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Posted by Johanne Potvin, CHRP, novembre 21 2019
Disability Cases
Disability Claim Management with a Non-Cooperative Employee

gestion invalidité

Employees must imperatively cooperate in the management of their disability claims. This is a prerequisite for their entitlement to income replacement benefits. 

While most employees adequately cooperate in the management of their disability claims, we have all been faced at some point in our career with one or several employees whose cooperation level was variable (from no cooperation whatsoever to low or barely sufficient cooperation). Fortunately, we also find highly cooperative employees with whom communication is easy, despite the difficult times they are facing.

In this article, we will discuss what you can do as an employer to elicit better cooperation from certain employees.

Early signs that help predict the level of cooperation 

In general, employee attitude and behaviour in the workplace are predictive of their level of cooperation should they become disabled. 

Employees who are usually engaged and very cooperative in their daily activities should remain so while on leave, unless conflictual or relational situations have substantially altered their perception of their work (this most important issue will be discussed at greater length in a future article) or if serious symptoms temporarily prevent them from cooperating in the management of their disability.

Thus, employees who are “normally cooperative” or “highly cooperative” should remain so throughout their disability period. (To reinforce their right attitude, think of highlighting in positive terms their level of cooperation in your communications! This recognition will help maintain a high level of cooperation.) 

Conversely, employees who are demotivated or entertain a negative perception of their work or workplace may more easily or repeatedly demonstrate a lower level of cooperation in the event of disability. 

Examples of non-cooperation

The following is a non-comprehensive list of situations that may be described as non-cooperative, i.e. when employees:

  • Are late in forwarding (failing to meet deadlines) or fail to forward the medical certificates signed by their physician (to their employer) or the Attending Physician Statement (to their insurer); 
  • Do not return calls from the person in charge of their disability claims (employer or insurer), or let several days go by before calling back after being left a message, or return the calls only outside business hours (this also applies to messages left by their supervisor); 
  • Avoid speaking of the progress of their situation/condition (e.g., answers that are short, lacking detail, beside the point or that shift attention toward something else) with their disability case manager (employer or insurer); 
  • Dodge any invitation to show up at the employer’s premises or attempt to limit contacts/communications with the person managing their disability claims (employer or insurer); 
  • Fail to follow the treatment or rehabilitation plan prescribed by their physician; 
  • Engage in behaviour that may delay their healing process or return to work; 
  • Forget to discuss with or present to their physician an offer to resume work gradually or with modified duties;
  • Fail/refuse to attend a medical expertise.

What are your rights as an employer?

First, it is very important to note that the Commission des normes, de l’équité, de la santé et de la sécurité du travail recognizes that employers have management rights, i.e. the right to direct their employees and make decisions related to the sound management of their business. 

As long as this right is not restricted under a collective agreement or a work contract and is not used unreasonably, arbitrarily or in a harmful manner against employees, it allows employers or their representatives (e.g., the insurer or the disability management service provider) to properly manage absences or benefit claims in the event of short- or long-term disability.

How to defuse non-cooperation?

First of all, we wish to specify that for the purpose of this article, only a few non-cooperation situations will be discussed, as our initial objective is to illustrate how to defuse them and elicit enhanced cooperation from certain employees.  

Our recommendations are applicable to insured plans, wage continuation plans or the payment of supplemental unemployment benefits. 

Quite often, a simple (constructive) reminder of the employee’s responsibilities or the appropriate procedure (including applicable time limits) is sufficient to correct the situation. Ideally, these responsibilities will be set out in a policy/procedure or a guide/brochure, which you and your employees can refer to as needed. 

However, when non-cooperation is recurrent or disrupts the effective management of the claim (without necessarily being voluntary or warranting administrative or disciplinary measures), some actions must be taken. For example:

Recommended action Practical examples
Convey your appreciation of the employee’s cooperation level in order to start a constructive discussion on the matter as soon as possible, to avoid the development of chronic non-cooperation. “Your insurer told me that they often find you hard to reach. As your cooperation is essential for the management of your disability claim, I would like to discuss with you how we could improve communication with your case manager.”
Clearly voice your expectations using concrete examples when the employee has not been cooperative enough. Your insurer has not yet received the attending physician statement. As you know, this form must be forwarded to the insurer within 7 days of stopping work. I would like to know the reasons for this delay.
Try to know more about the reasons or fears behind the employee’s lack of cooperation. I detect some reluctance on your part when we discuss your potential return to work. Are you anticipating problems when you will return? (wait for the answer and develop accordingly). I thank you for sharing your concerns with me. Your assistance is critical to achieving a successful return to work for everybody involved. I will get back to you…
Learn from the employee any constraints or situations that may explain the level of cooperation observed. The last time we spoke, you mentioned that you had to see a specialist. But so far, no appointment has been made. Do you have problems getting this appointment? (wait for the answer and develop accordingly). Maybe we could find a solution together…
Remind the employee of his/her responsibilities further to the filing of his/her disability claim. As I mentioned in my previous emails, your cooperation is crucial for the proper management of your claim. I appreciate your prompt replies by email; however, occasionally, I need to speak to you, as I am doing now. Since I can’t reach you directly, I would appreciate you calling me back within 48 hours at the following number: … I am once again inviting you to read about your responsibilities further to the filing of your claim, in the document entitled…”

Conclusion

In this article, we discussed “cooperation from an employee on disability” from the standpoint of “constructive” action. But what can you do if the employee remains uncooperative despite your attempts to defuse the situation or elicit stronger cooperation? If this topic is of interest to you, we invite you to read our next article!

Moreover, could you have prevented such situations from occurring? Absolutely!  It is possible to prevent non-cooperation through the implementation of effective staff and disability management practices.  

For more information on disability management, please download our guide.

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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