1. Rehabilitation & disability claims Louisa Botes

2. Agenda Pros and cons of rehabilitation South African perspective
Value of rehabilitation programmes in disability insurance

3. The case for rehabilitation
Improved outcomes
Enhanced service
Tangible difference

4. The case against rehabilitation
Adds complexity to claims assessment
Unknown cost implications
Role clarity

5. Prevalence of disability by age30 25 20 15
% Prevalence 10 5
0 - 9
80 +
Age groups
Census 2001

6. Age distribution of the South African population
25%
20%
15%
% Total population
10% 5% 0%
0 - 9
80 +
Age groups
Census 2001

7. Foreword to the CGP: Key aspects on the employment of PWD
A tool for equality
“Disability is a natural part of the human experience and in no way diminishes the rights of individuals to belong and contribute to the labour market.
When opportunities and reasonable accommodation is provided, people with disabilities can contribute valuable skills and abilities to every workplace, and contribute to the economy of our society.”
Foreword to the CGP: Key aspects on the employment of PWD

8. Richard’s story
“After six months of intensive rehabilitation, I had to try to integrate back into society.
Being confined to a wheelchair, I had to break through many stereotypes, labels and misconceptions. People tend to perceive a disability as an inability.
But I was determined to succeed and my determination finally led to a job at Old Mutual. Within my first few weeks at OM, I realised that there was no telling what I was capable of doing.
The working environment I found myself in was such a contrast to the rest of the world. At OM I’ve been encouraged to use my full potential and the facilities have helped me operate independently.
Without OM I would probably have lived a mediocre life.”

9. Key principles covered in code
Awareness & accessibility
Consultation & confidentiality
Reasonable accommodation
Equal treatment and opportunities
Retention, termination & benefits

10. Retention & termination
Retention is aligned with spirit of code
Advantages
Retains experience and skills
Minimizes isolation and financial hardship
Employer may terminate service

11. Business case for a managed disablity approach
Best practice on workplace & disability
Labour Relations Act, 1995
Employment Equity act, 1998
Align insurance with labour law guidelines
Definition of disability
Support return-to-work
Best practice on work rehabilitation
Early intervention
Reasonable accommodation
Disability management service
All stakeholders benefit
Cost containment

12. Benefits Managed disability Other disability products
Early intervention integral to product
Supporting product features
Other disability products
Mixed bag
Delayed or early contact with client
Same case management principles apply

13. Interaction with the employer
Involve key stakeholders
Establish a common frame of reference
Work together on individual cases
Report management information

14. Individual case management process
Case selection
Rehabilitation agreement, if necessary
Preparation for return-to-work
Review progress & adapt plan, if necessary
Return-to-work, or another outcome

15. Reason for termination of monthly income benefit
50%
40%
30%
Proportion
20%
10% 0%
Death
Retirement
RTW
Other
Event
PHI

16. Key success factors Aim for the best outcome for all parties Teamwork
Think and act holistically
Be flexible – follow principles

17. Value of rehabilitation programmes
Improved claims management
Lower incidence of claims
Ongoing learning for the business
Appropriate response to client needs

18. Empower employers Female supervisor Back problem due to IOD
Comprehensive treatment
“Workability”
In-house solution

19. The journey so far Introduced rehabilitation to the insurance industry
Changed the profile of claims assessors
Created a database of service providers
Developed products & services
Began to align with national initiatives

20. Road ahead Early intervention Use both the medical & social models
Interact with stakeholders
Understanding what works, and why

21. Keep learning
Plan
Act
Learn
Reflect

22. Comments or questions?
Thank you!