Module 5 Effective Disability Plan Management

Question 1

Describe the objectives and outcomes of disability management.

Answer 1

Once a plan member becomes disabled, the primary objectives are the plan member’s rehabilitation and return to the workplace if possible. Disability management can lead to improved health, restored income and renewed job satisfaction for plan members. For the plan sponsor, it can shorten the duration of the absence and reduce the amount of claims payments under the long-term disability (LTD) plan. In some cases, an LTD claim can be avoided. Effective management also demonstrates the plan sponsor’s concern for disabled plan members and helps it fulfill its obligations to these plan members.

Question 2

Outline the key disability management elements that can be used to achieve the objectives of plan member rehabilitation and return to the workplace.

Answer 2

Key disability management elements that can be used to achieve the objectives of plan member rehabilitation and return to the workplace are:

(a) Early intervention tailored to ill/injured employee’s situation and needs

(b) Effective case management practices by qualified case managers

(c) Return to work and work accommodation

(d) Coordinated approach to disability claims management services

(e) Plan design elements such as benefits period guarantees and financial incentives that encourage return to work

(f) Identification and management of barriers to return to work.

Question 3

Outline the personal and environmental barriers to return to work identified by the Canadian Society of Professionals in Disability Management (CSPDM). (11)

Answer 3

The CSPDM has identified the following barriers to return to work:

(a) Design, delivery and entitlement of benefits

(b) Corporate policies

(c) Collective agreement issues

(d) Psychological factors of disability

(e) Location and type of organization where the injured/ill plan member works

(f) Nature of disability

(g) Legislative implications

(h) Performance/productivity issues

(i) Workplace environment challenges

(j) Lack of related experience, requisite skills and training of the employee with a disability

(k) Supervisor knowledge of how to make accommodations

(l) Attitudes or stereotypes among co-workers and supervisors toward people with disabilities.

Question 4

Absenteeism has both direct and indirect costs. Outline both the direct and indirect costs of absenteeism from the plan sponsor perspective.

Answer 4

Direct costs of absenteeism include salary/payroll costs for absent employees, overtime costs to cover for absent employees, insurance premiums and costs related to absence, short-term disability (STD) plan costs, salary paid to employees while absent (if there is a salary continuance plan), cost of administering/managing workers’ compensation (WC) internally or through a third party or insurance carrier, workers’ compensation premium paid to a provincial board and LTD plan costs.

Indirect costs of absenteeism include replacement costs for recruiting and integrating new or temporary employees, management costs for the time and effort people leaders spend to manage the effects of absence and replacement, productivity loss resulting from work not done because of an absence, client service costs due to problems or penalties caused by delays or lower service standards, and lower employee morale from the psychological costs for employees who have to pick up the slack with a heavier workload.

Question 5

Explain the concept of duty to accommodate in employment as outlined by the Alberta Human Rights Commission.

Answer 5

The duty to accommodate in employment refers to an employer’s obligation to take appropriate steps to eliminate discrimination against employees and potential employees. Discrimination may result from a rule, practice or standard that has a negative effect on a person due to one of the protected grounds under the Act. An employer’s duty to accommodate employees or potential employees is far reaching. It can begin when a job is first advertised and finish when the employee requiring accommodation leaves the job.

Accommodation in employment most often involves the protected grounds of physical or mental disability. It may also involve the other protected grounds, including religious beliefs, gender (including pregnancy), gender identity, gender expression, family status and marital status.

Question 6

Identify what is required of an employer in Alberta when it receives an accommodation request.

Answer 6

An employer or service provider who receives an accommodation request must:

(a) Determine whether the request falls under any of the areas and grounds protected under the Act.

(b) Be aware that once a request is received, the onus to accommodate is on the employer or service provider.

(c) Respect the dignity of the person or group requesting accommodation.

(d) Respect the privacy of the person requesting accommodation. Medical information is considered personal information, and employers and service providers must abide by applicable privacy legislation when they collect, use or disclose an employee’s medical information.

(e) Listen to and consider the needs of the person seeking accommodation and their suggestions for accommodation.

(f) Review medical or other information that the person seeking accommodation provides to support the request for accommodation.

