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IS THE FUTURE GOING CRAZY? PSYCHOLOGICAL CLAIMS MANAGEMENT. BY LIZ SCOTT & MICHELLE MACINTOSH. AGENDA. The facts The solution The proof – case study. Manulife LTD Claims by Diagnosis 2001. Increased Cost in STD. OH&S Canada March 2001. Facts and Figures. Disability Costs. LTD. STD.

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agenda
AGENDA
  • The facts
  • The solution
  • The proof – case study
increased cost in std
Increased Cost in STD

OH&S Canada March 2001

facts and figures
Facts and Figures

Disability Costs

LTD

STD

WSIB

Payroll

the facts
Depression

Cost the Canadian & US economies $60 Billion US annually. Half in lost productivity.

Incidence is growing and getting younger

Depressive disorders account for 30-40% of mental illness in Canada, 50% of mental health $ spent

Fastest growing category of disability claims

Economic cost of mental illness in Canada are 14% of corporate Canada’s profits & 3% of our national debt.

The facts…
the facts7
Depression

Productivity Issues

Working longer but less productive

There is direct link between depression and loss of productivity

The future is mental!

Information economy

Human capital & the human mind are more important than brawn

Depression directly effects out human capital

Defeating depression must be a corporate priority!

The facts…
how much is it costing your company
How Much is It Costing Your Company?
  • Estimate number of days – present but not functioning
  • Estimate number of days – off work on “sick leave”
  • Estimate number of days – off work on “short term disability”
  • Multiply by the average daily wage?
the facts9
The facts….

Research to Reality

  • Berger, ML, Howell, R, Nicholsen, S & Sharda, C. (2003) highlight importance of keeping the workplace healthy
  • Claxton, AJ, et al (1999) indicate that appropriate treatment improves outcomes
  • Kessler, RC, et al (1999) depressed workers had 1.5 and 3.2 more short term work disability days
  • Mintz, J, et al (1992) Ten studies analyzed show therapy combined with medication had the most effective outcomes.
the facts10
The facts….

The Problem with Mental Health Claims

  • No lab, no physical, no objective tests
  • Takes 1.7 times longer
  • Not a fatal condition - don’t die soon, higher salary
  • Massive reserves - $250,000
  • Can be “physical” – pain, fatigue, chronic fatigue syndrome, fibromyalgia
slide11

The facts….

Bottom line “on the street”

Only 1 in 16…. or 6 in 100 good care rate

Over 40% of all Dr notes are inappropriate

* Coyne, 1995

** Katon, 1995

*** Kessler, JAMA, April 2003

the facts12
The Facts….

Long hours.

The employee puts in to demonstrate that the employee has a high level of commitment.

the facts13
The Facts….

Illness.

Employee going into work with sicknesses (migraine, colds, flu, allergies) and are unable to work at a normal output level

the facts14
The Facts….

Presenteeism.

At work but not working.

Time spent on other actions such as personal email, phone calls, internet surfing, “water cooler chitchat”, daydreaming.

the facts15
The facts….

CAUSES:

  • Mental and physical illness
  • Work/Life challenges
  • Corporate culture

Workplaces have little power to reduce actual illnesses, mental and physical, but have tremendous power in changing the sense of Work/Life Balance their employees experience and creating a Corporate Culture that supports and enhances its employee’s lives.

In managing Presenteeism and mutual health disability, companies can effect change in the cost of absenteeism and STD.

could you insure the quality of your service and products
Could you insure the quality of your service and products…….
  • If each employee spent 2 to 6 weeks at work not able to do the job well?
can you be confident about safety
Can you be confident about safety….
  • If 30 – 40% of your employees are to tired or sedated with diminished cognitive function and dexterity?
understanding health at work
Understanding Health at Work

Psychsocial

Work environment

Healthy work environment

Physical Work environment

Individual Health practices

basic mental health needs in the workplace
Basic Mental Health Needsin the Workplace
  • Respect & appreciation
  • Being heard and listened to
  • Sense of self-worth
  • Sense of belonging to a meaningful and supportive work group
  • Learning and challenge
  • Role clarity

Shain, M. Best Advice on Stress Risk Management in the Workplace

work factors that threaten well being
Work Factors That Threaten Well-Being
  • Work overload and time pressures
  • Lack of influence over day-to-day work
  • Lack of training
  • Poor communication - ambiguity
  • Too little or too much responsibility
  • Lack of status rewards
  • Discrimination/harassment
  • Role overload

Shain,M. Best Advice on Stress Risk Management in the Workplace

understanding health at work22
Understanding Health at Work

High JobPressure

Low Job Control

HomeStress

Low SocialSupport

=

Increased Risk to Mental and Physical Health

Illness, injury, infection, anxiety, depression, substance abuse

sociobiological translation
Sociobiological Translation

A mechanism by which human beings receive messages about the social environment and convert these messages into biological signals that trigger the processes of disease development or health promotion.

