In light of external factors such as the COVID-19 pandemic and constraints on health care, “disability has come to the forefront within the work we’re doing,” said Gordon Hart, founder, president and Right Path Advisor at Selectpath Benefits & Financial.
There was a time when morbidity rates and statistics around disability were reasonably clear, and the use of the upgraded Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was driving better outcomes for many disability insurers. But with COVID, “we’ve seen some of that go out the window,” Hart said, with more diagnosis of anxiety and mental health as a comorbidity where if it’s not a close secondary condition, it’s evolving to become the primary treating condition.
“There’s been a dramatic shift in the last 24 months in managing disability from a member use, and also from a cost sustainability standpoint. We’re trying to help organizations mitigate and manage this risk in a whole slew of ways.”
Selectpath is integrating disability management as part of its overall organizational wellness initiative which looks at the workforce holistically. Examples includes complimentary work around safety, ergonomics, and work management, such as flexible hours and shifts or job sharing where possible. They’re also helping organizations navigate disability claims that become problematic due to the employee’s lack of access to adequate care and diagnosis, or breakdown in communication “where an individual goes off and there’s radio silence.”
There’s a wariness when it comes to intervening in disability claims due to concerns over human rights or employment law, but Hart said they’re helping clients understand their rights, as the employer, to information that enables them to make better decisions about the individual’s ability to return to work and what that might look like. Currently, disability insurance companies fail employers around the return-to-work process because employers are typically notified by letter that an employee is returning to work - but by the time they receive that letter, they have less than a week to make arrangements to accommodate the employee. Hart said Selectpath is “forcing more frequent conversations, and monitoring the claim to give the employer better line of sight” on where it is in the process and when or if members are expected to return to work.
“That’s the reactive side, an example of the work we do to mitigate some of that risk, and most organizations are dipping their toe into the water,” Hart said. “On the proactive side, we’re big believers in wellness and putting more in the toolbox for plan members to navigate mental health issues and prevent a potential spiral into a disability claim.”
The proactive approach involves the use of tools like cognitive behaviour therapy, employee assistance programs and enhancing the psychology and social work counselling benefits on a plan. Selectpath also aligns clients with providers focused on pain management, which is one element of disability and usually comes with a dual diagnosis of anxiety or other mental health issue. What are the potential solutions to help people manage pain in a way that they can still be productive? Low dose narcotics to keep them safe in their work environment, for example, or using cannabis where there’s therapeutic value or CBD where there are no psychedelic effects if taken during work hours.
In addition, Hart also recommends stronger advocacy around the public health care system and increased access to care, which can include, for example, things like off-hour MRIs or patient advocacy to make sure treatment is being delivered. Is it the employer’s responsibility? No, he said, but by participating, they can mitigate some of their risk. Employers could also do a better job defining the cost of disability to both themselves and their workforce - a calculation that many may find clarifying. While changes to benefits to account for more preventative measures are an additional raw cost, it’s a fraction - “Less than 1/500th,” Hart noted - of what it costs for someone to be off for a month.
Insurance companies and risk managers should increase focus on the preventative side and get their message across more clearly to the customer base by encouraging these tools as staples in traditional benefit plans and potentially providing discounted rates or other incentives. The disability insurance landscape is constantly in flux, and currently there’s an upward trend as people struggle with their ability to navigate their own care, Hart said.
“If the insurance companies want to manage and mitigate their risk – and employers certainly do, it’s absolutely the right shift to build resiliency and people’s capacity to navigate whatever their health situation is,” he said.
