IN THE MID- TO LATE-1990S, CIBC noticed a significant increase in the number of employees going on long-term disability(LTD). After examining its data, the bank realized that while its incidence of short-term disability(STD)was staying constant, it was having to deal with more psychological claims. A greater number of those psychological claims—often more complex in nature—were reaching the LTD stage.

At the same time, the organization was starting to hear rumblings of dissatisfaction from employees and managers about the disability management program, so it decided to survey those groups to get a better sense of what the issues were. The results of that survey showed that managers and employees were equally unhappy with the company’s traditional medical model for managing disability, but for different reasons.

“Employees felt very disconnected from the organization,” says Lynne Gutteridge, senior benefits consultant, CIBC pension and benefits policy, in Toronto. “Managers, on the other hand, felt that employees seemed to go into a bit of a black hole. The employee produced a doctor’s note, there was an adjudication undertaken by Health Services and then the manager would hear nothing for long periods of time. And this is what happens, typically, in a traditional medical model.”

Like CIBC, many sponsors find disability management is a complex and emotional issue. Employees who go off on disability can end up feeling frustrated and isolated because of a perception that no one really believes they’re truly ill. At the same time, managers can end up feeling resentful and out of touch because they believe they’re not getting the full story or because of a lack of communication with the employee.

Not wanting to fall into that trap, CIBC started looking at industry studies and best practices and concluded that there was a better model out there for disability management. “The literature suggests that things like the diagnosis of the employee or the job demands are less predictive of both incidence and disability duration than the incidence of an employee having had a bad performance review or having a poor relationship with their manager,” she says.

In other words, if the employee’s perception is that they don’t have a great relationship with their manager, then they are less likely to want to return to work, thus prolonging the disability period.

CIBC decided to completely revamp its disability management program. Rather than focusing on what the employee can’t do, the process now focuses on what the employee can do. “The traditional model is all about proving your disability and a very mechanical process that has very little to do with the person’s abilities,” says Dr. David Brown, corporate medical director with CIBC in Toronto. “We decided to focus on people’s abilities.”

The underlying assumption in this abilities-based model is that disability is highly correlated with people’s perception of the work environment. For that reason, the employer’s early response is critical.

When an employee at CIBC has been absent for six consecutive days, an electronic file is downloaded into the company’s Health Services department. When the health services coordinator receives the file, they put a call through to the manager to find out what they know about the employee’s absence.

The health services coordinator also calls the employee and goes through a series of questions. The health services coordinator then makes the decision whether or not to start a meeting process. If they feel it’s appropriate, they will refer the case to an outside facilitator, who then contacts the employee and the manager to set up a meeting.

The purpose of the meeting is not to discuss the employee’s medical condition but rather to discuss what their abilities are on that particular day. “We focus on things like the ability to do job tasks, creating a culture of accommodation, and the relationship the employee has with their manager,” says Gutteridge.

The facilitator takes notes of the meeting and moves the discussion along but they don’t run the meeting. The returnto- work process is owned by the manager and the employee. “It’s up to them to put a return-to-work plan together because those are the people that know the most about the demands of the job and the employee knows best what he or she is able to do at a particular point in time,” says Gutteridge. These regularly scheduled meetings continue until the employee is back on the job at full duties. “Our model starts with a facilitated dialogue between the employee and the employee’s direct supervisor,” notes Gutteridge. “It’s this high level of formal, structured communication that really sets our process apart from others.”

Wherever possible, accommodations are made to help the employee return to work. If the employee needs an ergonomic workstation, for instance, the health services coordinator will make arrangements for that to happen. Under the organization’s old disability management program, funding for accommodation came directly out of the manager’s budget, leading to a patchwork record of workplace accommodation. Today, those decisions rest with a central corporate accommodation fund.

“Accommodation is no longer at the whim of somebody’s budget restraints,” says Gutteridge. “We just go ahead and provide funding for whatever the employee needs.”

When CIBC implemented its coordinated return-to-work strategy in 1999, it reduced its lost days by 30%, which translated into a savings of $6.5 million a year. The program was also recognized in 2000 as a finalist in the National Institute of Disability Management and Research’s national awards of excellence in disability management.

Both Gutteridge and Brown emphasize that the program’s keys to success are communication and accommodation. “Companies spend a fortune on independent medical assessments to check up on whether the person is really sick or not,” says Brown. “Where CIBC spends its money is on rehabilitation. Let’s spend the money where it’s going to have some benefit, as opposed to checking up on somebody.”

The abilities-based model adopted by CIBC is empowering for both managers and employees. It puts return-towork decisions squarely back on their shoulders.

“This high level of communication between employees and managers and our health services area is really key to successful disability management,” says Gutteridge. “It contributes to the employee-manager relationship, it helps identify abilities early in the process and it also helps identify barriers early in the process. And it allows the employee and the manager to come to some sort of mutual understanding and have some shared goals.”

While CIBC has achieved success with its abilities-based approach to disability management, the medical model is still prevalent and working well at some companies. The disability management program at Ontario Power Generation(OPG)is a medical-based one and, like the CIBC program, accommodation is the cornerstone. In fact, Diane Westcott, OPG’s director of wellness and benefits in Toronto, can’t recall a case where the organization has not been able to accommodate an employee’s return to work.

The electricity generation company employs 11,000 people across the province. It’s a diverse workforce encompassing highly technical positions such as nuclear engineer at either of the company’s two nuclear power stations to office jobs at the organization’s headquarters in Toronto.

