Controlling disability claims Featured

9:48am EDT July 22, 2002
There are plenty of disability management coordinators who would gladly trade places with Helen Simpson.

She says the overwhelming majority of disability claims that land on her desk at the Akron headquarters of FirstMerit Bank are pregnancies. The company averages a mere 65 injuries a year among its 3,500 employees, approximately 80 percent of whom Simpson estimates are women.

Many of those mishaps are relatively minor — slips and falls that result in a broken ankle or wrist, or back strains from lifting coin and cash.

“That sounds so funny,” she admits with a chuckle. “But these tellers are out on the front line, and they have to pick up their money at least twice a day and put it in their teller drawers. Those things can weigh 25 to 35 pounds.”

But the way the bank once handled injuries and health conditions that kept employees at home was no laughing matter. Paid leave was all too often prescribed not by a doctor, but at the discretion of the bank president responsible for that employee’s branch. An employee supervised by a more lenient bank president might get more time off than an employee at another branch suffering from the same malady.

Simpson admits some leaves were granted without confirming the required length of time off stated by the employee. The practices left FirstMerit vulnerable to legal liability as well as poor morale.

“We needed a standardized, centralized way of making sure we were in compliance with the Americans with Disabilities Act and Family and Medical Leave Act, to centralize and standardize how we applied these policies and procedures in law throughout our corporation,” Simpson says. “A person in Cleveland would be treated essentially the same as a person in Medina.

“Along with that, we wanted to control absenteeism. We’d have people off work, we didn’t know why or where, and we were paying them.”

In mid-1996, Simpson suggested the bank utilize disability management services offered by Premier Comp, based in Fairlawn, which is the managed workers’ compensation plan of HomeTown Health Network of Massillon. Together they began approaching disability cases using the same techniques traditionally applied to workers’ compensation claims: early intervention, intensive, hands-on case management, continued contact with the employee and light-duty/transitional work assignments that return the employee to the workplace.

“The main focus of disability management is to limit the amount of time that the employee is off work,” Simpson explains. “It’s all about an early, safe return to work.”

A pregnant employee, for example, would be asked to notify her supervisor as soon as she finds out she is expecting. The supervisor notifies FirstMerit’s nurse case manager, who in turn calls the employee at least every 30 days until the delivery. According to Simpson, the chats can identify problems that, if left untreated, could develop into unnecessary complications.

In the meantime, the mother-to-be — a teller, for example — might be offered a desk job that would keep her off her feet.

Case managers were nothing new to Simpson, who from time to time hired them on an as-needed basis to help her handle claims. But the first full-time case manager the bank employed didn’t see the value, for example, in calling pregnant employees right before they went on maternity leave. When Premier Comp director Stephen Elkins stopped to make a sales call, she discovered they shared the same philosophies regarding active case management.

“We both had the commitment and the energy, not just to talk the talk but to walk the walk,” she says.

Premier Comp provided the bank with a nurse case manager, Jean Phillips, who spends her 28-hour workweek at FirstMerit’s Akron headquarters handling both workers’ compensation and nonoccupational disability claims. A good deal of Phillips’ time, Simpson says, is spent on the telephone talking to supervisors and workers employed at the bank’s 188 branches.

She also helped Simpson implement a comprehensive disability management program, traveling to branches and explaining forms and procedures designed to collect the information essential to approving or denying a claim.

“Frankly, the procedures just grew out of folly,” Simpson says.

Premier Comp also helped establish a network of health care providers to handle on-the-job injuries. (Simpson stresses that employees are encouraged, not required, to use these providers, which are under contract to see them immediately.) Instead of pulling a network “off the shelf,” Elkins says Premier Comp helped Simpson create a roster that satisfied the bank’s specific needs.

“FirstMerit being a banking organization with many different branches, we contracted and established relationships with different providers that are near each of those branches so that they would understand FirstMerit — so that when someone was injured or ill, they could provide quality, timely medical services.”

Elkins declined to quote what Premier Comp charges for such customized services, explaining that costs differ from client to client.

“What FirstMerit has may or may not be what Company B gets,” he says. “Every company has a different management style. Every company has different goals.”

He’ll only divulge that fees are “somewhat in line” with the average amount U.S. companies dole out for disability management services. That price tag, he says, is about 1 percent of the 8 percent of payroll U.S. companies spend annually on workers’ compensation and disability claims — figures he quotes from a 1998 national study presented earlier this year in Akron at a Ohio Rehabilitation Association conference.

“For $1 invested in disability case management, $96 in savings can be attributed to that,” he adds.

Simpson, too, is reluctant to speak in terms of dollars and cents. Instead, she interprets savings in calendar days missed by employees: She says FirstMerit saved 10,466 days during the first nine months of 1999 alone.

“That translates into almost 29 years,” she says.

Simpson says Premier Comp’s disability management program has generally been well received by employees.

“Most people want to work,” she says.

Phillips does everything from answer garden-variety health questions to take blood pressure readings for a worker suffering from hypertension. More important, the nurse case manager acts as an advocate for the employee as well as the employer, functioning as a liaison between an injured/sick worker and his or her doctor and supervisor.

Indeed, Phillips’ presence is especially helpful when a hard-nosed boss doesn’t understand, say, why a woman can only work half-days during a difficult pregnancy or a cancer patient’s attendance may be erratic during chemotherapy.

“I could tell a manager, ‘So-and-so’s not feeling well, they’re unable to come in, and it’s necessary for them to be off,’” Simpson says. “They’ll argue with me, whereas they will not argue with the nurse. Because of confidentiality, ignorance is bliss all the way around.

“The nurse case manager serves as the trusted intermediary.”

How to reach: Premier Comp: (330) 666-6757