behavioral wellnessdmec.org/wp-content/uploads/@work-magazine_december-2012.pdfmetlife the hartford...

OFFICIAL PUBLICATION OF THE DISABILITY MANAGEMENT EMPLOYER COALITION

December 2012 Vol. 4, No. 5

www.dmec.org

In This Issue: Suicide Prevention @Work

Act Local–on Injured Tissue–to Prevent Pain from Going Global

In This Issue: Suicide Prevention @Work

Act Local–on Injured Tissue–to Prevent Pain from Going Global

Behavioral Wellness

DMEC HR Ad_Outlined_0512.indd 1 5/21/12 2:29 PM

contentsEditorial Policy: All articles and content Copyright © DMEC 2012. @Work is the official publication of the Disability Management Employer Coalition (DMEC). The magazine’s goal is to present industry and association news, high-light member achievements and promote the exchange of specialized professional information. The statements and opinions expressed herein are those of the individual authors and do not necessarily represent the views of the association, its staff, board of directors or its editors. Likewise, the appearance of advertisers does not constitute an endorsement of products or services featured in this, past or subsequent issues of this publication. DMEC makes no representations, warranties or assurances as to accuracy of the information contained in the articles.

@Work welcomes submission of articles of interest to disability and absence management professionals at all levels. Complete instructions to authors are published online at www.dmec.org.

DMEC membership: Individuals receive @Work by being members of DMEC. Call 800.789.3632 or go online to www.dmec.org for more information.

Contact DMEC: Mail: 5173 Waring Road Suite 134, San Diego, CA 92120-2705. Phone Editor Peter Mead at 541.434.9029, fax to 541.844.1880; other DMEC business to 800.789.3632, fax to 877.789.3632, email to [email protected].

SponsorsDiamond SponsorsMetLifeThe Hartford

Platinum SponsorsAon HewittBroadspireCIGNALiberty MutualMed-TekMercerPacific ResourcesPrudentialSedgwick CMSSpring Consulting GroupThe Reed GroupThe StandardUnum

Gold SponsorsAetnaAnthem Life

Virtual Education ForumUnum

Leadership SeriesLiberty Mutual

Published by DMEC, Inc.Editor in Chief: Rebecca Milot-BradfordEditor: Peter MeadTemplate: Suz Grant • www.suztopia.comLayout & Production: Suz GrantEditorial Review Panel: Carolyn Clark, RN;Diana Parkinson-Tripp; Ruth Galvin, MA, Ed, CRC, CPDM; Doug Geyer; Linda J. Croushore, M.Ed., CRC, LPC; Suzanne Suva, SPHR, CPDM, CBP, CCMP; Ontaria Read, CPDM; Steven M. Genduso, MA, CPDM, WCLS

December 2012 Vol. 4, No. 5

DEPARTMENTSPresident’s LetterPassing the Baton

4

FEATURES

Compliance Memos Health Reform Key Compliance Dates

7

DMEC NewsLeadership Series Theme Announced: ADAAA

21

Chapter DevelopmentsAtlanta Chapter Kickoff Meeting Nov. 15

23

COLUMNS

Suicide Prevention @WorkUncovering a Silent Killer

9THEME: BEHAVIORAL WELLNESS

PAINAct Local—on Injured Tissue—to Prevent Pain from Going Global

13

www.dmec.org ▪ @work 3

Absence Matters – Bryon E. BassInterplay: Behavioral Health Issues and the FMLA

17

Behavioral Matters - Dr. Robert N. Anfield, MDAvoid Employee Productivity Pitfalls by Knowing the Signs

18

Health & Productivity – Dr. Gary Anderberg, PhDGot EAP?

20

Correction: Bruce G. Flynn, MS, was omitted from the DMEC Honor Roll list in the October 2012 issue.

President’sLetterDecember2012

Passing the BatonAs of February 2013, I will be stepping

down as CEO/President of DMEC. I have had the privilege of shaping this

organization for the last 20 years, which has been a delightful and inspiring journey both personally and professionally. Having reached this milestone, it is appropriate to reflect on what the past 20 years have brought and some of the accomplishments that I am most proud to have helped shape:•Annual International Absence and

Disability Management Conference. This unique and widely recognized industry conference is now in its 18th year and draws over 600 attendees—primarily employers.

• Employer FMLA and ADAAA Com-pliance Conference. Our new, equally prominent and responsive educational forum is helping our members to meet the myriad of leave law challenges. Paired with this, our annual Employer Leave Management Survey also measures the pulse and meets the informational needs of employers in this ever-evolving area of leave administration.

•CPDM. Now solidly entrenched and recognized in the industry as the professional designation providing the

framework fundamentals for integrated disability and absence management (IDAM) experts—now 16 years running in cooperation with Insurance Educational Association.

• Behavioral Risk and Wellness. This growing and vitally important best practice has been taught in conferences, webinars and publications, as well as tracked in our biennial industry survey.

•@Work magazine. The first disability and absence publication in our field high-lighting member achievements, news and specialized professional information.

•Think Tank Series. Exploration of three high-profile topics have kept members on top of thought leadership as it relates to the Workplace Warriors (veterans); Extreme Productivity; and the Virtual Workplace.

• Leadership Series. Our employer-only focus group that investigates high-profile issues.

•Virtual Education Forum and Tools & Tactics Webinars. Now 20 sessions strong meeting the educational needs of our members on-line and conveniently.

