NAVIGATING THE STORMY SEAS OF

INTEGRATED DISABILITY MANAGEMENT

Presented by

Heather Luiz, President – CareWorks Absence Management

Jody Moses, President – York Public Entity

Integrated Disability Management and

Absence Tracking Programs

INTEGRATED CLAIM SOLUTIONS

Technology and Data Medical Information

We have increased the access

to information

Speed to response has

increased

Communication expectations –

fast is never fast enough

Storage of data and claim

history continues grow

Demand for response times

continues to shrink

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.

Continuous Changes in Claims

INTEGRATED CLAIM SOLUTIONS

Considerations for the “right”

plan for your organization

Program goals

Compliance

Management oversight

Policies and Procedures for

leave/absence reporting

Tracking

Technology

Privacy

Factors that impact the program

Multiple stakeholders

Resources

Organizational culture

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

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.

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.

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.

Lore v. Chase Manhattan Mortgage Co.

WHAT DOES IDM MEAN?

Integrated Disability Management

(IDM) typically includes:

Leave Management

Family and Medical Leave Act

(FMLA) and state leaves

Short and long term disability

Factors that impact the program

Americans with Disability Act (ADA)

Workers’ compensation

EAP

Disease management

Medical

Wellness programs

There are varying degrees of integration

STATES WITH ADDITIONAL LEAVE LAWS

AK

HI

NOT ALL LEAVES ARE EQUAL

FMLA ADA

Covered Employers • 50 or more employees

within 75 miles • 15 or more employees

Eligibility

• 12 months

(nonconsecutive)

• 1250 hours in last 12

months

• Coverage from day 1

Benefits

• Continued health care

coverage on same

terms as pre-leave

• Provide benefits during

ADA leave on same

conditions as provided

to employees on

other leaves

FMLA ADA

Duration

• 12 week max per

leave year for

employee own health

condition

• 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

NOT ALL LEAVES ARE EQUAL

ADA does not alter determining eligibility for federal or

state disability benefit programs or workers’ compensation laws

THE BENEFITS OF AN INTEGRATED SOLUTION

BENEFITS DRIVERS

• 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

INTERACTION BETWEEN BENEFITS

ADA

TIME

Date of

Disability 3 Months 6 Months 9 Months 12 Months

FMLA

WC

STD LTD

SAL. CON’T

EXTERNAL VENDOR INTEGRATION

EAP

Wellness

Disease

Management

Custom

Letters

Employer

Notices

Referrals

Benefit Offsets

Waiver

Leave

Tracking

TPA

WC

Carrier/Pool

Life carrier

HR/Payroll

Systems

Data Capture/Reporting

CASE STUDY

Problem

Customer requests

integration with occupational

health group for

behavioral health claims.

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

email notifications.

Solution

CASE STUDY

Problem Solution

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.

Customer’s WC carrier sends a weekly

claim file to IDM provider.

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.

CASE STUDY

Problem Solution

Customer’s provides transitional

duty for both occupational and

non-occupational injuries however

decentralized HR system creates

inconsistency in process and

adherence

IDM provider has a vocational service

to support return to work and

workplace accommodations.

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.

KEY CONSIDERATIONS FOR INTEGRATION

Compliance Privacy

Technology Tracking /

Reporting

KEY TAKEAWAYS

An Effective Plan

Complies with legal

requirements and obligations Controls the process

Key Steps

Create a

common

goal

Generate

organizational

support

Integrate

information

and data

Define

process

practices and

policies

Record and

measure

outcomes

Questions

ABOUT OUR PRESENTERS

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.

Heather Luiz

ABOUT OUR PRESENTERS

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.

Jody Moses