(g) Be willing to take substantial and meaningful measures to accommodate the needs of the person seeking accommodation.

(h) Consult an expert such as a human resources professional or lawyer if more information is needed to assess the request.

(i) Be flexible and creative when considering and developing options.

(j) Discuss options with the person who needs accommodation.

(k) Take reasonable steps to accommodate the person seeking accommodations to the point of undue hardship. If full accommodation is not possible without undue hardship, try to suggest options that may particularly meet the ends of the person seeking accommodation.

(l) Reply to the request for accommodation within a reasonable time period.

(m) Make a formal written accommodation agreement with the person being accommodated and ensure that the accommodation is given a fair opportunity to work.

(n) Follow up to ensure that the accommodation meets the needs of the person seeking accommodation.

(o) Provide details that explain why accommodation is not possible because it poses undue hardship or because of a bona fide occupational requirement.

(p) Be willing to review and modify the accommodation agreement if circumstances or needs change and the agreement is no longer working.

Question 7

Provide examples of accommodation measures in the employment context.

Answer 7

Examples of accommodation measures in the employment context include:

(a) Purchasing or modifying tools, equipment or aids, as necessary

(b) Altering the premises to make them accessible

(c) Altering aspects of the job, such as job duties

(d) Offering flexible work schedules

(e) Offering time off to attend rehabilitation programs

(f) Allowing time off for recuperation

(g) Transferring employees to different jobs

(h) Using temporary employees

(i) Adjusting policies (for example, relaxing the requirement to wear a uniform).

Question 8

Explain the concept of undue hardship.

Answer 8

“Undue hardship” occurs if accommodation would create significantly onerous conditions for an employer or service provider, for example, intolerable financial costs or serious disruption to business. An employer or service provider must make every effort to make a reasonable accommodation for an employee or client/customer. Some hardship may be necessary in making an accommodation; only when the point of undue hardship is reached is the employer’s or service provider’s duty to accommodate fulfilled. In addition to financial costs, determination of hardship would consider the size and resources of the employer or service provider, disruption of operations, morale problems of other employees brought about by the accommodation, substantial interference with the rights of other individuals or groups, interchangeability of workforce and facilities, and health and safety concerns.

Question 9

Explain the concept of “bona fide occupational requirement” (BFOR).

Answer 9

The law recognizes that, in certain circumstances, a limitation on individual rights may be reasonable and justifiable. Discrimination or exclusion may be allowed if an employer can show that a discriminatory standard, policy or rule is a necessary requirement of a job (referred to as a bona fide occupational requirement). For a standard, policy or rule to be considered a BFOR, an employer must prove, on the balance of probabilities, that:

(a) A workplace standard is rationally connected to the functions of the job performed

(b) The standard was established honestly and in the good-faith belief that it was necessary to fulfill a legitimate work-related objective

(c) The standard itself is reasonably necessary to accomplish the work-related goal or purpose. In demonstrating whether the standard is reasonably necessary, the employer must show that they have accommodated the employee to the point of undue hardship.

Question 10

Outline the milestones between the return-to-work coordinator’s (RTWC’s) first contact with an employee and closing the employee’s RTW file

Answer 10

RTWC determines whether intervention/assistance is required: If the RTWC determines that intervention/assistance is not required, the reasons are noted in the employee’s file. If the RTWC determines that intervention/assistance is required, the employee is referred to the appropriate rehabilitation provider, or the RTWC arranges for other assistance.

RTWC determines whether a formal RTW plan is required: Again, if the RTWC determines that a formal RTW plan is not required, the reasons are noted in the employee’s file. If the RTWC determines that a formal RTW plan is required, the first question is to determine whether a return to the employee’s preinjury position is possible. If the RTWC determines that it is not possible for the employee to return to their preinjury position, the RTWC and the employee complete a transferable job skills profile. The RTWC, the employee and the RTW committee identify job options. If the RTWC determines that it is possible for the employee to return to their preinjury position, the RTWC and the employee provide physical demand analysis (PDA) information to a doctor. The doctor completes the RTW form and suggests options for a safe and timely return to work. The RTWC and the employee agree on hours, duties and dates of return to work. The RTWC, the employee, the employee’s supervisor, an employee representative and the benefit provider obtain agreement on the RTW plan. The RTW plan is implemented. The RTWC, the supervisor and the doctor monitor the RTW plan to ensure a safe return to work.

