Short Term Disability Claim Management

 

Many employers have or are considering moving toward a self insured Short Term Disability Program.  Dynamic Insight Corp. provides the policy, procedures and supporting documents that will improve the quality and cost effectiveness of your existing program or enable you to move your Business into a self insured structure.  

Once in place, Dynamic Insight Corp. will offer to train your team on the implementation and management of the program as well as effective disability management strategies.  If preferred, we will provide full and inclusive disability management services directly for your business.

How Dynamic Insight Can Help You with Our Short Term Disability Products and Services

Dynamic Insight's Short Term Disability Products and Services are designed for self-insuring employers who want to ensure that the disability benefits paid, serve the intention for which they were put into place - to provide employees with a benefit that will replace a substantial portion of earnings lost due to extended periods of medical disability.

Companies who are cost sensitive and looking for the comfort and confidence that the integrity of their Short Term Disability Program is maintained while their employee's receive optimal care and health services will find that the Policy, Procedures, supporting documents and administrative and professional services available through Dynamic Insight Corp. are the perfect fit.  Timely and appropriate health care and claims management results in a cost effective Short Term Disability Program while facilitating healthy outcomes for those who need it.  This is the intention and balance of the Program being offered by Dynamic Insight.

These products and services provide consistency, integrity, and balance to organizations, making available exceptional care and services to employees while mitigating the high costs associated with disability in the workplace.  Our disability management services are action oriented, coordinating health care services so that clients have comfort in the care and information they are receiving.

Unlike the major insurance companies offering short term disability claim administration and advice to pay, Dynamic Insight's program delivers timely adjudication of claims (within 2-3 days of claim submission), regular follow up with those who are ill or injured, and coordination of healthcare services.  A product line that meets the needs of the client and administrative services that are timely with consistent application of the policy are the key to the success of a Short Term Disability Program.  This is what Dynamic Insight Corp. delivers.

Disability Management Services/Coordination of Health Care Services

Occupational and non-occupational injury and illness can result in significant direct and indirect costs to a business. Dynamic Insight Corp. provides proactive disability management services to employers to ensure that employees return to work in a safe and healthy manner at the appropriate time. Well networked, this may include timely referrals, assessments and treatments for injured or ill employees. 

Specializing in complex claim management, we are able to provide these services directly, review and give recommendations or train your staff on how to effectively do this. Review for possible cost relief and recoveries can be completed. 

We have developed and can provide you with a disability management program that can be modified to be workplace specific, meeting your needs. This may include developing a return to work program, a modified work program, policies and procedures, forms as well and training and implementing your team on the system.  Some of our services include:

  • Short and Long Term Disability Services, including liason and case management of sick time, short and long term disability cases whether self insured or managed by an insurance carrier

  • Managing of Addictions and the recovery process

  • Worker's Compensation

  • Absentee Management

Expert Medical Review and Consultancy Services

Many employers have established teams that manage WSIB/WCB claims and Short and Long Term Disability programs. On occasion, these teams require the assistance of medically trained and/or disability management experienced professionals when managing complex or unusual cases, appeals or critical incidents. Dynamic Insight Corp. has extensive experience and a network that allows us to provide these services. 

At times this means intervening to prevent exposure to risk (for example managing investigations and relationships following a serious accident) or in order to minimize risk (for example providing recommendations with respect to medical information, what can be expected, and whether there is a disparity requiring action).

Dynamic Insight Corp. does act as an independent appeal body for employers with self-insured and administered Short Term Disability policies.

Psychological Claims Management

It has been our experience that the management of psychological claims has become a challenge for many employers. Over recent years the frequency and duration of psychological and pain syndrome claims has increased significantly. Many employers have reported that psychological claims comprise up to 60+% of total short-term disability claim costs.

When these situations arise it is important to manage them in a timely manner, fairly and consistently. Dynamic Insight Corp. is able to offer adjudication, case management, expert opinion and consultancy services with respect to diagnosis, assessment of disability, restrictions and ability to work, reasonable treatment, prognosis and return to work. Intervention is key to successful management of these cases. Managing expectations and minimizing fear that is often associated with the return to work process is vital for success.

Our experience with the implementation of our managed care system for dealing psychological claims is a 50-75% reduction in claims cost and duration. The system is cooperative, fair and transparent resulting in very few differences of opinion. The focus is on “Facilitating Healthy Outcomes” (Dynamic Insight Corp.).

The Duty to Accommodate

The issue of the duty to accommodate has become significant and in many cases a challenge for an employer to manage. Many times it is a matter of confirming the presence of a medical disability, physical restrictions and deciding the best way to accommodate these in the workplace for both the business and the employee. On other occasions there may be a medicalization of occupational issues.

The medicalization of occupational issues occurs when an employee responds to a difficult or undesired situation at work or home by attending his/her physician who in turn writes a note that enables the employee to avoid the work environment or situation. This may be manifested as an absence from work, for example submission of a Worker’s Compensation or Short-Term Disability claim, requests for job modification, a schedule change, or a lessened workload. At times this is considerable challenge for the workplace with respect to operational costs, supervision, scheduling and morale.

Dynamic Insight Corp. has developed a strategy for managing these cases in a fair and cost effective way. An accurate assessment of the medical situation and workplace issues being key elements of the process. Should there be cases like this in your workplace, Dynamic Insight Corp. is prepared to provide recommendations, manage the case through providing the service directly, or train your qualified staff to do so.

Insurance Carrier and Worker's Compensation Appeals

At times, disagreements with respect to the extent and duration of WCB or insurance benefits and entitlement do occur. This can be attributed to the nature and structure of the provincial Worker’s Compensation Boards in Canada, the complexity of claims submitted and the interests of stakeholders. It is important for these situations to be addressed quickly and in accordance with the applicable provincial systems, as the statute of limitations, procedures and protocols differ across the country.

Dynamic Insight Corp. has the experience and technical knowledge to develop and implement the most appropriate way of handling all levels of appeals. Should you have cases that require review for a possible appeal, submission of an appeal or representation at a hearing, Dynamic Insight Corp. is capable of providing recommendations, writing and presenting appeals and even training your staff to do so.

Consultancy Services

Complete Occupational Health and Safety assessment, program development, implementation training are available through Dynamic Insight Corp. The program is compliant with provincial requirements and modified to meet the needs and culture of the workplace. Consultancy services with respect to managing, appealing and responding to orders are also provided should the need arise. Critical incident management services available.