Controlling the Cost of Mental Health Claims

One of the most unpredictable and uncontrollable risks encountered today by insurers and employers is human risk. The cost of absences that are work-related or non-work related can be reduced with proactive claims management and a well-coordinated return to work plan.

This article focuses on the best practices that can be applied to a return to work process designed for absences stemming from mental illness.

The topic of mental illness in the workplace has become increasingly important to businesses. Mental health disorders in the workplace cost Canadian companies nearly 14% of their net annual profits, up to $16 billion annually (Health Canada, 2002). Furthermore, calculations that include indirect costs suggest that the Canadian economy spends more than $30 billion annually on mental health and addiction-related problems (Scientific Advisory Committee to the Global Business and Economic Roundtable on Addiction and Mental Health 2002).

A study called “Building Mentally Healthy Workplaces: Perspectives of Canadian Workers and Front-Line Managers” was completed by the Conference Board of Canada and released at the Workplace Mental Health 2011 conference in Toronto, June 20, 2011. The study pinpointed the rising cost of addressing mental health concerns in the workplace. It showed that from 2009 to 2010, 67% of long-term disability claims and 78% of short-term claims were related to mental health issues.

The general public often associates mental illness with a violent disposition. However, statistics provided by the Canadian Mental Health Association indicate that a person with mental illness is more likely to be a victim of violence rather than the cause of it.

Due to the negative attitudes, social stigmas and discrimination that are still common throughout society, a person may postpone treatment or forgo treatment completely. Although mental illness is often transient and short-term in nature, this negativity tends to linger for a long period of time. According to the Canadian Human Rights Commission’s Policy and Procedures on the Accommodation of Mental Illness, it is these stereotypes and misconceptions that may affect a person long after the symptoms of mental illness have dissipated.

In my experience, assisting a person with his or her return to work after an absence due to a mental illness can be more challenging than assisting a person’s return to work after he or she has suffered from a physical illness. This is primarily due to the stigma surrounding mental illness. Employers and their staffs may have unfounded fears resulting from a lack of education, exposure and/or awareness about mental illness.

Based on the different return to work programs and structures that I have been involved with, it appears to be beneficial to have one person responsible for overseeing the coordination of the entire return to work plan. This person should have an in-depth understanding of mental health issues and the confidence to believe that return to work efforts will be successful. As the main driver of the return to work process, the coordinator needs to believe in the plan proposed for the claimant; otherwise, there is a tendency to extend less effort than needed to make the plan successful. This central coordinator facilitates the flow of necessary information amongst all the stakeholders in the return to work process. For the purpose of this article, we will call this person the “consultant”. When referring to the person who is returning to work, we will call him or her the “claimant.”

Under typical circumstances, the consultant receives pertinent medical information from the insurer to review before meeting with the claimant. This would include reports from a psychologist, psychiatrist or treating physician. The consultant conducts an in-person interview with the claimant, preferably at his or her home, where additional information about the claimant is obtained, as a visual overview of the living conditions can potentially reflect the claimant’s functioning level.

A detailed interview is then conducted to obtain information regarding the claimant’s daily routine. Aspects such as current medications (and side effects), current treatment, as well as the claimant’s personal opinion regarding his or her ability to return to work are reviewed at this point. Perceived barriers to recovery and the return to work process, and the claimant’s thoughts on how these barriers could be eliminated, are also discussed. The claimant knows what accommodations he or she needs in order to work productively more so than anyone else.

The claimant must be able to perform the tasks of his or her job at a level where meaningful work is possible, inclusive of appropriate accommodations. The work itself and the employee’s presence in the workplace should not pose a risk to the employee and/or co-workers (Canadian Human Rights Commission Policy and Procedures on the Accommodation of Mental Illness, October 2008). The consultant should weigh the claimant’s self-assessment against those made by the treating physician and other stakeholders to determine its appropriateness.

On occasion, a claimant may return to work when still experiencing significant symptoms of mental illness. These situations tend to occur when a claimant is running out of sick time or is worried about job security. Consequently, the claimant tells the treating physician that he or she is able to return to work even though recovery might not have progressed to a point for appropriate functioning on the job. Furthermore, the physician might approve the claimant’s return to work without having full knowledge of all work responsibilities. If the claimant returns to work and is unable to fulfill the job expectations, there is a high probability that the return to work process will fail.

With the claimant’s consent, the consultant can supply treatment providers with the claimant’s job description to fully inform them of the job duties, as well as obtain input into the development of the return to work plan.

The consultant is able to arrange a meeting with both the employer and the claimant to discuss and confirm the return to work plan. A return to work plan should include the following:

• A clear objective or goal (e.g. a return to work date within a particular position)

• A complete and detailed job description

• Hours of work associated with the job that the claimant is returning to, including the potential for graduated return to work hours if required

• Job restrictions

• Reporting lines (i.e. who the claimant reports to and when)

• Approved time away from work to attend medical appointments

• Evaluation dates for progress reports of the return to work plan

• Lists of any required accommodations

• Signed copies of the return to work plan by the stakeholders confirming their agreement and support

Employers are responsible for providing accommodation to the point of “undue hardship”. There is no list of required accommodations to match a specific illness since each situation is individualized. Ontario has accessibility legislation for persons with disabilities that addresses the duty to provide individual accommodations (AODA, 2005).

Accommodations can include the following:

• Modified or reduced work hours, graduated return to work hours and increased frequency of breaks

• Reasonable time off to attend counseling sessions or medical appointments

• Task variation to support stamina

• Job re-design (e.g. exchanging tasks with other employees that maintain work balance and capitalize on the strengths of each worker)

• Changes in supervision (e.g. brief weekly meetings with the supervisor may help deal with issues before they become serious and well-written instructions may help an employee focus on tasks more effect
ively than verbal instructions)

• Extra time to learn tasks if a person has difficulty with concentration

• The ability to perform some or all work from home

• Job coaching (i.e. assistance on the job)

• Flexible scheduling with respect to the start and/or end of normal working hours to accommodate effects of medications or appointments

• Changes to the location of the workspace to reduce distractions and improve concentration

• Use of technology (e.g. electronic organizers to keep track of items that need to be completed and associated deadlines or recording devices that track information discussed in a meeting)

Accommodations for mental health problems are often inexpensive to implement and may be temporary as a person continues to recover. By engaging a consultant who has return to work experience specific to mental health issues and who is able to be creative in the use of appropriate accommodations, the cost of mental health claims can be significantly reduced and the quality of a claimant’s life can be greatly improved.