RTWC determines whether the RTW plan is successful and sustainable: If the RTWC determines that the RTW plan is not successful or sustainable, goals or specific objectives are modified with appropriate individuals. If the RTWC determines that the RTW plan is successful and sustainable, the RTWC and the insurance provider close the employee’s RTW file.

Question 11

Explain the purpose and timing of first contact in the RTW process.

Answer 11

The purpose of the first contact is to open the lines of communication and to let the employee know that a support program is available. In some cases, the first contact may include a meeting between the employee and the RTWC to confirm that the employee has the appropriate benefit applications and whether they require assistance to complete them.

In the case of an accident, an RTWC should generally contact the employee within the first 24-48 hours. In the case of illness, an RTWC should contact the employee only if it appears from the initial information that the employee will be away for more than ten to 14 days. These are general guidelines. The nature of each illness or injury and the organizational framework must be considered.

Question 12

Outline stages in the overall RTW process.

Answer 12

Stages in the overall RTW process are:

(a) Providing support for treatment and rehabilitation, if applicable

(b) Completing a functional capacity evaluation and/or other assessments

(c) Providing information on how to obtain compensation and benefits

(d) Developing an RTW plan

(e) Implementing the RTW plan

(f) Monitoring and adapting the RTW plan, if required

(g) Evaluating the RTW plan.

Question 13

Explain the role of an employee’s medical treatment in the development of their RTW plan.

Answer 13

When an employee has been away from work for a specified time, many employers have policies that require a doctor to sign a functional abilities form. This is also required by a Workers’ Compensation Board (WCB) in some provinces. A functional abilities form does not indicate that an employee is fit to return to a previous job, but it should provide information on what the employee can undertake without aggravating an injury or illness. Returning employees may still require time off for continuing treatments, such as physiotherapy or counselling.

Once the doctor completes a functional abilities report indicating functional restrictions and the expected date of resumption of duties, the employee should inform the return-to-work coordinator (RTWC) and discuss any concerns. The WCB or the private insurance carrier will also receive the functional abilities report and may be involved in developing an RTW plan for the employee.

Question 14

Provide examples of assessments used in the development of an employee’s RTW plan.

Answer 14

Functional capacity evaluations are completed to determine whether an employee can return to work and under what conditions. They may be completed by the employer’s doctor or, if necessary, a trained assessor such as a physiotherapist or occupational therapist. Functional capacity evaluations provide information about the employee’s limitations and restrictions as well as current abilities, which are then matched to the requirements of the employee’s job. This matching is usually based on the physical demand analysis (PDA) provided by an RTWC. The PDA provides detailed information about job demands

Cognitive and psychological assessments (e.g., neuropsychological or psycho-vocational assessments) may be warranted in individual cases. Although these assessments are not conducted frequently, they can help identify the complex physical, psychological and social issues that may prevent an employee from returning to work in a timely manner.

Question 15

Explain the role of health status in planning for an employee’s return to work. Provide an example.

Answer 15

The required health status (i.e., whether an employee is fit to work) is based on the employee’s working conditions. To determine the required health status, the employee’s doctor evaluates the level of function of the relevant bodily system(s) required in the employee’s job using the appropriate clinical and laboratory procedures and tests. This is then compared with the employee’s level of function given the clinical impairment associated with their diagnosis. For example, working conditions requiring physical exertion, shift work and working in remote settings may be a fit for some employees with diabetes but not for others. Whether it is safe for them to work under those conditions will depend on the degree of clinical impairment associated with the nature, type and severity of their diabetes.

Question 16

Provide examples of workplace factors physicians consider when making fitness-to-work decisions.

Answer 16

Location of work: For example, is the workplace remote or isolated from medical and rehabilitation services?

Description of job: For example, is the job part of a scheduled process (i.e., cannot be interrupted for rest breaks), is it repetitive, is it self-directed (i.e., is the employee able to organize work in any way, provided the final outcome is achieved)?

Hours of work: Could it be flexible?

