Jody Goudreau Team Manager 15 years experience

Laurel Mansfield Organizational Health Consultant 20 years experience

Fred Smith Regional Director 36 years experience

1-855-787-0691

Agenda 1. Life Cycle of an LTD Claim:

a. Disability Assessment b. How the Employer can Manage Disability

2. Access to Information: a. If you have any questions 1-855-787-0691 b. Disability Claim Reports c. Centre for Mental Health

3. 15-20 Minutes for Questions

1-855-787-0691

GWL is the claim paying agent responsible for administering the negotiated LTD plan

Determine entitlement for LTD claims

Manage claims from a medical, vocational, and financial perspective

1-855-787-0691

Employee: ◦ Advise GWL of changes to their condition, treatment and

return to work plans ◦ Submit updated medical reports when requested ◦ Keep Case Manager advised of other income or benefits they

apply for and/or receive ◦ Actively participate in recommended treatment and

rehabilitation activities

Employer: ◦ Maintain a healthy workplace ◦ Advise Case Manager of any factors that may impact a return

to work ◦ Be willing and able to explore options to return an employee to

work (or help an employee stay at work)

1-855-787-0691

Pre-Absence

LTD Qualification Period

LTD = Great-West Life

1-855-787-0691

Available at: www.hbt.ca

◦ Employee Statement ◦ Attending Physician’s Statement ◦ Employer Statement

EIP file is requested from HBT

Forms should be completed thoroughly and submitted 8 weeks prior to the end of the LTD qualification period to ensure a timely review.

1-855-787-0691

General Principles regarding disclosure of Medical information

Medical information must be used for the limited purpose for which it was obtained and disclosed/distributed on a “need to know” basis. Medical information must not be disclosed to a third party without consent.

There is information that can be shared without sharing diagnosis: Nature of illness Limitations and restrictions Functional abilities

Open communication is key!

1-855-787-0691

Claimant Interview: Opportunity to connect with the employee; ◦ Medical questions ◦ Return to work barriers ◦ Non-medical challenges

Employer Interview: ◦ Pre-absence challenges in workplace ◦ Past workplace modifications? ◦ Are there performance or workplace issues? ◦ Options for returning to work?

1-855-787-0691

The CM has the opportunity to access the expertise of: ◦ Medical Board Consultant ◦ Medical Co-ordination ◦ Rehabilitation Consultant (HBT RC) ◦ Independent Medical Examination (IME) ◦ Functional Capacity Evaluation (FCE)

1-855-787-0691

Case collaboration ◦ Discussion and planning opportunity for all stakeholders

(CM, RC, employer, employee and/or union)

◦ Helps facilitate successful outcomes for employer and employee

1-855-787-0691

During the Own Occupation Disability Period: ◦ The employee’s complete inability as a result of sickness to

perform the duties of his/her own occupation

During the Any Occupation Disability Period: ◦ The employee’s inability as a result of sickness to engage in

any occupation of employment for which he/she is reasonably qualified for by education, training or experience or may reasonably become so qualified for wages or compensation.

1-855-787-0691

When a claim decision is made: ◦ Advise employee and employer by phone of decision ◦ Answer any questions ◦ Outline next steps ◦ Confirmation of decision by letter

1-855-787-0691

GWL monitors for opportunities to facilitate the earliest recovery; this may include medical coordination or rehabilitation interventions

Access resources as needed (IME/FCE)

CM continues to evaluate and consider if the end goal is a return to own job or to an alternate occupation

1-855-787-0691

Important to identify permanent restrictions, training or upgrading needs, work opportunities etc.

Employer contacted to explore work opportunities or modifications.

Collaborate with Employee and Employer to prepare for return to employability.

1-855-787-0691

GWL and/or HBT RC initiates a Return to Work Plan. CM will handle any straight forward return to work plans where there is no need for further intervention.

The employer may be contacted to provide feedback with respect to claimant’s progress.

Benefits will end when an employee becomes capable of working, as per the definition of disability in the contract.

1-855-787-0691

If employee’s condition is not expected to improve sufficiently to allow any form of work, benefits will continue

GWL continues to monitor employee for any changes

GWL will ensure employee pursues other sources of disability income (i.e. CPP) to relieve the LTD benefit

1-855-787-0691

Agenda 1. Life Cycle of an LTD Claim:

a. Disability Assessment b. How the Employer can Manage Disability

2. Access to Information: a. If you have any questions 1-855-787-0691 b. Disability Claim Reports c. Centre for Mental Health

3. 15-20 Minutes for Questions

1-855-787-0691

1-855-787-0691

Toll-free line allowing direct access to Team Managers working with Healthcare Benefit Trust Employers

1-855-787-0691

For any general or specific enquiries, such as: ◦ How do I complete the necessary paperwork to initiate a

long-term disability claim for my employee? ◦ How does the claims process work? ◦ How can I monitor my employee’s progress towards

returning to work?

1-855-787-0691

Through GWL’s convenient & easy-to-use online DCR system, employers can:

Check the status of an employee’s claim with updated

information Overall volume of claims for your facility Excel data spreadsheets Trend information (age, diagnosis, gender, etc) Forecasted recovery dates for employee Service turnaround times Convenient link on HBT website (self-service) All available 24/7

1-855-787-0691

Leading source of free, evidence-based practical ideas, tools and resources designed to help with the prevention, intervention and management of workplace mental health issues.

The Centre is a public resource established by GWL as our commitment to the communities where we live and work. All of the Centre’s tools and resources are available free of

charge to anyone Learn more at: www.workplacestrategiesformentalhealth.com

1-855-787-0691

1. Number of Open Claims @ Dec. 2012 – 6,350 2. Number of Open Claims @ January 2010 – 6,618 3. Number of New Claims Received in 2012 – 2,127 4. Number of New Claims Received in 2011 – 1,910 5. Most Common Diagnosis – Musculoskeletal (36%) 6. Second Most Common Diagnosis – Mental Health (27%) 7. Most Common Reason for Claim Termination – Returned to

Work (41%) 8. Items of Claim Correspondence Received in 2012 – 57,276 9. Percentage of Claim Correspondence Processed in

17 Calendar Days – 87% 10. Most Popular Disability Claim Report Available On-Line:

◦ Claimant Detail Report

1-855-787-0691

Agenda 1. Life Cycle of an LTD Claim:

a. Disability Assessment b. How the Employer can Manage Disability

2. Access to Information: a. If you have any questions 1-855-787-0691 b. Disability Claim Reports c. Centre for Mental Health

3. 15-20 Minutes for Questions

1-855-787-0691