10/2/2017 The Evolution of a Disability Claim Disability Management from a Humanistic Lens in an Ever Changing Environment Disclaimer • My opinion, not HEB Manitoba • My job: Manager 1
10/2/2017 Agenda • The HEB Manitoba Rehab Program • Some basic Disability Management principles • Practice model • Case study HEB Manitoba • Pension and Benefits for Healthcare Employees in MB • Disability & Rehabilitation (D&R) started in 2002 • Vision: collaborative, member focused, non-adversarial, mandatory rehab • Partner with Employers, Unions, Physicians and Rehab Providers • Focused on RTW and Change in Definition (CID) 2
10/2/2017 D&R Process • Initial assessment • Modified hierarchy of employment objectives • Focused on RTW • Focused on CID – accommodations and voc rehab Modified Hierarchy of Employment Objectives • We always stay focused on a modified HEB specific HEO 1. RTW Own Occupation (same employer) 2. RTW Modified Duties/ Accommodation 3. RTW Alternate Occupation (other employer) – job search 3
10/2/2017 No GRTW? • What if they’re not ready? • We help them get ready – Build rapport – Assess the barriers – Create a plan, implement and follow up – Maintain contact Rehab Options: What Works? • Graduated activity programs (PGAP , home exercise, volunteering) • Exercise – walking, swimming, cycling, yoga • Reconditioning programs (good fit) • Specific modalities if part of an active based treatment program • Counselling: CBT , DBT , and Eye Movement Desensitization and Reprocessing (EMDR) • Education – sleep, diet, exercise, hurt vs harm, etc • Good medical assessment and treatment • Helping people find joy in life 4
10/2/2017 Rehab Options: What Doesn’t Work? • Symptom focused passive treatment • Supportive psychology treatment not goal focused • Medical recommendations for bed rest or activity avoidance • Pain clinics • Multidisciplinary programs After Care • 6-month recurrent clause • Some rehab support during 6-month period – Not mandatory 5
10/2/2017 Disability Management Principles • Some basic principles Being kind matters • Be kind, patient, gentle • Have fun, have some energy • Check your personal bias – watch judgment • If people like you, you will have more success… sorry but it’s true • “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou 6
10/2/2017 Power Differential • Clients are inherently vulnerable • Knowledge of systems • Education level • Decision maker • Money • Ethical practice requires an awareness of power differential Have a Process • Follow the process – Plan Text/ Legislation – Internal policies and procedures • But remember people are not processes • Use processes to help people 7
10/2/2017 Legal Issues • Know your Plan Text, Legislation • Basic understanding of contract and employment law • Human Rights – Have a basic knowledge of the Code – Educate others on their obligations Physician’s Perspective on Disability Determination • 86% - completing disability forms adversely affects the physician- patient relationship • 62% - represents a conflict of interest • 56% - willing to exaggerate clinical data to assist a deserving patient • 80% - better for an independent group to determine disability From Dr. Matthew Burnstein De-Medicalizing Disability Management 8
10/2/2017 Working with Physicians • Stop communicating with Physicians? We can’t. • Partnership – Work with them • Provide more information than you ask for • Ask for R&Ls – give them easy forms • Specific questions – outline the plan and ask for contraindications • Talk on the phone – Have a reasonable plan – one that supports the client – If they don’t agree, ask why and discuss options – Summarize in writing External Rehab Service Providers • Physio/AT clinics, vocational rehab providers, OTs, Chiros, etc • Find good providers • Create good providers • Communicate effectively • Build our community • A rising tide floats all boats 9
10/2/2017 Motivation Model Case Study – Judy • 44 year old Administrative Assistant (unionized employee) • Off work 21-months due to: – Major Depression – Social Anxiety • No medical clearance for RTW • Can do rehab to prep for RTW Note: CID coming up in 3-months 10
10/2/2017 Initial Assessment • 2 cancellations from Member for initial rehab assessment • No show for 3 rd attempt – After no show she reported too much anxiety to come to HEB office – Offered to reschedule for home visit, member declined and said she would come to office – Advised verbally and in writing that claim would be suspended or closed if another cancellation or no-show without sufficient reason Initial Meeting • Member said “I love my job and I want to RTW. I don’t want to lose my job” – Change talk - use MI! Explore the change talk • Right before she went off work there were changes in her job – Two parts are now two jobs: Admin and Front Desk – She got the Front Desk job • Front Desk job very stressful – but could work as Admin 11
10/2/2017 Initial continued… • Independent in ADLs • Has support at home – husband and children • Vocational: Good work history, High School and College diploma • Exercises 3x/week at gym and walks dog daily 12
10/2/2017 Approved Rehab Program • RTW own occupation? • Contact employer – discuss job changes and options for possible future RTW • Start thinking CID Next steps • Spoke with Employer – Yes the job changed – Employer confirms Judy has a Front Desk position • Discussed with Judy – She is upset with this – Advised to review with her union • HEB writes to GP for medical update 13
10/2/2017 Medical report from GP • No specific restrictions and limitations noted • Front Desk is a stressful environment and she is not able to perform those duties • She is able to perform full duties of Admin position • Yes she can do a GRTW program over 6 weeks (Admin only) Roadblock • Employer states they are unable to accept medical • Employer requires specific R&Ls in order to accommodate • They consider this medical suggestions or recommendations, not medical restrictions that require accommodation 14
10/2/2017 Phone call to physician • RS phoned GP to discuss 1. ER not able to accommodate 2. Can we pursue voc rehab and job search? • Medical opinion was strongly confirmed – Can RTW but only in Admin job – Cannot RTW in Front Desk job – Cannot RTW in an unfamiliar environment – No you can’t do Job Search The problem • Employer refuses to accept the medical recommendation – Therefore we can’t start a GRTW • Physician won’t allow her to do TSA or Job Search – Therefore we can’t proceed with CID 15
10/2/2017 Discuss with the Member • She was not returning our phone calls • Finally connected • She only wanted the one job in Admin • She did not want to pursue job search or other options • She was not open to any discussions Adjudicate • Go back to the Plan Text • Member medically cleared to RTW in position of Admin • Real job that does exist even though not available to her at this time • Therefore = identified occupation and no longer entitled to benefits • Claim ended after a period of notice 16
10/2/2017 Case Study - Debbie • Went off work at age 33 – Major Depression and Anxiety • 8 years on LTD • Employment was terminated • Rehab program implemented – Rehab support – CBT with psychologist – Voc rehab – job search • New job and new life at age 41 My fellow support team, I write this to inform you that I am doing remarkable!!! The job at “XYZ” is amazing. And I did it all on my own along with the long time encouragement and faith of you both. My last appointment with Dr. X was this week and I cried. I cannot believe how far I came within a year with the right group behind me. Thank you both. I go forward finding great purpose and having more goals for myself. We are doing amazing, I have a promise ring that looks like an engagement ring on my finger. So cheers to new beginnings! Sincerely, and with hugs, A former client and success story 17
10/2/2017 Our Results 2016 • 1500 active D&R claims • Started with deficit • 800 to Rehab • D&R Plan fully funded • 748 Cases Closed • Net assets $210,996,224 – 80% claim ending reasons – 53% RTW own occupation Satisfaction Survey 2016 • 85% satisfaction • “My RS was so understanding and empathetic. I couldn't have asked for better.” • “ I can't say enough about your program. You went above and beyond. Thank you !” • “ My RS made a very difficult time in my life significantly less worrisome and infinitely more tolerable. Thank you.” 18
10/2/2017 Take care of yourself Questions? • Richard Broadhurst • (204) 942-6591 ext 264 • richard.broadhurst@hebmanitoba.ca 19
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