Job functions: For example, what are the demands of the job, is there heavy lifting, does it require long periods of sitting or standing?

Occupational health and safety hazards: For example, does the job involve risk of acute or chronic traumatic injuries, does it involve handling chemicals, is there frequent exposure to hazards or are there physical dangers?

Special job requirements: For example, does the job require unique actions or specific functions such as working in confined spaces or climbing to work spaces?

Psychosocial demands and psychosocial stresses: For example, do interpersonal or social group dynamics affect the job, is there exposure to frequent conflicts, or is coordination of the work of others or work with the public required?

Question 17

Describe the basis and implications of each of NIDMAR’s fitness-to-work outcomes.

Answer 17

Fit (for a specific job): The employee may be considered not disabled, temporarily partially disabled or permanently partially disabled. Fit means the employee will not be a hazard to self or others in the context of the stated working conditions. A judgment of fit for the pre-accident job (based on known working conditions) does not necessarily mean there is no disability. Employees classified as fit for the pre-accident job may not necessarily be fit for any job (where the working conditions may differ). If that pre-accident job is no longer available, a doctor may conclude that the employee remains unfit to perform other available work.

Fit (subject to work modification): The employee may be considered temporarily partially disabled or permanently partially disabled. If certain alterations are made to working conditions, the employee could be considered fit. This situation may be temporary if the healing process is not complete (correlated with the workplace disability category of temporary disability). If no further healing is anticipated, it is likely that this situation will be permanent (correlated with the workplace disability category of permanent partial disability).

Unfit (for a specific job) or unfit (for all jobs): The employee may be considered temporarily totally disabled for a specific job, permanently totally disabled for a specific job, temporarily totally disabled for all jobs or permanently totally disabled for all jobs. The clinical impairment and working conditions are incompatible. The employee is judged to be a hazard to self or others in the stated working conditions. This assessment is considered temporary if healing will lead to a reduction or moderation of the clinical impairment and permanent if no further improvement is anticipated. In this category, there are no work modifications that would permit fitness.

Question 18

Explain the factors that impact decisions about benefits and support programs in the RTW process.

Answer 18

Factors that impact decisions about benefits and support programs in the RTW process are:

(a) Whether the injury/illness is work-related

(b) Whether the injury/illness is the result of a motor vehicle accident

(c) Whether the employer provides short-term disability (STD) and/or long-term disability (LTD) benefits

(d) Whether the employee has private insurance

(e) Whether the employee is eligible for employment insurance (EI) benefits

(f) Whether the employee is eligible for Canada Pension Plan/Quebec Pension Plan (CPP/QPP) disability benefits

(g) Whether the employee is permanently disabled and requires significant job accommodations.

Question 19

Provide examples of benefit period guarantees that can encourage employees to participate in an RTW program.

Answer 19

LTD benefit period guarantees that may be offered to alleviate concerns an employee might have regarding termination of benefits as a result of participation in an RTW program include:

(a) LTD benefits payable for at least the duration of the rehabilitation program

(b) If the program involves a change in job for the employee, LTD benefits payable for the duration of the rehabilitation program and, in any event, until the date the definition of disability is due to change to include any occupation

(c) If the disability reoccurs (i.e., due to the same illness or injury and usually within six months of a return to full regular duties), continuation of LTD benefits for up to 24 months, as long as the employee is in the two-year own-occupation period or participating in an RTW program.

Question 20

Explain how any reduction in LTD benefits paid while an employee is being paid by an RTW program influences employee motivation to participate.

Answer 20

While plan members participate in a return-to-work program, their earnings should not reduce the LTD benefits by 100% of those earnings. The reduced LTD benefit should leave the plan members with a net profit from their rehabilitative employment after considering the additional expenses associated with the employment (e.g., transportation to and from work).

Some plans do not reduce LTD benefits unless the sum of the earnings from rehabilitation employment plus LTD and disability benefits from all other group and government plans exceeds 100% of the employee’s inflation-indexed income. Others may reduce the LTD benefit by 50% of rehabilitative earnings, subject to a similar overall limit of 100% of predisability income. Insurers are generally flexible and innovative in structuring financial incentives and accommodating the needs of disabled employees.

