© Copyright 2002 Rogers Media. The following article first appeared in the April 2002 edition of BENEFITS CANADA magazine.

"Doctors will make vague statements such as 'I believe this person is disabled and cannot do his or her job,' without even understanding what the person does, as opposed to providing relevant medical findings, medication history, restrictions and capabilities," he adds. "This is one of the major issues facing employers, third-party adjudicators and insurers."

The unfortunate outcome is the key parties involved in disability management lack the necessary information to assist employees. "This creates delays and makes the whole process more confrontational, expensive, time-consuming and, ultimately, more difficult for claimants to get their benefits," says Dr. Bhimji.

In principle, the medical profession understands the important role that both objective adjudication and work play in an individual's recovery from a disability. The Canadian Medical Association's (CMA) policy paper on disability and return-to-work management states that doctors should be "as specific as possible" when outlining a patient's work capabilities.

The CMA document goes as far as to say that physicians should encourage a patient's return to work as soon as possible after an illness or injury. And in some cases, "it may be appropriate for the physician to advise the patient that a timely return to work can facilitate his or her recovery by improving functional capabilities."

This message is not getting across to many family physicians who serve as the gatekeepers of our health information and management. This may be because doctors are overworked with little training in disability management, says Dr. Pierre Gosselin, medical director with Standard Life in Montreal. Or simply that they report on what "a patient tells them, not what they see and assess."

Terry Corcoran, a manager of disability claims for 31 years, adds that insurance companies must shoulder the responsibility along with doctors. "Some companies still use forms that ask a family physician whether the claimant is disabled or not. This puts the doctors in the role of adjudicator. [Insurers] should simply ask for a list of symptoms, treatments and limitations as well as abilities."

Regardless of who is to blame for the problem, the fact remains that, in many instances, employees are not well served by the current system. It's time to look for solutions. Physician education is the first and foremost area to tackle, say Drs. Bhimji and Gosselin.

Dr. Bhimji would like every insurance company to work with the Canadian Life and Health Insurance Association to produce a disability management kit for doctors. It would include information on what employers and insurers require to process claims, how doctors can assist in the process and the fact that their professional association supports objective assessment and timely return to work. "It is our [the benefits industry's] responsibility to help doctors understand our needs," adds Dr. Gosselin.

Corcoran regards this as a noble but herculian effort. He recommends starting with some less onerous but effective measures that include educating claimants about the need for assessment information as opposed to medical 'notes' as well as having an employer's or insurer's medical officers contact the family physician. "Sometimes a doctor-to-doctor conversation can get at the real issues," says Corcoran.

As with most benefits problems, the keys to overcoming this challenge are effective education and communication. BC

Kathryn Dorrell is the managing editor of Benefits Canada. kdorrell@rmpublishing.com.

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."