The Myths of Disability Management
June 9, 2017
Posted by: CPHR Manitoba
- Alberta physician offers frank advice to employers
Exclusive online extended version of Spring 2017 issue of HRmatters
Authored by: Dr. Roger Hopkinson
Dr. Roger Hodkinson has had a long and distinguished career as a scholar, physician specialist, teacher, public health advocate and successful medical entrepreneur. He is currently the CEO/Medical Director of Western Medical Assessments. Dr. Hodkinson can be reached by email (firstname.lastname@example.org) or phone (780 433-1191) at WMA’s Edmonton headquarters.
If a dollar saved is a dollar earned, why aren’t Canadian companies challenging the colossal cost of unnecessary treatments received by thousands of employees collecting disability benefits?
Here’s the problem: everything is not always what it seems in the disability management 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 beneficial when it is evidence-based, medically appropriate and time-limited. However, treatment providers for the disability management industry often succumb to the financial motivation of unnecessarily extending expensive ‘treatments’ well beyond evidence-based medical necessity, thereby delaying an appropriate return to work.
In my opinion, many ‘treatments’ involve the inappropriate use of narcotics and modalities with little evidence-based support—and many of my physician colleagues share this perspective with good reason. These treatment ‘industries’ include passive physiotherapy, massage, craniosacral therapy, TENS, facet joint injections, dry needling/IMS, trigger point injections, acupuncture, naturopathic and chiropractic ‘therapies,’ prolotherapy … 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 actually harm otherwise healthy employees by ‘medicalizing’ them into believing they are truly disabled and unfit 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 first and foremost a medical issue.
It’s long been my experience that wonderful things happen for employees (and companies) when diligent case managers have a well-supported medical diagnosis as the basis for approval of time-limited and medically effective treatment. This 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 increasing corporate wellness, productivity and profitability.
Myth 3: The family doctor’s note is sacred.
While I have the greatest respect for family physicians and GPs (I used to be one myself before becoming a specialist), they are frequently thrust into the difficult situation of being asked for a disability note before necessary diagnostic investigations or specialist referrals can be completed. In the absence of such evidence, it is ethically challenging 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 their customers.
Consequently, vague disability notes from GPs—I call it 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 managers are unaware of their right to challenge unsupported GP opinions. And many doctors are not always fully aware of their obligations for information sharing. (Information guidelines for employees, employers and doctors are generally available from Human Rights Commissions across Canada.) Family doctors and specialists may disagree on diagnoses, causation and/or treatment; but when there is disagreement, the independent opinion of a specialist pertinent to the disability generally takes precedence.
Myth 4: Disability case managers are powerless.
Many of the out-sourced disability case management companies in Canada could perhaps be more accurately described as ‘case monitoring’ companies—the obligatory relaying of messages to-and-fro, often with little resolution, between the family physician, the employer, ‘treatment’ providers and the insurance carrier. And employers generally accept the resulting 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 unsatisfactory, even if the case has been accepted for disability coverage by the insurance carrier. If subsequent information is still unsatisfactory or unsupportable for ongoing disability, then case managers have the right (indeed duty!) to challenge the medical authenticity of disability claims with an independent medical examination (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 involvement 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 dollars! This 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 effectively communicated this organization’s new evidence-based protocol!
In other words, while Canada’s disability management industry might superficially appear to be functioning reasonably well, a significant number of vested-interest stakeholders sometimes quietly and inappropriately benefit; whether they be GPs, ‘treatment’ providers, or out-sourced case management companies. However, I do wish to be very clear that I have the highest regard for case managers toiling in-house for employers and within insurance companies as their sole focus is the very difficult job of getting employees back to work safely and efficiently.
In summary, all disability case managers 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 accessible anywhere in Canada. The myths of this industry can be cost-effectively countered with independent medical expertise … and much-needed frank dialogue!
“Vague disability notes from GPs—the ‘Elephant-in-the-Room Syndrome’— are the single biggest contributor to the massive cost of disability in Canada.”