The increasing emphasis on rehabilitation will affect the basic role and responsibilities of advisers, say Helen Merfield and Joy Reymond
It is a common misconception that rehabilitation is designed only for those with severe illnesses or to address permanent impairment. In fact, it is an effective tool for dealing with all illnesses and injuries - from stress, mild psychological problems, strains and sprains to musculo-skeletal injuries and more acute medical problems.
The term rehabilitation covers a broad range of services and skills. One of the main distinctions is between medical rehabilitation and vocational rehabilitation.
Medical rehabilitation is normally part of a health insurance policy. It focuses on the physical recuperation of the individual who has suffered the illness or injury, including services such as surgery or physiotherapy. It aims to restore the physical wellbeing of the individual as closely as possible to his or her previous condition.
Vocational rehabilitation aims to help the individual return to the workplace. It is usually associated with income protection (IP), motor and employer's liability cover and deals with the emotional and psychological factors of illness or injury as much as the physical factors.
Standard definitions
Even within those distinctions, however, there are no standard definitions. Services and meanings differ from one provider to the next. Nor does the standard wording of many insurance policies help the cause of vocational rehabilitation or encourage advisers to get involved. Many policies are underwritten so the insurer pays out if the employee is not able to return to their original job, even if, with suitable vocational rehabilitation, they are able to return to a different job. The employer is unlikely to want to pay twice in this situation - once for the rehabilitation and once for insurance - and this is also not something an adviser is going to encourage.
But that doesn't have to be the case. Some insurers have income protection policies which make rehabilitation more feasible, by offering it as an integral part of their policies and by offering partial benefits for employees who return to work on alternative duties or restricted hours.
Moreover, where the policy wording does facilitate it, advisers are realising that vocational rehabilitation offers them the potential to make a huge difference in the claims outcome for their clients. It can considerably reduce not only the cost of employee absences and sickness management, but premiums, too.
The benefits of good vocational rehabilitation are widely acknowledged. A 2004 report by the Association of British Insurers (ABI) found significant benefits for employees, employers and insurers when return-to-work and rehabilitation are implemented effectively.
The Confederation of British Industry (CBI) estimates that 168 million working days were lost through absence in 2004, costing UK employers £12bn a year. Research suggests that these figures could be substantially reduced through greater use of rehabilitation.
It is not only employers who benefit from vocational rehabilitation. Insurers benefit from fewer and less expensive claims; employees benefit psychologically as well as financially from being able to return to employment more quickly; and the State benefits from fewer benefit claimants, shorter claim periods and the reduced burden on the NHS and/or social services. Crucially, advisers can benefit as well, through deeper and stronger relationships with both clients and insurers.
Despite it being implicit in most IP and employers' liability products, vocational rehabilitation in the UK is still a relatively immature market. Its growth has been led mainly by insurance providers developing services to reduce the insurance cost of absence caused by sickness or injury.
But most employers know little about rehabilitation or how it can help them reduce staff absence costs and improve efficiency. It is this knowledge gap that advisers are well placed to fill. By knowing more about rehabilitation, its models and the quality and service levels that should be expected, advisers can add great value to the purchasing process.
Advisers are accustomed to using their knowledge of their clients' businesses to evaluate and tweak insurance policies in order to get the most appropriate and cost-effective cover.
Similarly, they can use that knowledge to assess and refine the client's rehabilitation needs as well as sourcing the most suitable rehabilitation product.
An adviser who can talk knowledgably to an insurer about a client's rehabilitation needs and what kind of cover and services he or she requires - and who can weigh up the most appropriate options available to the client - is in a strong position.
After all, an employer which has been able to reduce its absence rates and sickness and injury claims can significantly reduce its premiums, as well as improving its workplace efficiency.
If the rehabilitation cover that delivered those reductions is the result of good advice from its adviser, the relationship can only benefit. Particularly in terms of standards, there is another important role for advisers to play.
The ABI/IUA, in conjunction with the Rehabilitation Working Party, launched the voluntary Rehabilitation Code of Practice in 1999, which sets out important good practice principles which can be applied by employers and service providers alike.
Although the rehabilitation sector as a whole is unregulated in the UK, several organisations are rising to the challenge of creating standards for practitioners to adopt.
The Case Management Society of the UK launched its standards in April 2005. These include a self-assessment tool which its members can use to ensure they meet the published standards. The Vocational Rehabilitation Association (VRA) is also developing standards of practice for its members which are due to launch later this year.
Quality service
By applying these standards when choosing vocational rehabilitation providers, advisers can play a valuable role in ensuring their clients get the quality of service they need.
And if they don't receive that level of service, advisers can use their knowledge of rehabilitation to find more suitable coverage elsewhere. By being more demanding and more knowledgeable, advisers can help the rehabilitation industry as a whole to raise its standards.
There's another good reason why advisers can and should get more involved in the rehabilitation process - they may soon have little alternative. Last year, the Department for Work and Pensions launched a vocational rehabilitation initiative: Building Capacity for Work: A UK Framework for Vocational Rehabilitation. This will develop new guidance for vocational rehabilitation standards.
The Government also set up a cross-departmental group to assess the economic benefits of greater NHS-provided rehabilitation. A second group - whose members included insurers, lawyers, the Health & Safety Executive, the NHS and other interested parties - has been established to look at developing mechanisms for earlier access to rehabilitation within the NHS.
The Government's main focus so far has been on rehabilitation within the NHS and in relation to personal injury claims. However, the fact that it is talking about rehabilitation at all is confirmation of the move towards the greater use of this facility to reduce claims and costs in health, injury and employment-related insurance in general.
Advisers have not been at the forefront of these developments to date, but they can't afford to be disinterested parties in this development. It is certainly in their clients' interests for advisers to become more involved in and knowledgeable about the rehabilitation process.
As clients become more knowledgeable about the potential value of rehabilitation, they will expect their adviser to be able to assist them in getting the greatest value for money from both their insurance and their rehabilitation services. With adequate preparation, education and commitment, it is in the adviser's own interests, too.
Given the variety of suppliers, the unregulated nature of the market and the significant potential to influence cost reduction for employers, this is a perfect opportunity for advisers to take advantage and show value to our customers, to gain new business and influence the changes required.
Helen Merfield is managing director of HCML. Joy Reymond is head of rehabilitation services at UnumProvident.
COVER notes
Vocational rehabilitation aims to help the individual return to the workplace.
Despite it being implicit in most IP and employers' liability products, vocational rehabilitation in the UK is still a relatively immature market.
By knowing more about rehabilitation, the models and the quality and service levels that should be expected, advisers can add great value to the purchasing process.