Tarlov, 1996

impact of the organization on employee health
Impact of The Organization on Employee Health

3x Heart Problems

3x Back Pains

2x Substance Abuse

High Effort/

Low Reward

+

High Demand/

Low Control

5x Certain Cancers

2x -3x Injuries

2x - 3x Conflicts

2x -3x Infections

2x - 3x Mental Health Problems

Shain, M. (2000) NQI - A Healthy Workplace

important learning s
Important Learning's…
  • Work-life balance can be affected by workplace responses
  • How work is managed and how decisions are made within an organization is an important variable
  • Accountability and infrastructure support are essential
  • Real benefits accrue to organizations who make a commitment
the underlying framework
The Underlying Framework

Workplace Necessities

Trust

Fairness

Purpose

Programs

trust
Trust

An understanding attitude towards employees is much healthier than denying the existence of family and family obligation

fairness
Fairness

2 Components:

  • Distributive - who get what, and when
  • Procedural - the process through which decisions are made
sense of purpose
Sense of Purpose
  • Understanding of the vision, mission and values
  • Understanding of how an individual contributes to the achievement of the vision, mission and values
programs
Programs
  • Design programs to assist employees in making the right choices
  • Lunch and learns
  • Newsletters
  • Fitness
what employees can do
What Employees Can Do

ATTITUDE INTERVENTIONS

  • Learning to Dance with Life!
  • Commit to staying healthy!
read the following
Read the following

RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN

read the following33
Read the following

REDBLUE ORANGEGREENREDBLUEORANGEGREENRED BLUE ORANGE GREEN RED BLUE ORANGEGREEN RED BLUEORANGE GREEN RED BLUEORANGEGREEN RED BLUE ORANGE GREEN RED BLUEORANGEGREENRED BLUE ORANGE GREEN RED BLUE ORANGEGREEN RED BLUE ORANGE GREENRED BLUE ORANGEGREEN RED BLUE ORANGEGREEN RED BLUE ORANGE GREEN RED BLUEORANGEGREEN

what is disability management
What is Disability Management ...
  • An integrated systematic process of returning people to functioning lifestyles following an event of disability

Organizational Solutions, 2002

the solution the bigger picture
The Solution… The Bigger Picture

Workplace Events

  • Early Intervention Disability Management

Absence

Management

Prevention

Programs

Adjudication

Disability to

Ability Mgt.

Interventions

Return to Work

Employee

Hired

(promises made)

Time

Treatment

& Recovery

Work

Trials

Return

To Work

Presenteeism

Work

Absences

Healthy

Employee Events

slide37

The Solution….

Disability Management Early Intervention = Success

why disability management
Why Disability Management ?

Probability of Returning To Work

100

80

60

Probability of RTW (in %)

40

20

0

0

3

6

9

12

15

18

21

24

36

Duration of absence (in months)

the solutions
The Solutions….

CORPORATE CULTURE

  • Policies and Procedures that support and are usable for managers and supervisors
  • Managers that have face to face managerial time built into their job
  • Clear role definition
  • Managers have Clarity- they are able to communicate, observe situations from a non-personal position
  • Build trust
the solutions41
The Solutions….

WORK/LIFE BALANCE

  • Live it!
  • Policies and procedures that are fairly created and implemented
  • Humour and sense of fun at work
  • Flexibility when exceptions are presented
  • Managers and supervisors that manage little challenges before they become large issues
  • Implementation and promotion of EFAP
  • Workshops that are meaningful to the employees
the solutions42
The Solutions….

Claim Initiation

  • Appropriate paperwork
  • Appropriate treatment
  • Focus on RTW / capability
claims management
Claims Management
  • Right care, right time, right outcome
  • Ensure employees have a “its my job to get better” attitude
  • Be in contact with the employee, Dr. and Manager
disease care management
Disease / Care Management
  • Claims management consists of monitoring a claim from the time it occurs until its final resolution.
  • Communication with the disabled employee during recovery should be frequent and should contain important messages,
    • Convey genuine concern,
    • Set expectation the employee will comply with company policies
    • Express a commitment to return them to work within their capabilities.
claims management45
Claims Management
  • Only 20% of diagnosed depressions get appropriate “guideline care”
  • Specialist more likely to provide appropriate care then the family doctor
  • What is guideline care – CPA website
return to work
Return to Work
  • What is the RTW expectation?
  • Establish a clear path
  • Is it based on functional objective information or opinion?
  • Ensure they progress once they RTW
  • Prevent recurrence
cognitive job demands vs cognitive capabilities
Cognitive Job Demands vs. Cognitive Capabilities
  • Do they have the cognitive capabilities to perform the cognitive demands of the job
  • Quantify – much like the PDA vs FAE approach
  • What can the employee do vs What they need to do
  • Positive work environment will be essential
the new approach
The New Approach

Right care,

at the right time,

for the right outcome

slide50

Thank You

HRPAO Presentation - 2006

Liz R. Scott PhD Organizational Solutions lscott@orgsoln.com

Michelle MacIntosh Baylis & Associates mmacintosh@baylis-efap.com

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