The Evolution of a Disability Claim Disability Management from a - - PDF document

10/2/2017 1

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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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Initial Assessment

• 2 cancellations from Member for initial rehab assessment
• No show for 3rd 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

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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

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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

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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

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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

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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

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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

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Our Results 2016

• 1500 active D&R claims
• 800 to Rehab
• 748 Cases Closed

– 80% claim ending reasons – 53% RTW own occupation

• Started with deficit
• D&R Plan fully funded
• Net assets $210,996,224

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.”

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Take care of yourself Questions?

• Richard Broadhurst
• (204) 942-6591 ext 264
• richard.broadhurst@hebmanitoba.ca