Almost every employer who faces long-term absence runs into the same question sooner or later: who does what? The occupational physician calls, the case manager emails, and meanwhile the employee who is ill asks their manager who is actually in charge. That lack of clarity is not harmless. When roles blur, delays creep into the reintegration process, deadlines are missed and sometimes a wage sanction from UWV follows.
The confusion is understandable, because both professionals move in the same domain: guiding an employee who is ill back to work. Yet their tasks, powers and responsibilities are fundamentally different. In its guidance on case management, the NVAB notes (in Dutch) that it is precisely around this distinction that uncertainty regularly arises about who leads the absence process. That calls for a clear explanation.
In this article we set out step by step what a case manager does, what an occupational physician does, where the roles touch and why good interplay between the two is so valuable for employer, employee and the reintegration process as a whole.
The occupational physician: a medical specialist with statutory powers
The occupational physician is the medical specialist at the meeting point of work and health. Their role is anchored in law: the employer is required to bring the physician in when someone is absent (in Dutch), and in most cases that has to happen within the first week of the sickness report. Only an appointed doctor may assess to what extent an employee is unfit for work; the employer may not determine that themselves.
By the sixth week of absence at the latest, the physician draws up a problem analysis. In it the physician describes the employee's limitations and possibilities, estimates the chances of a return to work and gives advice on the direction to take. (in Dutch) That document forms the basis for the action plan drawn up afterwards. In legal terms, the occupational physician is responsible for the whole of the social-medical guidance and for the advice to employer and employee.
The title is protected: the NVAB guards the quality of the profession through compulsory continuing education and assessment. (in Dutch) That means that as an employer or employee you know you are dealing with a qualified professional who meets strict professional standards.
The case manager: director of the reintegration process
Where the occupational physician gives the medical judgement, the case manager takes care of carrying it out and following it up. The case manager guides the reintegration process and is the point of contact for questions and concerns around the absence. (in Dutch) In practice, an employee who is ill has contact with the case manager more often than with the physician.
The case manager works at three levels at once. At employee level they offer personal guidance and support. At manager level they help with practical tips for holding good conversations. At organisational level they spot patterns and advise on preventing future absence. That makes the case manager above all a connector and a facilitator: someone who makes sure communication runs well, that agreements are kept and that everyone knows what is expected of them.
The Gatekeeper Improvement Act prescribes that a case manager is appointed from within the company in cases of long-term absence. (in Dutch) At larger organisations that is often an HR employee or someone from absence administration. Smaller organisations regularly choose to fill this role externally, through an occupational health service or a specialist absence adviser.
Two forms of case management you should know
Not every case manager has the same powers, and that is a distinction often overlooked in practice. There are two main forms.
The first is the process case manager. This professional watches over the process and makes sure that all the steps of the Gatekeeper Improvement Act are taken correctly and on time. They usually do not know what is going on medically, because that remains the responsibility of the occupational physician. The process case manager translates the physician's advice into concrete reintegration steps.
The second is the case manager working under delegated tasks. This case manager works under the responsibility of the occupational physician and may take over certain tasks the physician has delegated to them. (in Dutch) Think of making the first contact after a sickness report or requesting relevant information. The physician always remains ultimately responsible for the medical aspects and has to check actively that the delegate is carrying out their tasks correctly. Only in this delegated role may the case manager have sight of an employee's medical data.
A common misconception in practice
A persistent misunderstanding is that the case manager can replace the occupational physician, or that having a case manager automatically means the absence process meets the statutory requirements. That is not the case. Bringing in a case manager can mean the absence guidance does not meet the requirements of the Gatekeeper Improvement Act if the physician's medical role is not safeguarded alongside it. (in Dutch) The physician remains legally responsible for the social-medical guidance and cannot hand that responsibility over entirely.
The reverse holds too: an occupational physician who only delivers the medical judgement but pays no attention to directing the process leaves employer and employee empty-handed. Who watches the deadlines then? Who oversees the action plan? Who is the fixed point of contact? Without a good case manager these tasks fall between two stools, with all the risk that brings.
What good interplay looks like in practice
The strength lies in the combination. Below is an overview of who picks up what in a well-organised absence process:
- The occupational physician assesses fitness for work, draws up the problem analysis, advises on what the employee can bear and, where needed, prepares the WIA application.
- The case manager records the sickness report, keeps in regular contact with the employee, watches the deadlines set by the Gatekeeper Improvement Act and draws up the action plan together with employer and employee.
- The case manager brings the physician in when medical expertise is needed, and then translates the medical advice into concrete, workable steps.
- The employer remains responsible for reintegration and takes decisions on the basis of advice from both professionals.
- In complex cases, physician and case manager bring in other specialists in good time, such as a labour expert or a psychologist.
This interplay keeps information from getting stuck, deadlines from being missed and employee and employer from working against each other through lack of alignment. A clear division of tasks gives everyone involved calm and direction, precisely in a period that is already hard enough for the employee.
What this means for your organisation
For employers it is wise to think carefully in advance about how the case manager role will be filled. Effective absence policy calls for a clear division of tasks: who handles sickness reports first, who keeps in contact and who is the case manager? (in Dutch) Set this down in an absence protocol, so that everyone knows what to expect as soon as an employee drops out. For employees it is valuable to know at the start of an absence who their fixed point of contact is and when the physician comes into the picture. That clarity lowers the threshold to communicate openly, and that helps recovery.
When everyone knows who is in charge, the employee who is ill gets exactly the calm and direction they need.
A clear distinction between the case manager and the occupational physician is not a luxury but a condition for an absence process that works. Knowing who does what prevents delay, misunderstanding and unnecessary legal risk, for employer and employee alike.
Key takeaways
- The occupational physician is the medical specialist: only they may assess fitness for work, and they are legally responsible for the social-medical guidance.
- The case manager directs the process: they watch the deadlines, keep in contact with everyone involved and translate medical advice into concrete reintegration steps.
- There are two types of case manager: the process case manager (without access to medical data) and the case manager working under delegated tasks (under the physician's responsibility).
- A case manager never replaces the occupational physician: both roles are needed and complement each other for a complete, legally sound absence process.
- Set the division of tasks down in advance in an absence protocol, so that everyone knows what to expect when someone falls ill.
- Good alignment between case manager and physician speeds up recovery, reduces the chance of a wage sanction from UWV and gives the employee the guidance they need.
At Dokter Beter the occupational physician and case management work closely together, so that as an employer or employee you never fall between two stools. Questions about what that looks like in practice? Get in touch.