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Posted by Johanne Potvin, CHRP, mars 21 2018
Disability Cases
5 Critical Factors Leading To Shorter Disability Periods

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Faced with the ever-escalating costs associated with disability plans, employers have no choice but to rely on effective claims management strategies, particularly to reduce the duration of disability-related absences.

As in a labyrinth, it is important to make the right choices if you want to find your way out, without getting lost in administrative or legal mazes! Also, just like a labyrinth, disability management has its pitfalls that can lead to waste of time… and money. It is therefore essential to make the right moves at the right time and to implement winning claims management practices.

In our previous posts (Mental Health: Is it a priority for your organization? and Disability & Absence Management: A headache for managers?), we discussed the issue in terms of prevention and corporate strategies. In this segment, we will consider this problem from the standpoint of claims management administration in the context of an employer-managed salary continuance plan. Thus, you will discover how 5 critical aspects of the claims management process can lead to shorter disability periods.

Disability Periods: Critical factors and recommendations

To effectively manage disability claims under salary continuance programs, the person responsible for processing these claims must take into account the following critical factors and recommendations:

 

 CRITICAL FACTORS   RECOMMENDATIONS 
 Eligibility 

Managing eligibility is the first critical factor associated with a disability claim, because sound plan management requires that only eligible claims be accepted. 

  • Check whether the employee qualifies for benefits in accordance with your internal policies
  • Make sure you are presented with a valid medical certificate (signed by a physician authorized to practice in the province) justifying the employee’s inability to work in his/her own job
 
Ability to work

The mere fact of having received a medical diagnosis is not sufficient evidence of inability to work. The signs and symptoms reported must be incapacitating in order to justify absence from work.

 
  • Check the nature of the employee’s functional limitations against the requirements of his/her job or any other job you can propose in order to determine whether the absence is justified or if accommodations are possible
  • Do not hesitate to contact the attending physician, your consulting physician or an expert physician if the work inability period exceeds the “normal” duration for a similar condition
Changes in condition  An effective treatment plan will usually result in a gradual improvement of the employee’s condition, that will normally be followed by a lessening of functional limitations and the gradual restoration of the employee’s ability to work. Several causes (related to the employee’s perception of the workplace or his/her medical condition) can explain the lack of functional improvement; these causes must be investigated so as to be “managed”, resulting in shorter absence period.
  • During follow-up calls with the employee, check for changes in his/her condition and watch for any situation that could delay progress (e.g. complications, treatment that is not working or worsening symptoms, wrong diagnosis, conflicts in the workplace or fear of returning to work, non-compliance with the treatment plan)
  • Take action based on the reason for extended absence and do not hesitate to ask for a medical expertise, if needed.
 
Return to work  Planning the return to work is a process that begins at the onset of the absence by identifying any barriers impeding such return, whether they are administrative (e.g. restructuring or planned abolition of position), relational (e.g. workplace conflict or performance issue) or medical (e.g. ineffective treatment plan).
  • Manage any administrative or relational return-to-work barrier, as soon as possible
  • Do not hesitate to ask the attending physician, your consulting physician or an expert physician to specify the nature and duration of any functional limitations, in order to properly plan the employee’s return to work, whether on a regular status or assisted by accommodations (e.g. modified or gradual work)
  • Propose accommodations based on the reported functional limitations; this requires precisely knowing what prevents the employee from performing the essential tasks of his/her job or any other job or task you can propose, without minimizing the importance of administrative or relational barriers, if applicable
  • Perform post-return follow-ups in order to take proactive action in the event of problems and thus prevent relapses
 

 Transfer to long-term disability plan 

4 to 6 weeks prior to the end of the salary continuance program, if you are unable to reintegrate the employee into the workplace before the start of the long-term plan, it is time to prepare the transfer of the case (serious or permanent health condition) to your insurer administering the plan if you haven’t already done so.

  • Check for any work resumption opportunity during the absence, and especially during the 6 to 8 weeks prior to the start of the long-term disability plan
  • Forward the required forms to the employee and remind him/her of the importance of cooperating with the insurer in the management of his/her case
  • Advise the insurer of any administrative or relational return-to-work barrier, if applicable, and of any available accommodations or work resumption opportunities
  • Follow up regularly with the insurer (every 2 to 6 weeks depending on the severity of the employee’s medical condition) in order to monitor the status of the claim and watch for any possibility of work reintegration or referral to the Régie des rentes du Québec, in the case of permanent inability to perform any gainful occupation
 

 

While absence and disability prevention is one of the most recommended approaches for reducing the occurrence (frequency) of absences, sound and disciplined claims management will give you direct control over the duration (severity) of disabilities. In this perspective, and considering that the length of absences is the major contributor to claim costs, any action aimed at reducing the number of days off work will immediately have a positive impact on your costs, both direct (plan costs) and indirect (e.g. loss of productivity).

If you have any doubt about the actions you should take, do not hesitate to consult disability management experts or your consulting physician, if applicable.

 

managing-disability

Senior Advisor with JPotvin Santé/Productivité au travail | This article was written by our contributor, Johanne Potvin. Do you want to know more on this topic? Do not hesitate to contact her at JPotvin.spt@gmail.com or 514 770 1866.
Johanne Potvin, CHRP