About a year before the onset of the coronavirus pandemic, Algonquin College updated its disability management program.
The timing set the Ottawa-based college up for success when the crisis hit, says Jessica Myers, its acting manager of wellness and abilities, allowing her team to focus on proactive supports, knowing case management was well in hand.
Under the program, once an employee has been off work for a certain period of time, Algonquin engages its consultant. The firm conducts an intake call with the employee and provides the college with information on their restrictions and abilities to determine whether to move forward with an absence or a return to work with accommodations. Myers’ team maintains communication with the employee while they’re on leave, as well as with their manager. Planning the return to work is a team effort: the employee, their manager, a member of Myers’ team and, if applicable, a representative from the employee’s union, meet to discuss their restrictions and the accommodations that can be made within the role.
“Because we [already] had a consistent approach, . . . what it enabled us to do was focus on strong wellness initiatives over the pandemic,” she says. “We didn’t have to update our case management, but instead we could focus on resources for mental health.”
Over the past few years, Algonquin enhanced its employee assistance program, held a mental-health and healthy workplace speaker series and added psychological health and safety related questions to its employee engagement survey, among other initiatives, with the aim to support employees before they need to take leave.
While the pandemic has had some impact on plan sponsors’ disability management programs — from an increase in mental health-related and complex claims to new accommodation considerations in the hybrid work era — experts say the past few years have underscored the importance of existing principles around proactive and preventative supports and good communications.
“When we help draft policies and procedures, we’re always trying to reiterate the importance of [being proactive] and, even before the pandemic, we were trying to encourage active case management,” says Gianna Ricciardi, Vita Assure’s vice-president and practice leader. “It can make a huge difference in whether the disability drags on and the success of the return. I think there is a bit more awareness on the importance of that now.”
Managing complex claims
Multiple insurers and disability management specialists agree disability claims have become increasingly complex in the years since the pandemic was declared.
“Our case managers feel like they’re navigating more complex claims and conditions than probably they ever have before,” says Michael Lanteigne, vice-president of group life and disability at Manulife Financial Corp.
Marie-Chantal Côté, senior vice-president of group benefits at Sun Life Financial Inc., points to internal data that found, among plan members currently on long-term disability for a musculoskeletal issue, 40 per cent also take a chronic disease drug to treat a cardiovascular issue and a further 40 per cent also take a mental-health drug.
Claims involving one or more comorbidity are generally longer in duration, says Lanteigne. The average mental-health LTD claim is between 10 and 11 months, while the average cancer-related claim is 11 months. When both are involved, it adds roughly four to five months to the duration.
In the wake of more complex claims and a greater need for accommodations upon return to work, many employers are realizing they can’t manage disability claims alone and are seeking out third-party support, says Ryan Haffner, vice-president of operations for wellness and disability at Cowan Insurance Group. “There are a lot more requests to integrate managed short-term disability to alleviate issues with privacy, durations, offering extra support and really dealing with those complex issues around accommodations and return to work.”
Liz Scott, chief executive officer and principal at Organizational Solutions Inc. (now part of People Corporation Inc.), says case complexity drives home the importance of proactive engagement with members when they go on leave. “If you treat people right and help them navigate this crazy, ridiculous, tangled health-care system to find answers, they can focus on their recovery and return to work sooner.”
Algonquin’s revamped approach very quickly demonstrated the value of early and empathetic engagement. Between its 2021/22 and 2022/23 fiscal years, the college saw a 5.1 per cent decrease in disability claims across all diagnostic categories and a 55 per cent decrease in leave duration, translating to an average decrease of 80 days, according to Myers.
Sun Life is currently piloting a psycho-social questionnaire early on in plan members’ disability experience. The questionnaire asks members what factors are influencing their disability and may be relevant for a case manager to know when building a treatment plan. “There’s a lot of focus on medical questions and assessments, but we hypothesized that understanding the plan member’s environment can be very helpful to supporting them on their unique journey,” says Côté. “We cannot assume the journey of one person will be the same as another.”
A multi-disciplinary case management team is crucial in these types of cases, says Lanteigne, noting Manulife’s disability management team includes mental-health specialists, kinesiologists and occupational therapists.
Ricciardi also stresses the importance of embedding best practices for mental-health support in a disability management strategy. “Even if it’s not the original cause of the absence, it’s oftentimes the second diagnosis. Employers shouldn’t assume that because the issue is physical, they can ignore mental health.”
Accommodations and hybrid work
The pandemic-driven shift to hybrid and remote working arrangements has had some implications for workplace accommodations.
“Before the pandemic, certain types of businesses weren’t well-equipped to have people work from home, but it forced everybody to adopt better technology and procedures for remote work,” says Ricciardi. “[That] can help reintegration because employers are better prepared to help employees work from home and, in some cases, that could be a proper transition and allow people to get back to work sooner than if they had to go in person.”
