Transcript Presentation Title - Insurance Gateway

Rehabilitation
& disability
claims
Louisa Botes
Rehabilitation & Disability Benefits
Group Assurance
Agenda
 Pros and cons of rehabilitation
 South African perspective
 Value of rehabilitation programmes in disability insurance
2
Rehabilitation & Disability Benefits
The case for rehabilitation
 Improved outcomes
 Enhanced service
 Tangible difference
3
Group Assurance
Rehabilitation & Disability Benefits
The case against rehabilitation
 Adds complexity to claims assessment
 Unknown cost implications
 Role clarity
4
Group Assurance
Group Assurance
Rehabilitation & Disability Benefits
Prevalence of disability by age
30
20
15
10
Census 2001
5
Age groups
80 +
70 - 79
60 - 69
50 - 59
40 - 49
30 - 39
20 - 29
0
10 - 19
5
0-9
% Prevalence
25
Group Assurance
Rehabilitation & Disability Benefits
Age distribution of the South African population
20%
15%
10%
Census 2001
6
Age groups
80 +
70 - 79
60 - 69
50 - 59
40 - 49
30 - 39
0-9
0%
20 - 29
5%
10 - 19
% Total population
25%
Rehabilitation & Disability Benefits
Group Assurance
A tool for equality
“Disability is a natural part of the human experience and in no
way diminishes the rights of individuals to belong and
contribute to the labour market.
When opportunities and reasonable accommodation is provided,
people with disabilities can contribute valuable skills and
abilities to every workplace, and contribute to the economy of
our society.”
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Foreword to the CGP: Key aspects on the employment of PWD
Rehabilitation & Disability Benefits
Group Assurance
Richard’s story
“After six months of intensive rehabilitation, I had to try to integrate back
into society.
Being confined to a wheelchair, I had to break through many stereotypes,
labels and misconceptions. People tend to perceive a disability as an
inability.
But I was determined to succeed and my determination finally led to a job at
Old Mutual. Within my first few weeks at OM, I realised that there was no
telling what I was capable of doing.
The working environment I found myself in was such a contrast to the rest of
the world. At OM I’ve been encouraged to use my full potential and the
facilities have helped me operate independently.
Without OM I would probably have lived a mediocre life.”
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Rehabilitation & Disability Benefits
Key principles covered in code
 Awareness & accessibility
 Consultation & confidentiality
 Reasonable accommodation
 Equal treatment and opportunities
 Retention, termination & benefits
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Group Assurance
Rehabilitation & Disability Benefits
Retention & termination
 Retention is aligned with spirit of code
 Advantages
– Retains experience and skills
– Minimizes isolation and financial hardship
 Employer may terminate service
10
Group Assurance
Group Assurance
Rehabilitation & Disability Benefits
Business case for a managed disablity approach
 Best practice on workplace &
disability
–
Labour Relations Act, 1995
–
Early intervention
–
Employment Equity act, 1998
–
Reasonable accommodation
 Align insurance with labour law
guidelines
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 Best practice on work
rehabilitation
–
Definition of disability
–
Support return-to-work
 Disability management service
–
All stakeholders benefit
–
Cost containment
Rehabilitation & Disability Benefits
Benefits
 Managed disability
– Early intervention integral to product
– Supporting product features
 Other disability products
– Mixed bag
– Delayed or early contact with client
– Same case management principles apply
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Group Assurance
Rehabilitation & Disability Benefits
Interaction with the employer
 Involve key stakeholders
 Establish a common frame of reference
 Work together on individual cases
 Report management information
13
Group Assurance
Rehabilitation & Disability Benefits
Individual case management process
 Case selection
 Rehabilitation agreement, if necessary
 Preparation for return-to-work
 Review progress & adapt plan, if necessary
 Return-to-work, or another outcome
14
Group Assurance
Group Assurance
Rehabilitation & Disability Benefits
Reason for termination of monthly income benefit
50%
Proportion
40%
30%
20%
10%
0%
Death
Retirement
RTW
Event
PHI 2003 - 2006
15
Other
Rehabilitation & Disability Benefits
Key success factors
 Aim for the best outcome for all parties
 Teamwork
 Think and act holistically
 Be flexible – follow principles
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Group Assurance
Rehabilitation & Disability Benefits
Value of rehabilitation programmes
 Improved claims management
 Lower incidence of claims
 Ongoing learning for the business
 Appropriate response to client needs
17
Group Assurance
Rehabilitation & Disability Benefits
Empower employers
 Female supervisor
 Back problem due to IOD
 Comprehensive treatment
 “Workability”
 In-house solution
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Group Assurance
Rehabilitation & Disability Benefits
The journey so far
 Introduced rehabilitation to the insurance industry
 Changed the profile of claims assessors
 Created a database of service providers
 Developed products & services
 Began to align with national initiatives
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Group Assurance
Rehabilitation & Disability Benefits
Road ahead
 Early intervention
 Use both the medical & social models
 Interact with stakeholders
 Understanding what works, and why
20
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Group Assurance
Rehabilitation & Disability Benefits
Keep learning
Plan
Learn
21
Act
Reflect
Rehabilitation & Disability Benefits
 Comments or questions?
 Thank you!
22
Group Assurance