In the provisions discussed so far, impairment does not in itself bring forth a social policy response; instead, disability categories are derived by linking situations of disadvantage (lack of work, care needs) to medical evidence of impairment. However, there are some disability categories in Europe in which evidence of impairment is itself sufficient to determine a disability rating; i.e. to categorise a person as disabled. In practice there are some problems assessing a person’s degree of disability directly from a description of the medical condition; implicitly or explicitly a judgment about the severity of a condition is likely to consider its consequences for important life activities. However, it is still possible to identify some assessment systems in which impairment is what ‘counts’.
Disability ratings derived by assessing impairment are widely used in employment quota systems. Travel concessions and parking permits may also be allocated on this basis. In some states, means-tested benefits are paid on better terms to those with disability ratings than to those without.
There are a number of possible rationales for these systems, all of which involve some extension of or deviation from the idea that social policy is concerned with combating disadvantage. Impairment-based employment quotas might be rationalised as promoting equality of opportunity, although it is arguable that they have more to do with shifting the cost of income maintenance from the state to employers. Benefits and privileges for people with impairments can be understood as gestures towards compensation for harms inflicted by society (e.g. war injuries) or sheer bad luck.
The use of these disability categories therefore gives some insight into how the aims of social policy are defined in different countries. In states where compensation is largely privatised, we may find impairment-based assessments used by insurance companies and courts in settling negligence and other damages claims. By contrast, in countries where state or social insurance institutions are charged with providing compensation, impairment-based assessments may be part of the social security system.