Partnering with Your Insurance Carriers

Case management is defined as a process for coordinating health and social services so that a sick or disabled individual receives the most appropriate care in a timely and efficient manner. The goals are to enhance the recipient's quality of life and contain, whenever possible, the costs of the care.

Many employers have hired their own in-house case managers to act as liaisons with their medical, disability and worker's compensation carriers, as well as treating doctors. These individuals help those external forces understand the inner workings of the company and guide all parties, including the employee, through the maze of return to work.

Health carriers usually utilize case management for very severe illness or catastrophic situations, and not for return to work. Short and Long Term Disability plans usually offer vocational rehabilitation and return to work assistance as well as medical case management. Worker's Compensation also offers both.

If you don't know the details of your plans, ASK! Your Benefits or HR areas can provide you with copies of your policies or Summary Plan Descriptions.

• Look under headings such as "Rehabilitation", "Return to Work", "Risk Management", "Case Management".
• Contact the Account Managers to further discuss these sections of your plans.
• Ask the Account Managers to arrange meetings or conference calls with the carrier to further understand these programs.
• Get names and phone numbers of contacts.
• Ask them to help you to coordinate return to work efforts! The carriers are usually eager to establish a relationship with employer so that they can perform their job well, which is providing you with good and proactive services.
• Many carriers will help you to establish internal return to work processes and programs if you do not have such formal programs in place. Take advantage!
• Determine if they can provide you with reports on the cost benefit of early return to work for your employees, as well as suggestions to develop your in-house program. This can be very valuable in convincing senior management of the value of funding more extensive return to work efforts with employees.

Your disability carrier can also discuss plan design features with your Benefits Department that may actually be providing disincentives to your employees and their return to work efforts. Examples of these might be

• Rich benefit plans (i.e., 80% wage replacement)
• Minimal or no offset for return to work attempts (can result in greater than pre-disability earnings)
• No rehab or return to work provisions or incentives.

Some incentives that could be helpful to encourage return to work:

• Mandatory rehabilitation
• Disability benefit level of no greater than 60%
• Return to work incentive (lesser offset for partial work which is performed under the guise of a rehab/return to work plan)
• Additional disability payment for participation in a vocational return to work/rehabilitation plan.

It's also important that your employees be aware of these services available to them via their benefits programs.