Managing your Insurance Carrier
This is definitely one of my pet peeves. Rest assured, the insurance carrier you think you have managing your short-term disability, long-term disability and WSIB, ADJUDICATE your claims only! If you are an employer, or a case manager working for an employer, you need to manage your insurance carriers as well as your employees’ claims.
The primary purpose of insurance carriers is to adjudicate – to ensure the disability benefit policy is being followed, by reviewing the medical documentation that either supports total disability or not. Adjudication involves payment of the claim or denial.
We need to take the same position in non-occupational claims as we do with occupational claims. Everyone should be offered modified work sooner rather than later. It’s to everyone’s benefit that employees remain connected with the employer during their disability. Don’t wait for the insurance carrier to tell you that your employee is able to return to work – do your own work. Have regular discussions with employees, obtain functional information that can assist in a return to work, and discuss this with the health care practitioners that are deciding whether the employee can do something for you with his/her medical condition. Be proactive and involved from day 1 of the disability.
The disability process you have in the workplace for WSIB should be for all disability types, including short term disability. Too many times the employer has the right framework to reduce and/or eliminate lost time caused by workplace injuries or illnesses but for some reason there seems to a ‘hands off approach’ when it comes to employees off for non-occupational reasons.
There is for sure some disability diagnoses that requires time off from work but managing the early and safe return to work of these types of claims keeps your claim count lower so that when it is time to renegotiate your disability insurance plan, you don’t get a huge hike in insurance premiums, which seems to be quite common.
Be consistent. Manage all your disability claims – occupational AND non-occupational with the same process and with the same diligence. This is when you will see a significant, positive shift in the culture of the organization when it comes to disability.
Lucie M.H. Fournier RN, COHN(C), BA (Psych)
Founder/Workplace Health Strategist
Expertise in 6 distinct niches including:
1. Corporate and Transformational Coaching
2. Advanced level training for internal claims manager to MAXIMIZE cost containment
3. Sensitive claims management of professional staff, such as HR, health team, and/or executives such as supervisors, managers, directors
4. Complex claims management resolution
5. Mental health claim return to work & accommodations
6. Transitional Leadership when moving to & from a 3rd party disAbility management company
We service clients across Ontario in all types of employers – large or small. We provide a customized approach to your business because we, and you, are different than the company down the road. A cookie cutter approach is NOT our specialty; nor our interest! We enjoy keeping the humanity in disability management while assertively managing your claims and costs. Feel free to call if you want to examine a long-term approach that is unique to you and your employees.