Integrated Disability Management and Absence Tracking Programs

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1 Integrated Disability Management and Absence Tracking Programs NAVIGATING THE STORMY SEAS OF INTEGRATED DISABILITY MANAGEMENT Presented by Heather Luiz, President CareWorks Absence Management Jody Moses, President York Public Entity

2 INTEGRATED CLAIM SOLUTIONS Continuous Changes in Claims Technology and Data We have increased the access to information Speed to response has increased Demand for response times continues to shrink Storage of data and claim history continues grow Communication expectations fast is never fast enough Medical Information 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.

3 INTEGRATED CLAIM SOLUTIONS Considerations for the right plan for your organization Program goals Compliance Factors that impact the program Multiple stakeholders Tracking Policies and Procedures for leave/absence reporting Resources Management oversight Technology Organizational culture Privacy

4 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

5 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. Lore v. Chase Manhattan Mortgage Co. 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. 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.

6 WHAT DOES IDM MEAN? There are varying degrees of integration Integrated Disability Management (IDM) typically includes: Leave Management Family and Medical Leave Act (FMLA) and state leaves Americans with Disability Act (ADA) Short and long term disability Workers compensation Factors that impact the program EAP Disease management Medical Wellness programs

7 STATES WITH ADDITIONAL LEAVE LAWS AK HI

8 NOT ALL LEAVES ARE EQUAL FMLA ADA Covered Employers 50 or more employees within 75 miles 15 or more employees Eligibility Benefits 12 months (nonconsecutive) 1250 hours in last 12 months Continued health care coverage on same terms as pre-leave Coverage from day 1 Provide benefits during ADA leave on same conditions as provided to employees on other leaves

9 NOT ALL LEAVES ARE EQUAL Duration FMLA 12 week max per leave year for employee own health condition ADA 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 ADA does not alter determining eligibility for federal or state disability benefit programs or workers compensation laws

10 THE BENEFITS OF AN INTEGRATED SOLUTION DRIVERS BENEFITS 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

11 INTERACTION BETWEEN BENEFITS STD LTD FMLA ADA WC SAL. CON T TIME Date of Disability 3 Months 6 Months 9 Months 12 Months

12 EXTERNAL VENDOR INTEGRATION Referrals Data Capture/Reporting EAP Wellness Disease Management Custom Letters Employer Notices Benefit Offsets Waiver Leave Tracking TPA WC Carrier/Pool Life carrier HR/Payroll Systems

13 CASE STUDY Problem Customer requests integration with occupational health group for behavioral health claims. Solution 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 notifications.

14 CASE STUDY Problem Solution Customer s WC carrier sends a weekly claim file to IDM provider. 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. 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.

15 CASE STUDY Problem Solution IDM provider has a vocational service to support return to work and workplace accommodations. Customer s provides transitional duty for both occupational and non-occupational injuries however decentralized HR system creates inconsistency in process and adherence 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.

16 KEY CONSIDERATIONS FOR INTEGRATION Compliance Privacy Technology Tracking / Reporting

17 KEY TAKEAWAYS An Effective Plan Controls the process Complies with legal requirements and obligations Key Steps Create a common goal Generate organizational support Integrate information and data Define process practices and policies Record and measure outcomes

18 Questions

19 ABOUT OUR PRESENTERS Heather Luiz 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.

20 ABOUT OUR PRESENTERS Jody Moses 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.