Canadian HR Reporter

I f a dollar saved is a dollar earned, why aren't Canadian companies challeng- ing the colossal cost of unnecessary treatments received by thousands of em- ployees collecting disability benefi ts? Here's the problem: Everything is not al- ways what it seems in the disability man- agement industry. Vested interest has a significant but unspoken influence. So if you're a disability case manager who sometimes feels like Alice in Wonderland, allow me to debunk some myths about disability management based upon my experience reviewing the reports from more than 60,000 independent medical examinations. Myth 1: Treatment is good for you Treatment can be very benefi cial for pa- tients when it is evidence-based, medi- cally appropriate and time-limited. How- ever, treatment providers for the disability management industry often succumb to the fi nancial motivation of unnecessar- ily extending expensive "treatments" well beyond evidence-based medical necessity, thereby delaying an appropriate return to work. Many treatments involve the inappro- priate use of narcotics and modalities with little evidence-based support. ese treat- ment "industries" include passive phys- iotherapy, massage, craniosacral therapy, TENS (transcutaneous electrical nerve stimulation), facet joint injections, dry needling/IMS (intramuscular stimulation), trigger point injections, acupuncture, natu- ropathic and chiropractic "therapies," pro- lotherapy… the list is as long as an insurance carrier's willingness to pay. But unnecessary or excessive treatment is not just a waste of money — it can actu- ally harm otherwise healthy employees by medicalizing them into believing they are truly disabled and unfi t to return to their normal life, including work. Myth 2: Disability is an insurance matter Wrong. While the insurance carrier is a critical partner in disability management, disability claims are fi rst and foremost a medical issue. Wonderful things happen for employees (and companies) when diligent case manag- ers have a well-supported medical diagno- sis as the basis for approval of time-limited and medically eff ective treatment. is is the best strategy to optimize a safe return to work, while simultaneously preserving self- esteem and minimizing retraining costs. With timely and appropriate medical direction, any conscientious case manager can significantly reduce the number of long-term claims, thereby decreasing the insurance carrier's premiums — while in- creasing corporate wellness, productivity and profi tability. Myth 3: e family doctor's note is sacred Family physicians and general practitioners are frequently thrust into the diffi cult situ- ation of being asked for a disability note be- fore necessary diagnostic investigations or specialist referrals can be completed. In the absence of such evidence, it is ethically chal- lenging for any physician to provide a note for the patient's employer that estimates the duration of disability — recognizing that GPs are not only providing medical services, but also operating a business that depends on satisfying the expectations of customers. Consequently, vague disability notes from GPs — or the "Elephant-in-the-room syndrome" — are, in my opinion, the single biggest contributor to the massive cost of disability in Canada. Surprisingly, many disability case manag- ers are unaware of their right to challenge unsupported GP opinions. And many doc- tors are not always fully aware of their obli- gations for information sharing. (Informa- tion guidelines for employees, employers and doctors are generally available from human rights commissions across Canada.) Family doctors and specialists may dis- agree on diagnoses, causation or treatment, but when there is disagreement, the inde- pendent opinion of a specialist pertinent to the disability generally takes precedence. Myth 4: Case managers are powerless Many of the outsourced disability case management companies in Canada could be more accurately described as "case-mon- itoring" companies — relaying messages to-and-fro, often with little resolution, be- tween the family physician, the employer, treatment providers and the insurance car- rier. And employers generally accept the re- sulting annual insurance premium increase if it is within an approved budget band, even if it could have been avoided. In fact, all case managers have every right to ask an employee's GP for further information (within the limits of privacy legislation) if the original note is unsatis- factory — even if the case has been accept- ed for disability coverage by the insurance carrier. If subsequent information is still unsatisfactory or unsupportable for ongo- ing disability, then case managers have the right (indeed, the duty) to challenge the medical authenticity of disability claims with an independent medical examina- tion (IME) or document review — which is often paid by the insurance carrier as per contract provisions. While case managers will never create revenue for their employers, they are not always fully cognizant of the scale of savings that can result from more medical involve- ment in decision-making. For example, one major Canadian city reduced its long-term disability claims by 38 per cent over just a couple years — a saving of millions of dol- lars. is corporate wellness achievement was realized simply by adopting a diligent management philosophy that required medical substantiation for every case that failed to achieve a return to full-time work after time off for appropriate treatment. And the resulting water cooler gossip very eff ectively communicated this organiza- tion's new evidence-based protocol. In other words, while Canada's disability management industry might superfi cially appear to be functioning reasonably well, a significant number of vested-interest stakeholders sometimes — quietly and in- appropriately — benefi t; whether they be GPs, treatment providers or outsourced case management companies. However, I have the highest regard for case managers toiling in-house for em- ployers and within insurance companies as their sole focus is the very diffi cult job of getting employees back to work safely and effi ciently. In summary, all disability case manag- ers need to be constantly alert for claims that go in endless circles or claims that just don't appear to be reasonable. Positive, timely intervention is sensible and acces- sible anywhere in Canada. e myths of this industry can be cost-eff ectively countered with independent medical expertise — and much-needed, frank dialogue Roger Hodkinson is the CEO and medical direc- tor of Western Medical Assessments in Edmon- ton. He can be reached by email at rhodkinson@ westernmedical.ca. All case managers have every right to ask an employee's GP for further information. DISABILITY MANAGEMENT DISABILITY MANAGEMENT FEATURES By Roger Hodkinson disability management disability management Everything is not what it seems — vested interest has a significant but unspoken influence

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