Rehabilitation & disability claims Louisa Botes
Rehabilitation & Disability Benefits Group Assurance Agenda n Pros and cons of rehabilitation n South African perspective n Value of rehabilitation programmes in disability insurance 2
Rehabilitation & Disability Benefits The case for rehabilitation n Improved outcomes n Enhanced service n Tangible difference 3 Group Assurance
Rehabilitation & Disability Benefits The case against rehabilitation n Adds complexity to claims assessment n Unknown cost implications n 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% 5% Census 2001 6 Age groups 80 + 70 - 79 60 - 69 50 - 59 40 - 49 30 - 39 20 - 29 10 - 19 0% 0 -9 % 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 n Awareness & accessibility n Consultation & confidentiality n Reasonable accommodation n Equal treatment and opportunities n Retention, termination & benefits 9 Group Assurance
Rehabilitation & Disability Benefits Retention & termination n Retention is aligned with spirit of code n Advantages – Retains experience and skills – Minimizes isolation and financial hardship n 10 Employer may terminate service Group Assurance
Group Assurance Rehabilitation & Disability Benefits Business case for a managed disablity approach n Best practice on workplace & disability n Best practice on work rehabilitation – Labour Relations Act, 1995 – Employment Equity act, 1998 n – Early intervention – Reasonable accommodation Align insurance with labour law guidelines – Definition of disability – Support return-to-work 11 n Disability management service – All stakeholders benefit – Cost containment
Rehabilitation & Disability Benefits n Managed disability – Early intervention integral to product – Supporting product features n 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 n Involve key stakeholders n Establish a common frame of reference n Work together on individual cases n Report management information 13 Group Assurance
Rehabilitation & Disability Benefits Individual case management process n Case selection n Rehabilitation agreement, if necessary n Preparation for return-to-work n Review progress & adapt plan, if necessary n 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 n Aim for the best outcome for all parties n Teamwork n Think and act holistically n Be flexible – follow principles 16 Group Assurance
Rehabilitation & Disability Benefits Value of rehabilitation programmes n Improved claims management n Lower incidence of claims n Ongoing learning for the business n Appropriate response to client needs 17 Group Assurance
Rehabilitation & Disability Benefits Empower employers n Female supervisor n Back problem due to IOD n Comprehensive treatment n “Workability” n In-house solution 18 Group Assurance
Rehabilitation & Disability Benefits The journey so far n Introduced rehabilitation to the insurance industry n Changed the profile of claims assessors n Created a database of service providers n Developed products & services n Began to align with national initiatives 19 Group Assurance
Rehabilitation & Disability Benefits Road ahead n Early intervention n Use both the medical & social models n Interact with stakeholders n Understanding what works, and why 20 Group Assurance
Group Assurance Rehabilitation & Disability Benefits Keep learning Plan Learn 21 Act Reflect
Rehabilitation & Disability Benefits n Comments or questions? n Thank you! 22 Group Assurance
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