Everyone's talking about rehabilitation, but which insurers are coming up with the goods? Angela Faherty investigates
Rehabilitation has become the buzzword of the protection market in recent years. Rising costs associated with managing sickness absence in the workplace coupled with the increasing number of stress-related claims has caused insurers to shout about the need for improved sickness management at work.
It is estimated that employee absence costs UK companies approximately £11bn each year. And with this figure set to rise, the need for rehabilitation and early intervention following absence or injury at work is rapidly increasing.
The key focus for many insurers is early intervention. Getting to the injured or sick party as soon as possible can help to substantially reduce costs for the employer by getting the employee back to work at the earliest opportunity.
There are also benefits for the insurer. Early intervention could prevent an injured or ill employee from becoming a long-term claimant, reducing the amount of benefit paid out, if at all.
So, while there is a lot of discussion about rehabilitation and early intervention to better manage sickness absence in the workplace, are insurers actually providing rehabilitation facilities and services to their clients to help them address the rising costs of employee absenteeism they are currently facing?
The answer is yes - to an extent. Awareness surrounding the issue of rehabilitation is still relatively low and it is only the rising cost of employee absenteeism that is helping to bring the need for rehabilitation to the forefront of employers' minds.
In addition to this, insurers are reluctant to use rehabilitation services as a promotional tool for selling income protection to individuals although some may offer these services if the need arises.
An overall package
For the corporate market however, rehabilitation services are in the main, offered as part of the overall employee benefits package and it is in this area that the majority of insurers concentrate its services.
To understand the level of rehabilitation services offered by insurers, it is essential to grasp what elements go to make up the entire rehabilitation process. Addressing the medical needs of an individual is all very well, but it does not end there. Ensuring the individual returns to work is also crucial and can get overlooked.
"One of the things that a lot of providers focus on is the medical rehabilitation side of the process," says Helen Merfield, managing director of HCML, a health and case management company.
"However, there should also be a focus on the vocational side of the rehabilitation process. There is a need to do both. In the case of most injuries, there is always the potential to go back to work and it is important that this is not overlooked and is at the top of insurers' agendas," Merfield says.
The first stage of the rehabilitation process involves tackling the issue before it gets to claim stage. How this is tackled depends on the insurer involved.
"We encourage customers to inform us of any employee who has been absent for a four-week period, or immediately if there has been a work place injury, at which stage we begin to get involved," says Simon Bailey, head of marketing at Scottish Equitable Employee Benefits.
The approach taken by Scottish Equitable Employee Benefits is very much an external process. Once information regarding an absent employee has been received, a nurse is sent to assess the sick or injured party. The insurer uses a third party provider of 15 to 20 nurses trained in occupational health and familiar with insurance contracts to carry out assessments throughout the country.
It also has partnerships with 10 national centres, which are used for assessing and managing the rehabilitation of joint or muscle- related problems. In addition, it outsources medical examinations to over 350 consultant medical specialists and has a national network of physiotherapists.
These partnerships also extend to specialist disability centres and trauma centres as well as functional assessment centres, where loss of functionality is measured scientifically.
At Friends Provident, the process follows a similar vein. The insurer uses a specific group of four to six third party companies for both medical and vocational rehabilitation services.
Alison Cousens, senior claims technician at Friends Provident, explains the reasoning behind the insurer's choices.
"We try to fit the rehabilitation provider to the needs of the individual in every case and are always looking at ways this can be achieved," she said.
Cousens explains that the company has relationships with a specialist vocational provider called Crawfords Rehabilitation Network as well as with a medical advisory company called Health Claims Bureau.
Friends Provident also works with Salisbury-based firm, Rehab Logic who come in at a very early stage in the rehabilitation process. They visit the company in question a couple of days a week and help the firm try and improve the working conditions for its employee. This may be from an ergonomic point of view and could simply involve changing the employee's chair or reducing working hours.
Similar procedures are carried out at Norwich Union Healthcare (NUH). The company has a reasonable in-house offering on the case management side. It employs a medical officer who is a trained GP, a psychiatric nurse and has a claims team with approximately 50 members of staff.
It outsources occupational health services to a specialist health company called Harrisons Associates. In order to assess whether a client has the ability to carry out activities of daily work (ADLs) such as sitting, lifting and walking, NUH works with Physical Evaluation Systems, a company with expertise in this field.
On the vocational side, NUH works with Euro Careers Consultants, which helps to assess individuals if they need to return to another occupation. Outsourcing advanced medical and all vocational facilities is crucial, says Nick Homer, product and technical manager at Norwich Union Healthcare.
"Certain things work better when they are independent and not a Norwich Union service, and in terms of the advanced medical side of rehabilitation, expertise lies with specialist companies," he says.
Merfield agrees, stressing the need for specialist companies to get involved as soon as the process becomes more complex.
"In terms of providing adequate vocational rehabilitation services, I am not sure that insurers have the required skill set to run these services in-house," she says.
However, despite Merfield's views, UnumProvident is the only insurer providing in-house vocational rehabilitation services - a feature it actively promotes.
"In general, the market outsources vocational rehabilitation services to independent private consultants, but we do not think this is the best way to get results," says Joy Reymond, head of rehabilitation services at UnumProvident.
"With consultants, there is the possibility that they may not be working under a company ethos. Also, having vocational facilities in- house means that there is an understanding of how the claims process works," Reymond says.
UnumProvident's vocational rehabilitation team consists of 27 members of staff located throughout the country. The team's objectives is to pinpoint the skills and interests of clients, what their training requirements might be as well as to try and get them back to work as soon as possible.
In-house services
The newest provider on the scene - FirstAssist - also has a significant amount of in-house rehabilitation services. On the medical side, the firm has a rehabilitation case management team of about 30 people who organise and facilitate treatment and services such as counselling and MRI scans.
For injuries at a higher level, there is a specialist team of niche players called Pro-Care, made up of occupational therapists and physiotherapists and more senior case managers who undertake home visits and report on the condition of the client.
The team is split 50/50 in terms of medical and vocational focus, with the vocational side focusing on transferable skills through the use of psychometric testing. The team work throughout the UK to help get employees back to work.
CIGNA Healthcare UK provides a telephonic case management service in-house, which is staffed by over 30 people who handle each reported case. All occupational health services are outsourced to Glasgow-based company Healthsure, which arranges assessments of medical needs.
On the vocational side it outsources to human resource companies Drake Beam Moran and Pennar Sanders & Sydney, which deal with training and seeking suitable employment for those who need it.
The need for help in getting employees back into the workplace is increasing and insurers are more than willing to help their clients out. Currently, the main focus is on dealing with the medical side of the rehabilitation process, but the need to carry this further is being recognised with an increasing number of insurers acknowledging the demand for vocational services.
While the majority of services are outsourced, this seems fair in light of insurers' acknowledgement that there is only so much they can do to help the process along, and recognise that there is a need to build solid partnerships with specialist expert companies. And as rehabilitation becomes more of a recognised issue among companies, the services and facilities provided by insurers is likely to expand.
COVER notes
• It is estimated that employee absence costs UK companies approximately £11 billion each year.
• It is important that insurers recognise that rehabilitation encompasses both medical and vocational services.
• UnumProvident is the only insurer to provide vocational rehabilitation services in-house.
