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. |
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| 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. |
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| 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. |
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| 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). |
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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. |
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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.
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.