Question 21

Explain how the return-to-work coordinator (RTWC) works with the insurer in implementing an RTW plan.

Answer 21

The RTWC consults extensively with the insurer to ensure that early return to work does not affect an employee’s benefits coverage. By involving the insurer in developing an RTW plan, an RTWC can ensure that, if the return is not fully successful, the employee’s coverage can be reinstated without penalties. In addition, insurers may cover the cost of some accommodations and training.

Question 22

Outline the hierarchy of RTW options.

Answer 22

The hierarchy of RTW options is:

(a) Return to work, same job, same employer

Same job, no restrictions, no accommodations necessary
Same job, minor restrictions, some temporary accommodations necessary
Gradual return to work or transitional work options
Same job, permanent accommodations
(b) Return to work, different job, same employer

Different job, no additional training, job accommodations may be necessary
Different job, additional training required, job accommodations may be necessary
New job created by employer, additional training may be required, additional accommodations may be necessary
(c) Return to work, different employer

Similar job, same industry, minor retraining or accommodations may be required
Different or modified job, same industry, training required, accommodations may be required
Different or modified job, may be in a different industry, additional training required, accommodations may be required
(d) Self-employment

Vocational assessment services to determine potential for benefiting from training or self-employment
Training and counselling to develop self-employment options suited to employee’s restrictions as well as aptitudes and marketable skills.

Question 23

Illustrate how job accommodation can be achieved using assistive devices or by modifying the work environment.

Answer 23

(a) Job accommodations include any modification of job demands or hours, physical or structural modifications, and the installation of assistive devices required for a disabled employee to return to work. Job accommodations can be temporary or permanent, depending on the needs of the employee and the workplace. Examples of job accommodation using assistive devices include headsets, computer hardware and software (e.g., specialized keyboards, hearing aids, magnifying optical lenses).

(b) Modification to the work environment can include physical changes to the work area or equipment as well as changes to the way parts of the job are done (e.g., ergonomically designed chairs, sound proofing of work areas that are close to loud machinery).

Question 24

Describe the role of transitional work in an RTW plan and outline some of the risks associated with transitional work.

Answer 24

Transitional work is a type of job accommodation generally required for a longer period of time and may be appropriate for a more severe, temporary, disabling condition. Options include any group of tasks or specific jobs that are not intended to be the end result of the RTW process. Through modified work hours or duties, the employee is expected to eventually be capable of returning to full predisability duties. Transitional work provides an opportunity for an employee with a temporary disability to remain involved in the workplace and with other employees as well as to maintain income levels and the self-discipline of a standard work routine. However, without clear guidelines, there are risks to this approach:

(a) There may be a tendency to add on tasks that could impede the employee’s full rehabilitation or that could create new trauma or illness

(b) There may be a tendency for the employee to overextend (overwork) in an effort to get back to work as soon as possible

(c) An employee may become so attached to the transitional work that there is a reluctance to return to former duties.

Question 25

Explain the role of work hardening in an RTW plan.

Answer 25

Employees who require transitional work opportunities may have been away from work for a significant period of time and may have lost some of the physical strength required to perform the job tasks. In these cases, gradual physical conditioning, known as “work hardening,” is a necessary first step. It is designed to gradually develop an employee’s strength and endurance. In some cases, it is accomplished within the employee’s workplace by introducing modified work hours and gradually increasing the amount of time spent at work and completing tasks. Work hardening programs are also available at separate rehabilitation facilities, operated by private organizations or by workers’ Compensation (WC) or long-term benefit providers.

Question 26

Describe graduated return to work (GRTW) in the context of an RTW plan and provide examples.

Answer 26

Workers with restrictions can be offered a graduated return to work, which involves the increasing of time or difficulty of job tasks as the employee’s strength and endurance increase. Where appropriate, less demanding tasks that are a part of an employee’s original job can be combined with temporarily assigned job tasks that are compatible with the employee’s abilities. One example of GRTW is initially returning to work for only two hours per day and, over an eight-week period, gradually increasing the number of hours spent at work to a full shift. The objective of graduated return to work is to ensure that the functional or work capacity of the individual matches the demands of the job.