Canadian HR Reporter

CANADIAN HR REPORTER April 20, 2015 14 FEATURES DISABILITY MANAGEMENT The disability case manager's tool box Assessments involve physicians, health-care providers, employees and employers By Laurie Down D ealing with a disability claim is no easy task, and insurers play a key role in serving as a touchpoint for em- ployers, employees, physicians and health-care providers. From the initial claim forms to return-to-work facilitation, an insurer will have contact with an employee's physician, treat- ing specialist, nurse practitioner, physiotherapist, psychologist or other treating health-care prac- titioners at multiple stages of a work absence. Whether it is a short-term or a long-term disability claim, there are multiple points during the as- sessment and ongoing manage- ment of a claim when an insurer will require medical information. To thoroughly assess and manage a claim, it's essential to have medi- cal evidence provided on claim forms, in specialized reports or through customized letters. Canadian life and health insur- ance companies recognize the ad- ministrative burden such requests can place on family physicians and other primary health-care providers. To help minimize the time and effort required, the Canadian Life and Health Insurance Associa- tion (CLHIA) developed standard medical request forms that can be used throughout the disability claim life cycle. Attending physician statements When submitting a claim for short-term disability benefits to an insurer, there is an Attending Physician Statement (APS) that requests details of the employee's medical condition. The disabled employee is responsible for having the form completed. Depending on the nature of the condition, the form could be com- pleted by the family physician, a treating specialist or another pri- mary health-care provider such as a nurse practitioner. Some of these forms are short and concise and if the work ab- sence is of very short duration, only a few lines on the first page need to be completed. Once an employee has been off work for an extended time, a long-term disability claim may be contemplated. To gather the pertinent medical details needed for such a claim as- sessment, a standard APS is also available, capturing the initial evidence to support a medical ab- sence from work. Many insurers have a suite of disease-specific forms available. Later this year, the CLHIA will release a standard Mental Health Condition Questionnaire devel- oped with help from the Cana- dian Psychiatric Association and industry experts. Other tools In many instances, the most in- formative details a case manager gathers are from the disabled em- ployees themselves, such as infor- mation about the medical condi- tion, the treatment plan, response to therapy, return-to-work goals and non-medical factors affect- ing an employee's circumstances. In some cases, a case manager may call the primary health-care or treatment providers to clarify information and expedite the as- sessment process. At times when more detailed medical information is required, a case manager may send a con- dition-specific letter or medical questionnaire to a health-care provider. e written request is customized so the questions are specific to the employee's situ- ation and to the point in time of the file review. To obtain medical records of Credit: Jojje/Shutterstock EMPLOYER > pg. 16 In many cases, the most informative details a case manager gathers are from the disabled employees themselves.

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