Five years ago, OPG introduced a more formalized disability management program. It was developed by a team consisting of members of the company’s two largest unions, as well as OPG management. The program is based on the premise that early return to work is beneficial for employees and that accommodating employees’ disabilities— whether temporary or permanent—is paramount.

Using a medical model, OPG employs 23 full- and part-time occupational health nurses to manage approximately 1,400 major medical absences a year. “We use a team approach,” says Westcott. “Along with the employee and the nurse, there’s also the employee’s supervisor, a staff physician and, if necessary, the union representative.”

The program is mandatory for any employee who is absent for longer than five days. On day five of an absence, the supervisor notifies the nurse care coordinator that they have an employee who’s on a major medical absence. There’s also an electronic system which notifies the nurse should the supervisor forget. This electronic system also sends an e-mail to the supervisor, reminding them about their responsibilities under the program. “A supervisor can go years without having a staff member on a major medical absence so the process wouldn’t necessarily be intuitive to them,” says Westcott.

The supervisor is responsible for getting a medical absence report form to the employee, who then takes it to their physician. The treating physician is required to submit the form to OPG within 14 days. “The form we use asks for diagnosis and prognosis,” says Westcott. “We also tell the doctor that OPG is committed to accommodating employees in the workplace so that the doctor understands that we can probably accommodate any restrictions and offer the employee modified duties.”

The nurse care coordinator takes on the case management role, asking the employee about their treatment plan and coordinating that plan with return to work and accommodation.

Ongoing communication with the nurse care coordinator continues until the employee returns to work at full duties.

In cases where there’s a serious illness, such as cancer, and it’s obvious the employee will be away from work for several months, the nurse care coordinator job is simply to stay in touch with the employee.

“It’s very case specific. The process is really tied to sick leave benefits payments,” says Westcott. “The biggest thing associated with the payments is cooperation with the program. As long as the employee is cooperating or we’re aware of why they can’t, then their sick leave benefits are paid.”

By formalizing the disability management program and making it mandatory, OPG has been able to focus more of its resources on accommodation and rehabilitation. “It put resources toward accommodation that were there if you sought them out in the past but weren’t offered up,” says Westcott.

The program has taken some time to fully implement the way it was intended. OPG hasn’t yet conducted a formal evaluation of the program but does have some statistical evidence of its success. At one of the organization’s nuclear plants where the program has been implemented, the length of absences has dropped considerably.

“Our lead plant has actually seen quite a dramatic decrease in the duration of major medical absences,” says Westcott. “They have the same frequency, which is not unexpected since this is not the program that is targeting prevention. That plant has the same frequency and same profile of illnesses as the other plants do but the duration of their major medical absences is significantly shorter than the other plants.”

Westcott underscores the importance of unions when introducing a new disability management program or making changes to an existing one. “Unions play a critical role in the return to work of complex cases and long-term cases because they’re the employee advocate,” she says. “Collaboration with them is absolutely key to the program being successful.”

One of OPG’s sites has launched a pilot project whereby it actively works with one of the unions to review all major medical absences on a monthly basis. “We tell the union which of their members are off, when they went off work, when they’re expected to return and whether we have all their forms in and if there are any issues. We obviously don’t discuss any medical information or diagnosis,” says Westcott. “But that review process is probably the most significant improvement we’ve made to the program when it comes to collaboration with the unions because we’re not bringing them in at the 11th hour.”

Westcott believes the company’s disability management program contributes to higher employee engagement and greater accountability for recovery. “Whether it’s a sports injury from Sunday night hockey or a major depression, you want to engage that employee in working to get better,” she says. “It saves the company money but it’s also the right thing to do for employees.”

Westcott acknowledges that OPG’s program is fairly resource-intensive compared to non-medical models that are out there. But her experience so far is that this medical- based approach is working for OPG.

“The reduction in sick leave we’ve seen certainly pays for the resources provided,” she says. “Even though it’s resource-intensive, it’s still quite cost-effective.”

Crystal Ball Gazing

Predictive modeling can pinpoint the amount of time staff will be off work.

Being able to predict recovery times and return-to-work dates helps plan sponsors manage their financial and human resources. Predictive modeling examines historical insurance claims data and enables employers to estimate when an employee might be expected back on the job.

Predictive factors such as age, gender, weight, underlying medical conditions, smoking, and type of job will all have an impact on when an employee on disability might be expected to return to work.

For example, let’s take Jenny, a healthy, non-smoking, 35-year-old employee who works in a sedentary job at a bank. She discovers she needs a hysterectomy. Using predictive modeling based on historical claimant files, the case manager can reasonably assume that Jenny will be back on the job in six to eight weeks.

At the other end of the spectrum is Judith, a 58-year-old overweight smoker with diabetes who works as a general labourer in a factory. Based on those predictive factors, it’s reasonable to assume that if Judith has a hysterectomy, she will require a longer recovery period than Jenny.

“Being able to extract this information assists in determining whether a treatment plan is reasonable, whether they can actually predict an expected return-to-work date,” says Rebecca Kwiatkowski, a consultant on the integrated absence management team with Aon Consulting in Toronto.

From a wellness perspective, predictive modeling looks at the demographics and other variables of an employee population to predict the types and timing of health issues the population could face in the future, which can impact disability costs down the road.

So far, Canadian employers are just beginning to look at predictive modeling. “Most of the health models here are still looking at past or current health data versus predicting the future,” says Rochelle Morandini, national lead for organizational health, with Hewitt Associates in Vancouver.

Andrea Davis is a freelance writer in Guelph, Ont.