1. Identifying and managing disabilities in the workplace
Maggie Clack
22 November 2013

2. Indentifying disability cases
Starts with absenteeism management
Chronic disease management
Look at the monthly trend
Top diagnosis within the company
Who are the individuals that are potential cases

3. Looking at absenteeism stats
Monthly Trend:
Top diagnosis:

4. Link between disability claims experience and economic conditions
Karl Schriek - GENRE
Insurers offer: 1. Lump sum
2. Income benefits
Lump sum is easier to understand – cheaper to administers, does not require ongoing claims management
Does not require ongoing payment
Claiming for disability is easier in economic hard times
Employers offer this as an alternative to retrenchment
Safety standards cost money
Maintaining technical skill cost money
Psychological claims increase
State of economy affects how strictly insurers apply claims management

5. What are the definitions of disability? Policy needs to be referred to

6. Definition of Disability
Is a legal process assessing the extent of the person’s impairment, judged in conjunction with their job description, policy wording and personal factors

7. Definitions Temporary disability –
Permanent disability – totally and permanently disabled to perform own occupation
Impairment – this assessment entails making a diagnosis an then determining on medical grounds which function the claimant is still able to perform
Own/any occupation – any function with any employer that will enable the insured person to generate an income
Own occupation – the type of work the insured person was performing with the Employer immediately before the waiting period
Alternative occupation – any alternative occupation with the employer for which the insured person is suited – taking into account age, training, knowledge, ability and experience
Look at definition in policy w.r.t. own employer or any employment in the open labour market

8. Lump sum disability
Total and permanently unable to perform own occupation/alternative occupation
Looks at experience – or claimant could become qualified and suited for
It takes into account the degree of disability
Takes into account knowledge, training, educations, ability, experience and age

9. Income Replacement
If the injury/disease renders you totally incapable of doing own /alternative occupation
Assessment done on a regular basis
Experience/qualifications are considered
What to do if benefits are accepted?
HR often “scared” to terminate on grounds
of incapacity

10. Quadriplegic patient……

11. Income Replacement

12. When to submit a claim?
When you suspect that it is unlikely that an employee will be able to return to work.
When an employee, who has returned to work after an illness or injury, is unable to perform work duties.
When an employee has been diagnosed with a progressive/chronic condition, which is likely to result in a lengthy period of absence from the workplace

13. What do I submit? Employer section Claimant section
Copy of the claimant’s identification document
Job description or performance contract
Comprehensive specialist report or completed medical questionnaire
Sick leave records with available reasons for absenteeism – past 2 years
Latest payslip with full salary

14. Liability of submitting a claim
Employee – The onus lies on the employee to provide supporting evidence that he/she is disabled
Employer – the policy holder – has to facilitate the process
Employer is supported by HR/OHMP/OHNP
Liability of who has to submit an application - refer to policy document

15. What is the date of absence?
Contractually this date is the day after the claimant was last actively at work performing the material duties of his / her occupation
Occasionally, i.e. in the case of a chronic medical condition, a claimant’s productivity decreases over a period of time. In these instances, the insurer will negotiate a fair date of absence that reflects the date when the claimant last performed the material duties of his/her occupation
This date indicates the start of the waiting period

17. Insurance Assessment Contract clause Medical profile Personal profile
Functional profile
Occupational profile
Personal profile

18. Managing Risk Employer Employee Insurer/ Administrator
Employee Risk
Consumer debt, 46,8% of consumers can’t service personal debt
Psychological effects such as stress and work pressure are also economically linked.
Highest incidents HIV/TB/Alcohol/Smoking/Road traffic injuries in world
Less health benefits
Challenges in state health systems
Medical scheme fraud, estimated at about R15bn annually
Psychiatric disorders as a cause of occupational disability are under-recognised and under-treated world wide / very difficult to manage
Depression will be most common disease in the world by 2020

19. 7 out of 10 employees will be off on temporary disability during their work life If you do not return to work with 9 months – return chance decreases

20. Incapacity/termination of employment contract vs a disability claim
Incapacity & disability process runs at the same time
Recommended not to terminate in the waiting period
Section 8 (10)of LRA – temporary incapacity – consider nature of the job, period of absence, seriousness of illness/injury and possibly getting a temporary replacement
permanent incapacity – secure alternative employment, adapting duties or work circumstances to accommodate the employee
NB – IOD cases particular consideration – employers duty to accomodate

21. Incapacity and Disability
Incapacity – “the failure of the employee to perform his/her duties satisfactory” due to poor performance or ill health/injury. This is due to external factors and NOT misconduct
The disability definition –” the failure of the employee to perform his/her duties satisfactory – due to ill health or injury”
Note: 70% of incapacity is NOT due to wellness issues. It is therefore essential to clearly understand the reasons for the incapacity
Note: A application for disability could be a tool to assist in dealing with incapacity.
The previous speaker spoke to us about incapacity. From the talk it is clear that:
Incapacity is the failure of the employee to perform his/her duties satisfactory” due to poor performance or ill health/injury. It is not linked to misconduct but rather to external factors.
The insurer is also concerned with a failure of an employee to perform occupational duties but we are only concerned about incapacity when a illness and or injury is present
It is therefore clear that illness and injury will most likely lead to incapacity but that all incapacity is not due to illness or injury.
In fact 70% of incapacity is NOT due to wellness aspects and not all wellness issues will become valid disability claims. An application for disability benefits is therefore a tool that will be used for only a small percentage of the incapacity problems that you deal with on a daily basis
A application for disability must still always be kept in mind as a possible TOOL to deal with incapacity when this gets investigated

22. Questions? More Information?
Maggie Clack Tel: