Identifying and managing disabilities in the workplace

Maggie Clack 22 November 2013

Indentifying disability cases

 Starts with absenteeism management  Chronic disease management  Look at the monthly trend  Top diagnosis within the company  Who are the individuals that are potential cases

Looking at absenteeism stats

Monthly Trend: Top diagnosis:

Musculoskeletal Respiratory Psycho social Gastric 13% 20% 33% 34%

Link between disability claims experience and economic conditions

Karl Schriek - GENRE  Claiming for disability is easier in economic hard times  Employers offer this as an alternative to retrenchment

Insurers offer:

1. Lump sum 2. Income benefits  Safety standards cost money   Maintaining technical skill cost money Psychological claims increase  State of economy affects how strictly insurers apply claims management  Lump sum is easier to understand – cheaper to administers, does not require ongoing claims management  Does not require ongoing payment

What are the definitions of disability?

Policy needs to be referred to

Definition of Disability

Is a legal process assessing the extent of the person’s impairment, judged in conjunction with their job description, policy wording and personal factors

Definitions

 Temporary disability –  Permanent disability – totally and permanently disabled to perform own occupation  Impairment – this assessment entails making a diagnosis an then determining on medical grounds which function the claimant is still able to perform  Own/any occupation – any function with any employer that will enable the insured person to generate an income  Own occupation – the type of work the insured person was performing with the Employer immediately before the waiting period  Alternative occupation – any alternative occupation with the employer for which the insured person is suited – taking into account age, training, knowledge, ability and experience  Look at definition in policy w.r.t. own employer or any employment in the open labour market

Lump sum disability

 Total and permanently unable to perform own occupation/alternative occupation  Looks at experience – or claimant could become qualified and suited for  It takes into account the degree of disability  Takes into account knowledge, training, educations, ability, experience and age

Income Replacement

 If the injury/disease renders you totally incapable of doing own /alternative occupation  Assessment done on a regular basis  Experience/qualifications are considered  What to do if benefits are accepted?

 HR often “scared” to terminate on grounds of incapacity

Quadriplegic patient……

Income Replacement

Submission period Waiting period Initial Period Extended period 3 months 4 weeks Absence from work End of NRA 65 Waiting period (Date of absence) Payment starts valid claims Death Resign Recover Normal retirement date

When to submit a claim?

 When you suspect that it is unlikely that an employee will be able to return to work.

 When an employee, who has returned to work after an illness or injury, is unable to perform work duties.

 When an employee has been diagnosed with a progressive/chronic condition, which is likely to result in a lengthy period of absence from the workplace

What do I submit?

 Employer section    Claimant section Copy of the claimant’s identification document Job description or performance contract  Comprehensive specialist report or completed medical questionnaire  Sick leave records with available reasons for absenteeism – past 2 years  Latest payslip with full salary

Liability of submitting a claim

 Employee – The onus lies on the employee to provide supporting evidence that he/she is disabled  Employer – the policy holder – has to facilitate the process  Employer is supported by HR/OHMP/OHNP  Liability of who has to submit an application - refer to policy document

What is the date of absence?

 Contractually this date is the day after the claimant was last actively at work performing the material duties of his / her occupation  Occasionally, i.e. in the case of a chronic medical condition, a claimant’s productivity decreases over a period of time. In these instances, the insurer will negotiate a fair date of absence that reflects the date when the claimant last performed the material duties of his/her occupation  This date indicates the start of the waiting period

THE ASSESSMENT PROCESS Benefit calculation Admit and Payment Submission of a new Group Income Review updated information Protection claim Validation Assessment of Disability Decision Defer Group Income Protection claims: Reassessment and Case management Information long outstanding If covered Decline Continue Payment Terminate Retirement Fit to return to work Resign Death Suspend

Insurance Assessment

Personal profile Contract clause Occupational profile Functional profile Medical profile

Managing Risk

Employee Risk

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Consumer debt, 46,8% of consumers can’t service personal debt

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Psychological effects such as stress and work pressure are also economically linked.

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Highest incidents HIV/TB/Alcohol/Smoking/Road traffic injuries in world

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Less health benefits

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Challenges in state health systems

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Medical scheme fraud, estimated at about R15bn annually

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Psychiatric disorders as a cause of occupational disability are under recognised and under-treated world wide / very difficult to manage

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Depression will be most common disease in the world by 2020

Insurer/ Administrator Employer Employee

7 out of 10 employees will be off on temporary disability during their work life If you do not return to work with 9 months – return chance decreases

Incapacity/termination of employment contract vs a disability claim

     Incapacity & disability process runs at the same time Recommended not to terminate in the waiting period Section 8 (10)of LRA – temporary incapacity – consider nature of the job, period of absence, seriousness of illness/injury and possibly getting a temporary replacement permanent incapacity – secure alternative employment, adapting duties or work circumstances to accommodate the employee NB – IOD cases particular consideration – employers duty to accomodate

Incapacity and Disability

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Incapacity – “the failure of the employee to perform his/her duties satisfactory” due to poor performance or ill health/injury. This is due to external factors and NOT misconduct

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The disability definition –” the failure of the employee to perform his/her duties satisfactory – due to ill health or injury ”

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Note: 70% of incapacity is NOT due to wellness issues. It is therefore essential to clearly understand the reasons for the incapacity

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Note: A application for disability could be a tool to assist in dealing with incapacity.

Questions?

More Information?

Maggie Clack

[email protected]

Tel: 041 581 0965