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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.
| Know your vendors and carriers! Develop a close relationship
with them! |
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.
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