As rehabilitation continues to top insurers' agendas, Helen Merfield talks to Angela Faherty about the importance of increasing awareness on this subject
Helen Merfield is a champion for rehabilitation. As managing director of health and case management firm, HCML, Merfield is well placed to further promote the case for rehabilitation. A current member of the Association of British Insurers' rehabilitation working party, Merfield has recently been appointed director of the Case Management Society UK (CMSUK) and is determined to drive home the need for rehabilitation.
"My role is to raise awareness of rehabilitation and discover the issues and views people have about the subject," she says. It was while working as a trainee nurse on a spinal injury unit in Woolwich that Merfield began to develop an interest in rehabilitation. As a result, she found herself working as a nurse at AIG and eventually helped set up a specialist rehabilitation company.
"I quickly realised that if I was going to supply rehabilitation for injured people it needed to be separate from the insurance company. So I put a proposal forward for an independent in-house case management firm called AIG medical and rehabilitation (AIGMR)."
AIGMR grew substantially and after four years, had 27 staff and four offices based in Ireland, Croydon, Manchester and Glasgow. However, despite its success, Merfield felt the services would work better independently outside the insurance sector.
"It was very difficult to work in an environment where you were owned by an insurance company. We could have done much more, so I made the decision to provide rehabilitation to a wider audience and left to set up my own business, HCML."
Imperative
Since its launch in November 2003, HCML has been actively taking on cases. The business currently has a total of13 staff and is recruiting on a monthly basis. Business is booming and Merfield is excited about the expansion plans. "We have people waiting to join us and things are snowballing. We are moving to Croydon in May and hope to open a branch in Manchester at the end of the summer," she says.
HCML provides rehabilitation case management, vocational rehabilitation and occupational health services. Merfield is keen to stress the importance of vocational rehabilitation in particular. She says if a patient has suffered a disability and needs a new job, vocational rehabilitation is imperative.
"Some cases need a lot of work and have to undergo aptitude testing, job skill analysis and personality tests to help them find a suitable job. We work with them to identify suitable occupations so they know it's safe for them to return to a new position," she says.
One of the most important aspects of a case manager's role, says Merfield, is to help people get motivated and to help keep their self-esteem in check. It is useful to look at people's entire social circumstances when helping them to get better, she says.
"It is important to look at the whole person rather than the injury alone. For example, do they have a parent they look after, and what will be the implications if they are injured too?"
Merfield is well aware of the growing importance of rehabilitation in the insurance sector and strongly supports insurers embracing the concept. "I think there are a lot of good in-house case management companies, but I think it is easier to provide a service if you are independent. That doesn't mean the in-house companies are not doing a good job, I just think that internal resources can sometimes be a problem."
While Merfield works with a range of clients both in the insurance sector and outside it, she is keen to develop greater ties with income protection (IP) providers. However, she understands that the proposition is different from that of the general insurance market and feels this needs to be broadly understood before any real development can be made.
Bone of contention
"The procedures we have set up for employers liability and public liability generally work across the board because all the cases are for liability and are generally very similar. But with income protection, it depends what the carrier wants to achieve and how much time they are prepared to invest," she says.
One particular bone of contention is the deferment period on many IP plans. Most policies do not kick in until three or six months after injury and some people do not have to notify their insurer until the deferment period is over. However, in many cases it may be that the patient will get worse if something isn't done during that time, so investing some time in rehabilitation at an early stage may prevent them from needing to tap into the policy at all.
"The deferment period can be an issue. We work differently with each insurer because one size doesn't fit all, but there is a risk of wasting valuable time in terms of rehabilitation. Sometimes it may be better to bite the bullet and risk losing a couple of hundred pounds on rehabilitation than wait and risk losing thousands of pounds if you wait too long to get involved," she says.
Universal approach
Merfield believes that a more universal approach also needs to be adopted by insurers if rehabilitation is to succeed in the sector. It needs to be driven from the top down, she says, and everyone needs to be involved in the decision-making process, rather than having an ad hoc approach, where one underwriter may consider it and another will not.
"Rehabilitation needs support and education so everyone is informed. I get the impression from some insurers that they are so busy and they have so many files, that instead of sitting down and looking through each case to see what rehabilitation may be needed and what can be achieved, sometimes it is just easier not to," she says.
While Merfield fully supports the Government's plans for getting people back to work and off disability benefits, she feels more needs to be done if the plans are to succeed in the long term.
"I think the Government could do a lot more. There are no rehabilitation units in the NHS, just pockets here and there, and these are mainly used for spinal and head injuries. I think the problem is that if it is going to invest in rehabilitation it needs to be a long-term issue. There needs to be a national centre of excellence for rehabilitation set up to promote this."
Looking ahead, Merfield understands that there is no quick fix to providing rehabilitation to all those who need it, but she is determined to raise awareness on the subject. "The problem is that if it is left too long, people start to focus on their disability rather than being positive about life, and that then sets a downhill spiral in terms of getting better. That is why there are so many people out of work and it is costing the industry so much money. It's important that we get this right," she says.
