Fifteen to 20 years ago, the approach to managing disability claims was a little like an assembly line. Employers handed over a claim to insurers with an “it’s your problem now” attitude. Insurers either accepted or rejected the claim. And a claimant, now homebound, viewed the workplace from the sidelines. A rather cold, harsh reality.
But in the last five to 10 years, as disability claims increased steadily and different types of claims such as mental illness and soft-tissue injuries emerged, the nature of the claims experience has changed. The assembly line has stopped, giving way to a team huddle, as insurers and employers now work collaboratively to engage employees in the rehabilitation process and return them to meaningful work.
Increasing Claims
Even though employers make every effort to avoid disability claims, they still continue to mount. “Employers are experiencing more claims than they did five or 10 years ago,” says Todd McLean, a consultant with Eckler Ltd., a benefits consulting firm in Toronto. One, albeit smaller, reason for the increase is our aging workforce. “We’re breaking down,” says McLean. But the bigger reason is simply the complexity of claims in the last 10 years.
Fibromyalgia, or soft-tissue injuries such as sprains and strains, is becoming more common. Although an X-ray of a sprained ankle doesn’t reveal anything out of place, that doesn’t mean the employee is pain-free. In a case like this, severity and symptoms are much harder to decipher. Unlike the more apparent injuries, which are uncomplicated in terms of assessment. “Disabilities arising from broken bones and serious diseases like cancer, quite bluntly, they’re fairly straightforward to manage,” says McLean. “Everybody knows how serious those are, what the symptoms are and what people’s constraints are when they’re undergoing treatment.”
Even more prevalent than fibromyalgia are claims relating to mental illness. Depression, bipolar disorder, anxiety or any number of mental health issues represent up to 40% of reported disability claims in Canada, according to the Canada Safety Council. And because there is a degree of subjectivity, they are more challenging to adjudicate and manage, and therefore, more time-consuming.
Further adding to the complexity of claims is knowledge. Employees are increasingly more aware of their benefits, rights and entitlements, says McLean. An informed employee may fight her claim if it is initially rejected.
Even issues in the workplace can add to a claim’s complexity. “Business-based issues do have a ‘not-so-trickle-down’ effect, I think, on disability claims,” says McLean. “We see it when the economy gets soft, disabilities tend to go up. Similarly, when people don’t like their jobs, are stressed out or have a bad supervisor, insurers are finding a lot of these people are filing for disability.”
Changing Approaches
Not only have claims themselves changed, the approach insurers take to assess claims has changed, too. “It has moved from a medical administrative model to a functional ability model,” says Christine Potvin, vice-president, disability risk management, health and wellness at Standard Life in Montreal. “If we talk about 15, 20 years ago, case management was simply making sure the person was eligible contractually, then documenting the file to make sure the person still was disabled.” Where once the sole manager worked away on a claim, now a whole team—claimant, employer, HR, physicians—looks at an employee’s “functional side,” that is, what he can and cannot do.
Insurers are not the only ones changing their approach. Employers, too, are approaching human rights legislation with more intent. Under this legislation, an employer has a “duty to accommodate” an employee unless it causes “undue hardship.” Cindy Arcand, leader, employee benefits service, at the Health Organization Benefit Plan (HOBP) in Alberta, says employers are starting to realize that it is required, not optional. “To do nothing, in fact, could represent discrimination,” she says.
McLean agrees. “I think very few people paid attention to wanting to accommodate disabled people 10 years ago. It’s far more rigorous now in terms of the human rights legislation.” Under the legislation, employers must make every possible effort to integrate an employee back into the workplace, whether it’s returning to his pre-disability job, a modified version of that job or a completely new job.
Every possible effort can also mean granting requests for a revised work schedule. Metroland Media Group in Mississauga, Ont., has a few facilities where employees work 12-hour shifts. “Most of those jobs are filled by parttime people, who would not have access to short-term disability,” says Anne Williston, director of pension and benefits with Metroland. “But we would still accommodate them if that were necessary. In fact, in February one employee came with a doctor’s note indicating that he could work only eight-hour shifts. “It’s not unreasonable for us to make that accommodation,” says Williston.
Of course, avoiding disability is utmost in employers’ and insurers’ minds. Prevention is key. A prevention program—with health and wellness resources available from the employer—is one of the three necessary programs of a truly comprehensive disability management policy (the others being ability management and return to work). “We’re orienting more and more to services to help employers with prevention and impacting the overall health of their workforce, avoiding disabilities as much as possible,” says Mike Schwartz, senior vice-president, group benefits at Great-West Life in Winnipeg.
Arcand says HOBP’s employers can use its services—such as medical co-ordination—even before an employee goes off sick. “That is the ideal kind of early intervention,” she says, “before a claim even starts.”
New Services
Services, such as vocational rehabilitation, that help return employees to work sooner have been around for years. A few of the newer ones, however, are still evolving. One such program is workplace facilitation. “It’s not really mediation, but it is intervention by a facilitator,” says Schwartz. A facilitator may be brought in to work with the employee and the employee’s supervisor if there are workplace issues, or to help the supervisor understand how that employee might be accommodated back into the workplace.
Insurers are also seeing employers request to have them intervene at the short-term disability stage. Schwartz says a few larger companies with “salary continuance plans” now want insurers to get involved right away, instead of waiting until the employee is approaching long-term disability.
Return-to-work programs are continuing to implement physical programs. Potvin says Standard Life has integrated both physical fitness and yoga in its rehabilitation programs for the last three or four years. “And we have had a lot of success.” A program that addresses both the physical and the psychological aspect is beneficial, she says. “You need a program that will touch every aspect of a human being.”
But while a return-to-work program is under development, the employee must maintain some kind of attachment to the workforce. “One of the things that is very clear is that if individuals haven’t been back to work as a result of a disability for a certain period of time, they will likely never go back,” says Wolfgang Zimmermann, executive director of the National Institute of Disability Management and Research in Victoria. “One can easily see how having to deal with serious pain and not being at work can create a very insidious mindset,” he says.
Whether an employee is approaching long-term disability or sick leave, employers and insurers must continue to collaborate through a comprehensive disability management program to prevent (ideally) disabilities before they occur. Simultaneously, they must continue to enlist all professionals to assess cases and return to work strategies.
Brooke Smith is assistant editor of Benefits Canada.
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