**1. Introduction**

The outbreak of COVID-19 has affected every region of the world since November 2019. To combat the impact of this pandemic, governments have implemented measures such as adjustments to existing occupational accident insurance programs within their social security frameworks. These changes aimed to address the specific challenges posed by COVID-19 [1]. Local government institutions play a crucial role in balancing the need for social distancing to prevent the spread of COVID-19 and the need for economic recovery, as seen in the study of 28 provincial governments in China during the early outbreak of 2020 [2]. Moreover, the World Health Organization issued a series of physical distancerelated regulations to ensure that the COVID-19 pandemic would be contained [3]. As a result of the outbreak of COVID-19, plenty of unfavorable things have occurred concerning work all over the globe. More than a hundred individuals have died in Indonesia due to the COVID-19 pandemic, and the bankruptcy of several companies has had a knock-on

**Citation:** Kurnianto, A.A.; Fehér, G.; Tololiu, K.E.; Wikurendra, E.A.; Nemeskéri, Z.; Ágoston, I. Analysis of the Return to Work Program for Disabled Workers during the Pandemic COVID-19 Using the Quality of Life and Work Ability Index: Cross-Sectional Study. *Int. J. Environ. Res. Public Health* **2023**, *20*, 3094. https://doi.org/10.3390/ ijerph20043094

Academic Editor: Delfina G. Ramos

Received: 31 December 2022 Revised: 7 February 2023 Accepted: 9 February 2023 Published: 10 February 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

effect on the country's economy [4] and the quality of life of its workers. It shows that despite their abilities, the pandemic has made it difficult to access a range of activities. As one of the most vulnerable groups affected by the COVID-19 pandemic, people with physical disabilities are at high risk of COVID-19 exposure and have difficulty carrying out daily activities including following COVID-19 prevention protocols [5,6]. During the COVID-19 pandemic, stakeholders focused on ensuring the baseline health of RTW participants and the health and safety considerations for disabled employees, particularly if they had underlying health disorders that increase the risk of COVID-19. Workers with physical disabilities need special equipment or environmental adjustments to carry out the rehabilitation activities as part of the RTW program. Due to constraints on in-person connections and limited resources, implementing these adjustments during a pandemic may be challenging. During the pandemic, some health care providers adopted telemedicine, which may be challenging for disabled workers who need in-person treatment [7]. In addition, the pandemic has made the condition more challenging to return to work after being injured in a workplace accident. This concern has been highlighted because it is imperative for a person whose impairment was caused by a workplace accident to make significant alterations to cope with the new phase of their life.

Indonesia has a unique social security system based on employment, which allows the government to provide a benefit from occupational accident insurance in the form of a specific disability management program called Return To Work (RTW). This program is distinct compared to those offered by other developing nations [8]. The RTW program serves as a complement to in-kind benefit services by providing a comprehensive rehabilitation program. This program included medical, vocational, and psychological rehabilitation with the assistance of case managers [9]. Moreover, in the context of social security and occupational injury insurance, an in-kind benefit is a type of non-cash benefit that is provided to an individual as part of their insurance coverage. These benefits can include things like medical treatment, rehabilitation services, and other forms of assistance that are designed to help an individual recover from an occupational injury or disease. In-kind benefits may be provided directly by the insurance provider, or they may be arranged through third-party providers. For example, an insurance company may cover the cost of medical treatment from a specific hospital or clinic, or they may provide a payment to an individual to cover the cost of rehabilitation services [10].

In this case, BPJS Ketenagakerjaan, the Indonesian social security organization, provides a combination of cash and in-kind benefits to a person who has experienced an occupational injury or occupational disease. A worker could receive a cash payout to compensate lost income due to an occupational accident as well as in-kind benefits to cover the cost of medical care, and rehabilitation services in the form of a case management system and the RTW program [11]. In-kind benefits play an important part in social security and occupational injury insurance systems, supporting those who have been injured or suffered a disease because of their job, and enables individuals to regain their dignity by enhancing their productivity during the course of the RTW program.

The RTW program in Indonesia is designed to support workers who have suffered a disability due to an occupational accident or disease and have been registered as customers of BPJS Ketenagakerjaan. The program provides employees with a range of support services including medical rehabilitation, vocational rehabilitation, and psychosocial rehabilitation to help them regain their physical and mental abilities and to make the transition back to work as smooth as possible. Eligibility for the RTW program is typically determined by BPJS Ketenagakerjaan based on medical indications such as the type of impairment and the employee's ability to perform essential job tasks.

Disability is a complex phenomenon that includes biological functions, activity limits, impediments to participation, and environmental influences, among others [12]. Nonetheless, the social stigma associated with a disability is still widely held in today's culture, which is one of the environmental aspects to consider. Some individuals still have the view that people with disabilities are entirely reliant on the kindness and assistance of others. Due to this viewpoint, many people with disabilities face discrimination, which prevents them from leading independent lives.

Regulations about equal job opportunities initially sought to enhance the personal well-being of people with disabilities. Unfortunately, the participation of disabled people in the labor market is minimal, and their earnings are meagre. Measuring the quality of life as a kind of individual welfare for employees with disabilities is one way to evaluate the effectiveness of employment restrictions for people with impairments [13]. Disability discrimination in the workplace is a significant issue, and it is important to think about ways to reduce the stigma that disabled people experience at work. Promoting equality and inclusiveness in the workforce requires addressing the stigma faced by disabled individuals [14]. The RTW program for disabled workers can reduce disability discrimination by providing support and accommodation for reintegration into the workforce.

By examining their employment capability, businesses may better accommodate persons with disabilities and provide them with equal chances in the workforce. The work ability index, which accounts for factors such as mental and physical well-being and the capacity to manage obstacles in the physical realm [15,16], may be used for this measurement. On the other hand, quite a few researchers have studied the connection between RTW results and job-related factors such as the quality of life and work ability index among impaired workers. Therefore, this study aims to examine the dynamic relationship between the quality of life and work capability index among disabled workers by analyzing a case management system of disability management through a RTW program experienced by disabled workers during the COVID-19 pandemic.