Lianne Clarke, principal and vice-president of wellness and disability innovation and growth at Cowan, says employers that shifted to remote work during the pandemic may have a more difficult time making the case that an accommodation that involves working from home would cause undue hardship to their operations.
“As an employer, you’ve been [effectively] accommodating them during the pandemic, so how do you switch it up and say you’re not going to accommodate them. The employer has to be able to show what’s changed after . . . they accommodated that person for two years [and] why they can’t accommodate them now.”
As more employers ask staff to return to the office full time or for a majority of the week, Haffner says they should be aware it can lead to a rush of medical accommodation requests. Many people with mental-health challenges or chronic health conditions realized they were able to manage better while working at home than when they were in the office every day pre-pandemic.
According to the 2021 Benefits Canada Healthcare Survey, 77 per cent of employees with chronic conditions or chronic pain said the shift to remote working during the pandemic helped them miss less work. Working from home was particularly beneficial for plan members with arthritis (93 per cent) or chronic pain (83 per cent). Some 68 per cent of plan members with a mental-health challenge said working from home reduced the days they were off due to their condition.
In cases where an employee files a medical accommodation request after being asked to return to the office, Scott says her organization “walk[s] a delicate tightrope,” delineating between true medical accommodations and personal preferences. In cases where accommodation is warranted, she says the most important thing is to get that person assistance with their condition before pursuing a transitional return to work.
Outside of accommodation considerations, ongoing remote or hybrid working arrangements present complexities for employers, says Clarke, including balancing employees’ desire for flexibility against the potential social isolation and downstream mental-health impacts of working entirely remotely, as well as the risks of poor ergonomic setups at home.
Communication key in hybrid environment
It has always been important to have regular communication during an employee’s leave, says Ricciardi. However, post-pandemic, with many teams working remotely, the need for good communication has only increased.
3M Canada expanded and formalized its disability management program during the pandemic. Michelle Brown, the company’s disability management specialist, says regular communications during the return-to-work process is a key component.
The employee, their supervisor, an occupational health nurse and Brown meet ahead of the employee’s return to discuss restrictions and accommodations and sign off on a plan. The employee fills out a work journal every day on how their work went and if they had any issues; if they did, they’re asked to speak to their supervisor that day.
An ounce of prevention
Employers and insurers alike are doubling down on preventative solutions aimed at reaching plan members before they have to take leave.
At 3M, where musculoskeletal issues are among the top drivers of disability, employees can visit an onsite nurse if they notice the start of a workplace injury.
As mental-health claims began creep-ing up into the top three causes of disability claims, the company increased the number of onsite counsellors available through its EAP program to three and aggressively promoted its other mental-health supports. While mental health represented 13 per cent of STD cases in 2019, it dropped to 10 per cent in 2020 and fell out of the top three diagnostic categories in 2021, says Brown, and mental health-related LTD absences also decreased, from 21 per cent of total claims in 2019 to 13 per cent in 2020.
As part of its absence management program, Manulife has a team of ergonomists that can help employers conduct assessments of plan members’ work setups and provide education on topics such as appropriate desk height, chairs with good back support, proper lighting and posture and how often to take breaks. While employers have previously been concerned about the cost of such an offering, says Lanteigne, “there’s more interest now than there has been. . . . I think, generally speaking, there’s more recognition that hybrid and virtual is here to stay.”
Cowan’s consultants are also talking with employers about more unique preventative solutions, says Haffner, including chronic condition coaching and pharmacogenetic testing to help plan members with mental-health challenges get faster access to effective medication.
Meanwhile, Sun Life has invested in data and artificial intelligence tools to reach plan members exhibiting risk factors for taking leave. In 2021, the insurer expanded its partnership with CloudMD Software & Service Inc. to make its mental-health coach program a part of Sun Life’s group benefits. The coach identifies plan members who have stopped a treatment plan, who aren’t adhering to their medication or who exhibit other risk factors of taking leave and point them to mental-health solutions available in their benefits plan.
Among plan members who met with a coach through the program during an STD, 50 per cent fewer claims transitioned to LTD than among plan members who didn’t meet with a coach, while STD durations were, on average, 5.6 weeks shorter, regardless of the mental-health issue. For plan members on leave due to an adjustment disorder — a type of claim that increased significantly during the pandemic, according to Sun Life — the mental-health coach shortened their STD duration by 13.7 weeks on average.
The insurer’s AI assistant Ella is also being used to reach plan members who may need extra support, says Côté. “With access to data, we can take a more tailored approach and identify people at risk. That space is really important to better understand as an industry so we can intervene to avoid someone going on disability.”
Kelsey Rolfe is a Toronto-based freelance writer.