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NAVIGATING THE STORMY SEAS OF
INTEGRATED DISABILITY MANAGEMENT
Presented by
Heather Luiz, President – CareWorks Absence Management
Jody Moses, President – York Public Entity
Integrated Disability Management and
Absence Tracking Programs
INTEGRATED CLAIM SOLUTIONS
Technology and Data Medical Information
We have increased the access
to information
Speed to response has
increased
Communication expectations –
fast is never fast enough
Storage of data and claim
history continues grow
Demand for response times
continues to shrink
There is an increasing emphasis
on medical spend
Medical spend is driving more
of the total spend of claims
There is a greater complexity of
the combinations of medical
equipment and medications
Cyber security is critical, but
can be costly.
Continuous Changes in Claims
INTEGRATED CLAIM SOLUTIONS
Considerations for the “right”
plan for your organization
Program goals
Compliance
Management oversight
Policies and Procedures for
leave/absence reporting
Tracking
Technology
Privacy
Factors that impact the program
Multiple stakeholders
Resources
Organizational culture
THE COST OF ABSENCE
Employee absence costs employers between 20% and 22 % of payroll
Direct Costs
• Overtime payments
• Replacement workers
• Wage/salary
Indirect Costs
• Lost productivity
– Replacement worker
– Co-workers
– Supervisors
• Rate of paid time off
What’s Not Included?
Cost of non-compliance
Increased healthcare costs for overworked employees
THE RISKS OF NON-COMPLIANCE
Schultz v. Advocate Health
and Hospital Corp.
Employee alleged his termination was the result of being unfairly penalized for taking time off to care for his aging parents under FMLA. Over the period of intermittent leave, the supervisor created unreachable performance standards and eventually terminated the employee.
The result: A federal Jury awarded 11.65M to employee (10.75M against the employer and .9M against the two supervisors).
Verizon Communications
Telecommunications giant Verizon Communications paid $20 million and provide significant equitable relief to resolve a nationwide class disability discrimination lawsuit filed by the U.S. Equal Employment Opportunity Commission (EEOC). The suit, filed against 24 named subsidiaries of Verizon
Communications, said the company unlawfully denied reasonable accommodations to hundreds of employees and disciplined and/or fired them pursuant to Verizon’s “no fault” attendance plans.
Supermarket Giants SUPERVALU INC., American Drug Stores LLC, & Jewel Food Stores, Inc. (collectively referred to as “Jewel-
Osco”)
Jewel-Osco’s policy of terminating employees after the exhaustion of 12 weeks of leave cost them 3.2 million. By automatically terminating the employees after 12 weeks of leave, the EEOC argued successfully that Jewel-Osco failed to engage with
employees in a interactive discussion to assess potential reasonable accommodations, which is in direct violation of the ADAAA regulations.
Nicholas Lore requested leave for his own serious health condition. He was told a new manager would be brought in temporarily to replace him while on leave. After months of waiting and no sign of a new manager, Lore once again inquired about his leave status. Less than a month later he was terminated.
The result: Plaintiff's verdict for $2.2 million. Once liquidated damages equal to the amount of the verdict as well as prejudgment interest are added in -- both are mandated under the FMLA -- the former employee's recovery could fall somewhere between $6.2 million and $7.6 million.
Lore v. Chase Manhattan Mortgage Co.
WHAT DOES IDM MEAN?
