Presentation Title - Insurance Gateway
Download
Report
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.”
7
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.”
8
Rehabilitation & Disability Benefits
Key principles covered in code
Awareness & accessibility
Consultation & confidentiality
Reasonable accommodation
Equal treatment and opportunities
Retention, termination & benefits
9
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
11
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
12
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
16
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
18
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
19
Group Assurance
Rehabilitation & Disability Benefits
Road ahead
Early intervention
Use both the medical & social models
Interact with stakeholders
Understanding what works, and why
20
Group Assurance
Group Assurance
Rehabilitation & Disability Benefits
Keep learning
Plan
Learn
21
Act
Reflect
Rehabilitation & Disability Benefits
Comments or questions?
Thank you!
22
Group Assurance