Symptom siren

Early intervention is a key area for advisers to add value for their clients, but only if it is done right, finds Edmund Tirbutt

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Intervening early and rehabilitating people back to work is core to the marketing strategies of group income protection providers, ideally before the scheme’s deferred period has ended. For advisers that get involved in the early intervention process in a constructive way there is also an opportunity to really add value. While early intervention is key for all providers, advisers do have a range of approaches to how that intervention is managed.

Getting in early is something of a given for providers – anything one insurer can do, others invariably claim they can do earlier. Friends Provident, Unum and Legal & General, for example, even invite notification from day one in a minority of cases. Yet despite this, there are new ideas in the market too.

Legal & General is unusual in offering schemes with over 250 lives a 5 per premium discount if they notify it of 80 per cent of employees absent for four weeks by week six. It has also developed an effective cognitive behavioural therapy (CBT) model in conjunction with specialist provider CBT Services. It reports that it helps 70 per cent of individuals treated with CBT for psychological illnesses back to work within a year.

Unum and Aviva differentiate themselves by offering specially enhanced services to large schemes, with the latter also providing both line managers and employees with access to a helpline manned by trained counsellors. Additionally, Canada Life is notable for its use of the Hanasaari model, a biopsychosocial format that focuses on man, work and health.

Helen Sellings, senior rehabilitation consultant at Canada Life, says: “It’s very important that we understand an organisation’s structure and philosophy and all the processes involved. For example, corporate lawyers will literally work 24 hours around the clock to meet deadlines, so you need to understand job requirements and the nature of business before sending employees back to work. We try to build a working partnership and involve all of the stakeholders in the early stages, jointly agreeing an ongoing management structure.”

Providers are keen to remind advisers how to ensure that a company’s management is involved more effectively in the early intervention process. The most commonly volunteered observation is that line managers are frequently reluctant to contact absent employees.

This tends to be especially the case when absence is due to stress-related illnesses because employers often fear being accused of harassment and running into legal problems. HR departments, in particular, are highlighted as tending to be overly conservative and scared of doing the wrong thing.

Lack of medical expertise within employers is also an issue. Declan White, group risk marketing manager at Friends Provident, says: “Sometimes there can be a lack of knowledge amongst management about the medical conditions concerned and this can create a barrier because the employee will know all about the condition.

Employees may not want to discuss their conditions with their employer, so the employer may not understand why they are off work. So having a third party to liaise can help the employer, who may not see the signs of depression developing in someone or who may not understand why someone may not be able to come back to work when treatment ceases.”

Some insurers feel there are less than a dozen intermediaries capable of adding any real value in the early intervention process

Some intermediaries can also play a valuable role in the early intervention process and they may or may not charge extra for their services in this respect. The Holy Grail is to have a tripartite relationship in which all parties understand exactly what they do and when they do it.

Katharine Moxham, spokesperson for industry body Group Risk Development, says: “The intermediary should sit in the middle and develop an absence process, but the reason that clients often don’t buy into this type of service is that to do it properly requires at least a quarterly meeting with all parties involved. When I used to be a consultant less than 20 per cent of my clients did this and, because time is money, it was a constant battle to get some of them to do anything.”

Lorica Consulting, which is unusual in having its own dedicated early intervention team, does manage to successfully engineer such tripartite relationships, with all parties meeting at least quarterly – either faceto- face or via conference call. But some insurers feel there are less than a
dozen intermediaries capable of adding any real value in the early intervention process and prefer to deal direct with clients on claims rather
than involve smaller non-specialist intermediaries.

The largest and fastest rising employee benefit consultants can offer holistic health and wellness consultancy, looking at an organisation’s overall processes as well as putting in products and services. They can also co-ordinate the whole early intervention process and in some cases act as the first point of contact.

Jelf Group, for example, normally tells its smaller clients to phone it in the first instance and, if it feels it appropriate, it will then refer news of absenteeism to the insurer. With larger clients, on the other hand, either Jelf or the insurer may be the first port of call.

Nevertheless, the one thing that proponents of early intervention conspicuously still lack is adequate data to prove the business case. Only Legal & General volunteers anything compelling. When it receives notification of absence within four to five weeks it managers to get 69.8 per cent of individuals back to work within a year but when it is notified after 26 weeks the average length of absence is 73 weeks.

Sally-Anne Etienne, head of life and health claims at Swiss Re, says: “I feel having an evidence base could make early intervention go forward in leaps and bounds. In order to make employers really buy into it early you need to have enough examples, but we haven’t got them and until we can really quantify things it will largely be hit and miss. We can’t really educate consistently until we have the evidence to do it.”

Hopefully, it will not be too long before such information comes to light. Bupa reports that it has just started gathering data and hopes that this will enable it to make the business case for early intervention within a year. Other insurers may then reflect on the thought that failure to do so will leave them at a commercial disadvantage.

SUPPORTING THE LINE MANAGER

Canada Life has a policy of supporting line managers in the knowledge that they do not usually have medical backgrounds and that many do not have any experience in rehabilitation. This certainly paid off in the case of a client’s female employee with anxiety and stress who wanted to get back to work because it helped her cope with her home life.

Alex Freeman, rehabilitation manager at Canada Life, says: “Initially she did very well but after two weeks I got a phone call from her line manager saying she was crying in the toilets. So it was reassuring for him that I could explain that the problem had nothing to do with work because she had phoned me provisionally to say that the crying had been caused by problems at home.

“Eventually the situation resolved itself but, if I hadn’t told him this, he would have sent her home and she would have lost her coping mechanism. It all hung on the fact that we had built a rapport with the line manager and kept him in the loop, making it clear that he should not hesitate to phone me if he needed any help. “

EXPERT VIEW REHABILITATION

Joy Reymond, Unum.
Joy Reymond, Unum.

Not everyone who wins a battle with cancer will react in the same way. Some will feel they have gained a completely new perspective on life and will want to quit work to be with their kids but many others will actually be keen to get back to the workplace as early as possible.

Joy Reymond, head of rehabilitation and health management services a Unum, says: “Because cancer used to be a death sentence people are far more likely to feel they have won the battle if they go back to work. There is no evidence to suggest that returning to work leads to
better recovery or longevity but lots of evidence to suggest that their quality of life is better.

Because cancer used to be a death sentence, people are far more likely to feel they have won the battle if they go back to work.”

“We even find that those with cancer who get a recurrence say it was wonderful to go back to work, so part of the educational process is helping employers understand that it’s normal for people to want to get back to work. I recommend that people should never use the word “suffer” in conjunction with cancer, or indeed with other illnesses, as it makes those who have been receiving treatment feel the victims. This is particularly important with cancer as those recovering feel they want to take charge and be in control.”