Winning strategies for disability claims

According to a 2013 Conference Board of Canada study, Canada has an average of 9.3 days lost per employee per year, compared to between five and seven days in the U.S. and the U.K.

While it’d be ideal if workers were never away, employees are going to be absent at some point. “Zero percent absence is not feasible [in the workplace]; it should not be a target because it simply isn’t realistic,” said Maureen Long, assistant vice-president, disability claims, group benefits, with Sun Life Financial, speaking at Benefits Canada’s Benefits & Pension Summit last week.

The optimum level of absences should be the goal, she said, adding that recovery time is essential.

But while absenteeism is a given, so is the cost. And it’s high in Canada, representing 2.4% of gross annual payroll. “It’s the payroll cost that is the single largest expense item for an organization,” Long said.

So how can companies keep this cost at bay and avoid long-term absences?

Liz Scott, principal CEO of Organizational Solutions Inc., said employers need a care management model. That means establishing a clear claims process, including claim adjudication protocols, assertive goal-directed care management and structured return-to-work (RTW) programs.

Scott presented a case study of a manufacturing company with multiple locations and a unionized environment and an average employee age of 38.

The duration of the company’s claims were 86 days per closed case, with a claim rate of 16% of the employee population, and 42% of the files were psychological in nature. The modified RTW plans were more than 12 weeks in duration, with 15% of files going to long-term disability (LTD).

To transfer to a care management model, an employer needs to ensure the appropriate paperwork, make sure there is a solid adjudication, ensure appropriate treatment and interventions and then focus on the RTW capability.

The employer must also distinguish between a disability and a non-disability early and have a solid program in place to differentiate the two, Scott said.

With the RTW program, the employer has to ensure the following:

  • the employee’s capabilities match to the demands of the job;
  • the program is progressive and time limited (to a maximum of six weeks);
  • the employee’s return to full duties is monitored;
  • the success of the program is assessed and evaluated; and
  • all the relevant company policies are taken into account.

As a result of the care management model, the manufacturing company’s first annual results show that durations are down to 32 days and less than 4% of claims have transferred to LTD. The company has also seen significant cost savings and received positive feedback from employees.

All the articles from the event can be found on our special section: 2014 Benefits & Pension Summit Coverage.