April 2026 – Understanding Tolerance
On February 8th 2026, at the Winter Olympics in Cortina Italy, the world held their breath as Lindsey Vonn threw herself down a mountain… The previous day, against all odds, she posted the 3rd fastest time in qualifying. She was enduring a torn ligament in her knee and had been warned against competing. She ignored that advice.
Her level of tolerance to overcome that adversity was astounding!
Interview on TODAY Show.
Tolerance is such an important factor in return to work, yet we often ignore it, choosing to manage a claim by the medical diagnosis, or injury code, rather than looking at the individual behind the claim.
In this month’s newsletter we explore this in more detail.
Ian Bridgman
The Claim Lab
Lindsey Vonn, Cortina Italy, Feb 6th 2026 – Getty Images
Understanding Tolerance in Disability Recovery
Key Insights from Dr. Les Kertay
In disability management, clinical information such as diagnosis, restrictions, and limitations often guides decision-making. However, Dr. Les Kertay emphasizes that these factors alone do not fully explain why some claimants return to work quickly while others experience prolonged absences. A critical and often overlooked concept is tolerance.
Dr. Kertay defines tolerance not as a medical finding, but as a psychosocial one, referring to what a person is willing to do under their current circumstances, which is not always the same as what they are medically capable of.
Limitations reflect what a person cannot do based on their condition, while restrictions tell us what they should not do due to risk. Neither fully captures real-world functioning. Tolerance sits at that intersection, shaping how these factors translate into action.
What influences tolerance is not the medical, but the psychosocial. Factors such as emotional distress, loneliness, sleep disruption, financial strain, and workplace relationships can significantly impact what a claimant feels able to manage. This is why whether a claimant will return to work is not the same as whether they can.
- A medical question asks, “Can they do the job at acceptable risk?”
- A tolerance question asks, “Are they willing to work within the available circumstances?”
Answering that requires conversation and a broader understanding of their situation, not clinical assessment alone.
Tolerance is also closely tied to perception. A claimant’s beliefs about their condition and their recovery can strongly influence outcomes. When someone does not see a path forward, their tolerance for activity tends to decrease. One of the most telling predictors is simply asking, “Do you see yourself returning to work in the next three months?” because their perception often becomes their reality.
Evidence from the ACOEM (American College of Environmental Medicine) guidelines shows that accommodations, where an employer actively supports a claimant through a transition period, have the greatest impact on return to work, surpassing any clinical intervention.
When both an employer and claim manager reach out, check in, and demonstrate a genuine willingness to accommodate, it sends a powerful message: that the claimant is valued and wanted back. A claimant who feels cared for is far more willing to push through discomfort and re-engage with work.
We are not suggesting that everyone with a knee injury should throw themselves down a mountain, but understanding tolerance shifts the focus from what a claimant can do to what they are willing to do.
Let’s try to ignore the medical diagnosis and focus on the whole person…
Dr Kertay is the Chief Psychologist at The Claim Lab