Integrated Disability Management
(IDM) typically includes:
Leave Management
Family and Medical Leave Act
(FMLA) and state leaves
Short and long term disability
Factors that impact the program
Americans with Disability Act (ADA)
Workers’ compensation
EAP
Disease management
Medical
Wellness programs
There are varying degrees of integration
STATES WITH ADDITIONAL LEAVE LAWS
AK
HI
NOT ALL LEAVES ARE EQUAL
FMLA ADA
Covered Employers • 50 or more employees
within 75 miles • 15 or more employees
Eligibility
• 12 months
(nonconsecutive)
• 1250 hours in last 12
months
• Coverage from day 1
Benefits
• Continued health care
coverage on same
terms as pre-leave
• Provide benefits during
ADA leave on same
conditions as provided
to employees on
other leaves
FMLA ADA
Duration
• 12 week max per
leave year for
employee own health
condition
• Not specific but not
indefinite or open
ended
Job protection
• Right to restoration to
same or equivalent
position
Unless undue hardship:
• Restoration to same position
• 2nd option – placement in
vacant position
• 3rd option – placement in vacant lower position
NOT ALL LEAVES ARE EQUAL
ADA does not alter determining eligibility for federal or
state disability benefit programs or workers’ compensation laws
THE BENEFITS OF AN INTEGRATED SOLUTION
BENEFITS DRIVERS
• Focus on core service
(outsourcing of non-core
competencies)
• Need to simplify
benefit administration
• Ensuring service delivery and
productivity with decreasing
resources (doing more with less)
• Increasing costs associated with
lost work days
• Aging workforce
• Data analysis and consolidated
vendor management
• Streamlined employee
experience
• Compliance
• Consistency
• Holistic view of employee
absence
• Control over costs
• Increase in productivity
• Ease of Vendor
Management
INTERACTION BETWEEN BENEFITS
ADA
TIME
Date of
Disability 3 Months 6 Months 9 Months 12 Months
FMLA
WC
STD LTD
SAL. CON’T
EXTERNAL VENDOR INTEGRATION
EAP
Wellness
Disease
Management
Custom
Letters
Employer
Notices
Referrals
Benefit Offsets
Waiver
Leave
Tracking
TPA
WC
Carrier/Pool
Life carrier
HR/Payroll
Systems
Data Capture/Reporting
CASE STUDY
Problem
Customer requests
integration with occupational
health group for
behavioral health claims.
IDM provider customizes its claim
process/system to identify and target
behavioral health claims based on
employer-defined guidelines.
Automated task prompts case
manager to request employee
authorization for referral to
occupational health group.
Electronic referrals are sent to
occupational health group via
email notifications.
Solution
CASE STUDY
Problem Solution
Customer’s disability plan has a
workers compensation (WC) offset
provision. The customer requests
integration with WC carrier to avoid
overpayments and to capture
double filing.
Customer’s WC carrier sends a weekly
claim file to IDM provider.
Provider runs an automated report to
match any WC claim to any leave or
disability claim that exists for an
employee.
Results are communicated to employer
and WC carrier.
CASE STUDY
Problem Solution
Customer’s provides transitional
duty for both occupational and
non-occupational injuries however
decentralized HR system creates
inconsistency in process and
adherence
IDM provider has a vocational service
to support return to work and
workplace accommodations.
Onsite evaluations and job analysis
performed to identify all transitional
work options and create a robust
program and process.
Consistent and compliant process
followed to return all injured workers
back to work.
KEY CONSIDERATIONS FOR INTEGRATION
Compliance Privacy
Technology Tracking /
Reporting
KEY TAKEAWAYS
An Effective Plan
Complies with legal
requirements and obligations Controls the process
Key Steps
Create a
common
goal
Generate
organizational
support
Integrate
information
and data
Define
process
practices and
policies
Record and
measure
outcomes
Questions
ABOUT OUR PRESENTERS
In her role as President of CareWorks Absence Management, a member of the York Family of Companies, Heather is responsible for the strategic growth and operational success of CareWorks Absence Management. Heather has 20 years of professional experience across the insurance, financial services and logistics industries. Heather has extensive experience with strategic planning, operational effectiveness and business development.
Prior to joining CareWorks, Heather worked for Liberty Mutual Insurance Group where she led the Group Benefits Product Development and was responsible for the absence management, group disability and life products and services. She was also Director within the Liberty International Claims Center of Excellence where she led the claims operational transformation for the Irish business.
Heather also has worked for DHL Logistics as part of their corporate strategy team and as Head of Operations for their environmental technology and consulting group. She also has experience in investment management where she held positions in business development and relationship management.
Heather holds a BA in Political Science from Wellesley College, an MBA from the F.W. Olin School of Business at Babson College, is a Certified Professional Disability Management (CPDM) and a Certified ADA Administrator.
Heather Luiz
ABOUT OUR PRESENTERS
Jody Moses, President of York Public Entity, has more than two decades of experience in claims administration to designing, implementing, and managing customized claims management solutions for public entities. Ms. Moses is a certified workers’ compensation claims adjuster with recognized expertise in the complex California workers’ compensation system. She is a licensed General Adjuster and has earned an Associate in Risk Management designation. Ms. Moses is
a frequent speaker and workshop leader at regional and national public entity risk management conferences and actively works with public entities to analyze and influence legislative and regulatory changes that directly affect public entity risk management programs.
Jody Moses