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Properly managing a disability claim involves more than just receiving and filing a medical certificate, even in an insured plan. In fact, such management requires some action on the employer’s part along with adequate and ongoing monitoring that can make the difference between a claim that will last a few weeks or many months! This article describes three actions that form the basis of effective disability management in an insured plan. Read on to learn more!

1. Make of a list of employees on disability

This list provides a snapshot of employees on disability and the status of their claims. To compile such a list, the following information relevant for case tracking should be collected and regularly updated based on how cases are progressing.

List of employees on disability from_____ to ______

This list is also useful for the following purposes:

• Prepare statistics on open and closed cases, lost days, nature of disability, etc. and track trends over time;

• Document your file by recording and updating the information obtained and the steps to be taken (in the table entitled “Action Plan”) to effectively manage each claim;

• Facilitate information sharing between members of the Human Resources (HR) team on the progress of active cases or back-to-work plans underway through a centralized file (limited access);

• Review the cases with HR team or insurer.

2. Ask the right questions in disability management

Even when the insurer collects information from employees on disability and regularly assesses their inability to work, it is nevertheless advisable that the employer maintains regular contact with employees while they are on disability.

Such contacts provide the employer’s HR team, contract manager or plan administrator with a special opportunity to:

• Confirm some information with employees, if applicable;

• Answer questions from employees or reassure them, as needed;

• Refer employees to assistance resources, as applicable;

• Remind employees of their responsibilities to ensure effective management of their claims, if required.

It is also a good time to enquire about how the employee is doing:

• How are you doing?

• Do you feel a bit better than the last time we spoke?

Without being intrusive, such questions show a genuine interest and will enable you to better support employees during their disability thanks to additional information on their general state of health.

Usually, if the employees’ condition improves, it’s a sign that the treatment plan is effective and the employees are on track to resume work once they complete the recovery period required by the nature of their disability. In this case, you will be able to discuss the expected back-to-work date with the insurer (ask the insurer for the likely duration of the disability) and plan the employees’ return with their immediate supervisor.

Conversely, a worsening condition or the lack of improvement could be a sign that the treatment plan is insufficient, that other factors are impeding the employee’s healing, or that the disability is complex, serious or has a strong chance of resulting in permanent functional limitations. You have to pay special attention to these cases and promptly inform the insurer of your conversations with the employee.

Asking the right questions also means getting the following information from the insurer:

• Likely duration of disability;

• Whether the information collected by the insurer revealed work-related issues (e.g., workload, conflicts, stress, anxiety) that could disrupt the healing process or represent return-to-work barriers;

• Presence of temporary or permanent functional limitations for which accommodations could be proposed to facilitate work resumption and reduce the disability duration;

• Actions the insurer will take to support employees or increase their functional capabilities, speed up the healing process or plan a prompt and sustainable return to work, especially in complex cases.

3. Perform monthly case reviews internally and with the insurer

Performing a monthly review of active cases, first internally (within the HR team) and then with the insurer, allows for the identification of return-to-work barriers, especially with complex cases. Such reviews also provide an organized and structured framework to:

• Assess any case where the absence is longer than expected, in order to understand why and take appropriate action based on each situation (e.g., ask specific questions to the attending physician, ask for medical expertise, refer the employee to rehab);

• Plan assistance and support measures for the employee, and also for his/her immediate supervisor, when planning and managing return to work after a disability that was preceded by a difficult situation (e.g., conflicts, work overload, behavioural or performance problems);

• Identify employees who are likely to experience permanent functional limitations requiring special accommodation (e.g., reassignment to another position);

• Discuss the progress of current back-to-work plans (e.g., work capacity, expected date for resuming usual work, required support measures).

Such monthly reviews are not meant to replace the “daily” sharing of information between insurer and employer based on case requirements and progress. They are rather an additional opportunity for key stakeholders to share information critical to effective disability management (in keeping with applicable confidentiality rules), especially for more complex cases. You should also take this opportunity to discuss what actions should be taken to reduce the severity of absences and prevent them from becoming chronic.

As cases are increasingly complex and additional factors may disrupt the healing process (e.g., difficult access to specialists or healthcare, conflict in the workplace, rising incidence of psychological illnesses), effective disability management increasingly requires technical and personal skills, even within an insured plan.

Consequently, do not hesitate to provide your HR team with the proper training that will enable them to apply the best absence/disability management practices in order to achieve better prevention, shorten the disability period or support the supervisors and operational managers in handling distressed employees, following a disability or when planning return to work.

This article was written by our colleague Johanne Potvin, CPHR, Senior Advisor with JPotvin Santé/Productivité au travail. Would you like to find out more on this subject? Please do not hesitate to contact her at JPotvin.spt@gmail.com or by phone at 514 770 1866.