A complete disability management team makes all the difference
It takes a whole team to provide the best support for your employee to return to work at the right time. There are a variety of disability management teams available with different health care professionals and processes to help you and your employees get the help you need. Here’s what that team may look like.
The case manager takes the lead
The disability case manager is the point person who manages the disability claim. They’re responsible for all decisions on a claim, from the initial acceptance to a successful recovery and return to work.
The case manager is the main contact for both you and your employee, supporting you through the entire claim process.
Making the initial decision
The case manager examines all the information received for the claim to assess the employee’s eligibility for benefits. Once they determine the employee is eligible, they move on to verify whether the employee is disabled from work, according to the contractual definition of disability.
Every claim is different. Some claims are simple with a clear diagnosis, limited duration and a return-to-work date. Others are more complex and may need several actions to make the initial decision and to ensure the claim moves toward a positive resolution.
As part of their initial assessment, the case manager may:
- Hold interviews to get information from you, the employee or their treatment providers
- Gather medical and functional information from treatment
- Use AI-generated data to compare the claim’s predicted recovery timelines and outcomes against similar claims
- Gather details of the job requirements to compare against the employee’s functional abilities
- Consider factors that may affect the duration of the absence and the recovery, such as:
- Workplace issues
- Personal life stressors
- Access to resources and supports
It’s all about training
Case managers are trained in interviewing skills, effective listening and showing empathy – all geared towards engaging and motivating the person on disability. They can assess all types of medical conditions, whether mental or physical, that may affect a person’s ability to work.
Building the case management plan
If the employee is disabled and qualifies for benefits, the case manager immediately builds a plan with activities aimed at resolving the claim early and helping the employee return to work. These activities could include:
- Collecting medical and functional information from treatment providers or from independent assessors
- Referring the claim to a medical consultant for an opinion or advice on medical management, drug therapy, clinical consulting or physical therapy
- Funding treatment and activities that’ll help the employee overcome barriers to returning to work
- Referring to a medical co-ordinator or rehabilitation consultant on their own team
- Working with you to identify early return-to-work opportunities
Monitoring progress
As the plan progresses, the case manager will follow up regularly with you and your employee to keep you informed and to determine if the plan is moving forward as anticipated. They’ll re-adjust their plan proactively if needed, implementing new activities to overcome barriers that may come up. The case manager will continually assess the claim against the applicable definition of disability as they collect and receive new information.
Terminating the claim
When the employee no longer meets the definition of disability, the case manager will terminate the claim. In most cases, the employee will have returned to work successfully.
Other roles in disability management
Team managers
Teamwork is essential to effectively manage disabilities and provide the level of service that’s needed. Case managers are part of small teams that report to a team manager. Team managers coach their team members, review some of their decisions and may meet with you if needed.
Medical co-ordinators
These are regulated health care professionals with clinical experience and extensive knowledge of the health care resources available in their province and in Canada. They help arrange the right care at the right time for employees to recover sooner. They work together with the treating health care providers and the employee.
The services they arrange may include diagnostic tests, consultations with specialists, surgeries, assessments, and treatment plans with specialized health care professionals. Their goal is to help the employee improve their health to get them ready for return-to-work planning.
Medical co-ordinators don’t typically communicate with employers. They get in touch with case managers who’ll let you know how the employee is progressing towards recovery.
Rehabilitation consultants
You can think of rehabilitation consultants as intervention specialists. They help employees overcome medical and non-medical barriers and find the path back to work.
After an in-depth interview with the employee, the rehabilitation consultant will assess if rehabilitative treatment such as counselling, physical and psychological therapies or multidisciplinary rehabilitation programs can help. They’ll also provide advice and make recommendations to support the employee.
Rehabilitation consultants will work closely with you to explore early return-to-work opportunities and workplace accommodations. If an employee can’t return to their workplace, rehabilitation consultants can provide job-search assistance.
Medical consultants
The case manager has access to many medical consultants to help them build the best possible plans. They can benefit from a national team of medical consultants that could include general practitioners, specialists, pharmacists, physiotherapists and psychologists. They also have access to mental health and musculoskeletal consultants who provide them with insights and coaching related to their specialty.
Last but not least – employee and employer roles
The employee
The employee has an active role in their recovery and should feel empowered to make decisions that will affect their health and well-being. Employees should be encouraged to work collaboratively with the case management team, with you and with their health care providers, to find solutions to help them recover their function and return to work.
Employees who communicate openly will be more satisfied with the progress and outcome of their claim because the solutions will be more likely to meet their individual needs.
The employer
As the employer, you know your employee and you’re able to provide us with valuable background information that’ll help us build a more effective case management plan. We’ll also look to you as the expert on the needs of the workplace and the duties of the job.
Whenever appropriate, you may want to assign other individuals in your organization who work closely with the employee, such as a direct supervisor, to provide first-hand information.
The case manager will regularly keep you updated on the employee’s current functional level, their capacities and their limitations. Regularly compare the employee’s capacities with work duties and ask yourself if you can accommodate them in modified or transitional work. If you think there’s an opportunity for accommodation, contact the case manager and discuss options with them.
The case manager will do their best to help you find ways to get a productive and experienced employee back to your workplace as soon as possible.