, he is still able to review code, mentor a young employee, consult on Zoom, assist in solving a problem that others have been racking their brains over for a week. And here the paradox enters. The question of whether Shmulik will be able to do this is no longer just a medical question, but an impossible choice. Because everything he does could be misinterpreted.

Total loss of work capacity is an insurance category, not a determination that a person has lost all their value. From the employer's point of view, the retained capabilities are proof that it is worth finding an accommodation that will allow him to continue to contribute. From the insurance company's point of view, those same capabilities could raise an eyebrow: perhaps his condition is not as severe as determined? And so one of the strangest traps imaginable is born. To prove that he has lost work capacity, a person is required to show what he is not capable of doing. To continue to be a productive person, he is required to show what he is capable of doing. And any evidence for one side may be used as evidence against him on the other.

This is not just decision-making under conditions of uncertainty. This is a decision under conditions of ambiguity — the hardest decision. And ambiguity does not just create anxiety, it also creates avoidance. When we don't know what is allowed and what is forbidden, we prefer to do nothing. This is not about weakness or laziness. This is a rational response to a crooked incentive structure. If a mistake in one direction could cost you the allowance you live on, and a mistake in the other direction costs "only" identity and meaning — avoidance is the logical choice. Perhaps that is why lawyers in the field recommend avoiding any action, even if the policy allows it, so as not to give "ammunition" to the insurance.

What is called: the person did not fail. The system failed. And so, instead of encouraging people to contribute as much as they are able, the system encourages them to stop contributing completely. Because of the ambiguity, not the competence. And this ambiguity costs us all dearly. The employee loses much more than potential income. He loses the professional identity built over years, the sense of self-worth, the reason to get up in the morning — on days when it is possible to get up. But studies show that adapted work can be a therapeutic factor. And forced inactivity worsens the physical and mental state alike.

And the irony is that the system that insures our health, in the end, causes us harm. The employer loses tacit knowledge accumulated over years that is very difficult to acquire in a tender or replace with rapid recruitment. And the marginal contribution of Shmulik's two hours is particularly high, and its cost to the employer is relatively small. This is the best deal he cannot make. And the state loses tax revenue, spends more on the health of people who have been forcibly excluded, and creates a sustainable mechanism: everyone who sees Shmulik learns the lesson. Even the insurance company loses: the assumption that the insured is wrong unless proven otherwise leads to lawsuits, makes litigation more expensive, and condemns the insured to a longer dependence on the allowance. And this is a particularly strange equilibrium: no player benefits from the ambiguity, and yet it is maintained.

All this because we love labels. They are simple and comforting. Fit or unfit. But human beings are not percentages. One can solve a complex mathematical problem and not be able to sit for ten minutes in an office, write code for an hour and not function for two days afterwards. And our systems still require us to choose a box. But modern medicine is full of people who are in the middle, and binary thinking misses them all. And this is no longer just a problem of loss of work capacity. The irony is that the system itself does not strive for this situation. But between the declaration and reality lies an abyss.

However, it does not have to be this way. And you don't even need to change the amount of allowances or medical definitions to change the situation. You just need to define the rules. Instead of people guessing, clear boundaries should be set in advance: which activities do not violate rights, how many hours are allowed to work and in what, what is considered rehabilitation and what is employment, what requires reporting and what does not. And above all — to commit that anyone who acts within these boundaries will not be required to explain themselves. Once the boundaries are clear, you don't have to choose between health and contribution. Because ultimately, loss of work capacity is not a loss of value. And a person who is unable to work full-time is not necessarily a person who is unable to contribute.

The question is not how many percentages of a position a person has left. The question is what kind of society we want to be: one that allows those who are not one hundred percent fit to continue to contribute and maintain meaning, without every attempt to contribute becoming self-incrimination, or a society that sends home everyone who no longer fits into the comfortable template called "position". Today it is just Shmulik's problem. But tomorrow it could be our problem.

The author is an expert in behavioral economics and decision-making, a faculty member at the Baruch Ivcher School of Psychology at Reichman University.