Taking the long view on effectively dealing with LTD claims

On average, one in three Canadians will be disabled for 90 days or more at least once before they reach age 65, according to the Canadian Life and Health Insurance Association.

Therefore, income protection is important, but it’s not always fully understood and cost is sometimes perceived as too high. As a result, some groups forego this type of insurance. A 2018 Ipsos survey found less than half (48 per cent) of Canadians have disability benefits, down from 57 per cent in 2015.

To help keep long-term disability affordable and accessible, while increasing effectiveness, the insurance industry is learning and advancing: leveraging data, refining predictive analytics and developing new tools to hone everything from pricing to claims management. Today, more than ever, there’s a need to bring art and science together to avoid wasting time and to help plan members make a safe and sustainable return to work.

Read: Employee well-being critical to return to work after pandemic

Disability management teams have been using predictive analytics for many years, leveraging volumes of plan member demographic data — stripped of any personal identifying details — to forecast the arc of specific claims. New work originating in the U.S. allows for even more precision. Questionnaires can be sent to claim applicants and plan sponsors to get a 360-degree view of the work situation, the individual and families involved. These questionnaires, which are voluntary, gather psychosocial data such as the person’s work environment, personal  situation, financial health, physical and mental health and skills.

The volume of data in these questionnaires provides insights into case management and reveals which practices may result in faster, more successful and cost efficient treatment — resulting in faster return to work. The questionnaires may also reveal indications of mental-health issues and possible situations where prescription management (antidepressants and pain medications) may have become an issue.

Read: 60% of Canadians with mental-health concerns not using workplace support tools

According to a white paper from the Centre for Addiction and Mental Health published this year, mental-health challenges are a leading indicator and cause of short- and long-term disability claims. Carriers today are able to identify and bring mental-health services to the table to prevent and mitigate stress from building into a more serious and debilitating claim.

The presence of a good employee assistance program and wellness benefit program can be promoted to team members so they reach out without stigma in a highly confidential environment. Should members fail to fully embrace these facilities and become absent from work, a recommendation to utilize cognitive behavioural therapy services may provide them with tools to cope.

CBT is a psychosocial intervention that aims to improve mental health. It focuses on challenging and changing unhelpful thought patterns and behaviours, improving emotional regulation and personal coping strategies to solve current problems. This isn’t a new concept, but offering CBT online is relatively new. Originally, the online version was introduced to help provide access to people in remote areas or in areas with long wait lists. The challenges of coping with COVID-19 have made it an even more important practice. As a result, these programs have been adopted by many Canadian insurance carriers in their return-to-work planning.

Read: 67% of working Canadians would use virtual tools for mental health: survey

Just as not all physical conditions result in time off work, it’s important to understand that emotions and reactions, including stress, aren’t necessarily illnesses that result in disability. Sometimes, there may be justifiable reasons to be absent from work that aren’t related to the employee’s own health. Comprehensive followup interviews would be conducted to manage the process and monitor the progress made. Should the member continue to experience mental-health induced stress and absence, CBT can be continued as part of the return-to-work protocol.

The final tool that we’ll discuss here is the use of pharmacogenetics in assisting claimants on long-term disability.

Pharmacogenetics is the study of how an individual’s genetic makeup tolerates taking certain prescribed drugs and the efficiency of the individual being compliant. Antidepressants and pain medications, when prescribed, are critically managed to be sure the best result is achieved. Despite best efforts, a result short of the mark may be experienced as the member might not tolerate the drug or it simply might not work.

Read: Pharmacogenetic testing’s place in long-term disability programs

When applied, pharmacogenetics services could be used to assist in determining the right drug and dosage to help ensure a better health outcome and perhaps mitigate, if not eliminate, the length and severity of a long-term disability claim. Leading carriers today use all of these tools alongside the tried and true process of personal contact by dedicated case managers to be sure they can deliver optimal service for plan members and assist in maintaining sustainable long-term disability rates for all stakeholders.

The marriage of art and science in disability management is helping carriers work more effectively and efficiently with people who are off work. While it may take a village to raise a child, it takes a well-equipped team to manage a disability practice. At the end of the day, there’s a person who needs help and a disability team that wants to help in the best way they can.