When DMEC was first conceived, it in-volved a passion to help employers save money and encourage return to work. It was based on the feeling that this was the rightthing to do. It was propelled by those of us who felt that human cost savings were even more im-portant than corporate cost savings. I could not have made this journey alone. It started

Marcia Carruthers,MBA, CPDM

President and CEO, DMEC

“The Spanish word for retirement is ‘jubilacion’ and that fairly expresses my feelings. I’m ex-

cited and happy about my next move into the Chairmanship role…. Thanks for the wonderful

memories and the enduring friendships.”

4 @work ▪ December 2012 Vol. 4, No 5

with an idea that Sharon Kaleta and I hatched, and continued with the sup-port of many others we met along the way who helped in this effort, most of whom are still strongly involved. Not only have we become known for our exceptional networking opportu-nities, but even more importantly for the strong collegial relationships and warm welcoming environment that is the hallmark of being a member of DMEC. It is a sense of “family” that endures.

Looking ahead, I am so pleased that Charlie Fox has agreed to step up as our next CEO/President. A wise and hard working individual, he clearly has the expertise in association management to bring DMEC to the next level in our growth. His legal acu-men in employment law, experience in running a healthcare organization

and knowledge of employer coalitions will be much-needed assets as the depth and breadth of IDAM expands. Backing him up will be our solid and hard-working staff (including new Education Manager Terri Rhodes); dedicated Executive Advisory Board and Employer Advisory Council con-tributors; and the loyal chapters and membership that make up the fabric of our organization. It is an army of thousands that will guide and preserve the mission and vision that have been crafted over two decades.

The Spanish word for retirement is “jubilacion” and that fairly ex-presses my feelings. I’m excited and happy about my next move into the Chairmanship role and ready to take on new challenges at a strategic level, letting the daily operations be com-petently handled by my successors. It

has been an extraordinary privilege to serve the members of DMEC. Thanks for the wonderful memories and the enduring friendships. I leave the legacy to the next generation of innovative integrators to take us to the next level!

Be well and keep hugging,


When employees miss work, it can cost your company and be a real pain to manage. There’s the direct cost of the lost time, the lost work, and the effort that goes into complying with FMLA and so many other leave entitlements. That’s why smart companies partner with Unum for their disability and leave management programs. As an industry leader in disability and absence management, Unum’s expertise and experience in managing employee absences benefi t our customers on many fronts. So HR can spend less time worrying and more time building your company’s success. For more information about the support we can offer, call one of our expert representatives or visit unum.com/relief.

DISABILITY ° ABSENCE MANAGEMENT ° L IFE ° VOLUNTARY BENEFITS

© 2012 Unum Group. All rights reserved. Insurance products underwritten by the subsidiaries of Unum Group.

Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. NS11-114

The cost implications of employee absenteeism are unsettling

The loss of productivity is painful

And administration can be a headache

But powerful relief is on the way

COMPLIANCEMemos

Although 2014 is regarded as the major year for rolling out high-impact components of the Patient Protection and Affordable Care

Act (PPACA), several milestones for employers and health plans will occur on January 1, 2013 and later in the year.

1-1-2013Executive CompensationLimits the employee compensation amount that corporations can deduct from income taxes at $500,000 under IRC §162(m)(6) for most em-ployees of certain health insurance providers. Qualified “performance-based” compensation, however, is exempt from this limit. Although the cap on deductibility of employment compensation applies to amounts paid on or after 1/1/2013, any services performed on or after 1/1/2010 that have not been paid before 2013 can also be taxed.

FSA LimitsAnnual employee contributions to flexible spend-ing accounts (FSAs) will be capped at $2,500. This amount will be indexed to the consumer price index (CPI) starting in 2014. This is not a “per-family” but a “per employee” limit; a couple working at the same employer could contribute a total of $5,000 into their FSA.

Plans are allowed to provide a grace period of up to two months and 15 days for FSA par-ticipants that did not use their full FSA contri-bution before the end of the plan year. Without this provision, however, FSA participants face a “use-it-or-lose-it” rule at the end of the plan year (which may or may not be a calendar year). The IRS recently asked for public input on the “use-it-or-lose-it” rule and IRS representatives in October confirmed that public input was in favor

of ending the rule. No action has been taken at this writing, however. Although employees face an annual cap on contributions, this cap does not apply to contributions an employer places in the employee’s FSA.

Hospital Insurance Tax/Medicare Payroll TaxImposes an additional FICA and SECA tax of 0.9% on the wages of an employee above $200,000 or $250,000 if filing a joint tax return. Imposes a 3.8% tax on such individual’s net investment income.

Medicare Retiree Part D SubsidyThe Medicare Part D retiree drug subsidy becomes taxable.

3-1-2013Employer Notice RequirementsEmployers must provide written notice to em-ployees regarding:•The existence of the health insurance

exchange(s) where they can purchase health insurance;

• The potential eligibility for federal assistance if the employer’s health plan is “unaffordable” based on criteria under PPACA and if the employee household income is below certain thresholds;

•That employees may lose the employer contribution to health coverage if they purchase health insurance through the health insur-ance exchange.

The federal government is expected to publish a model notice that can be used as a template for employers to comply with this requirement.


CM#10: Health Reform Key Compliance Dates

John C. Garner, CEBS, CLU, CFCI, CMC

Principal, Garner Consulting

Finding hidden employee benefitopportunities takes more than eyesight.

It takes 20/20 insight.

Opportunities are rarely visible. At the same time,

your benefit resources are finite. And, as an overhead

expense, they’re subject to extreme scrutiny.

But what if your employee benefits plan had an

attractive ROI? Raised employee recruitment and

retention rates? Led to unprecedented employee

satisfaction and higher productivity?

As an employee benefits advisory firm with over

three decades of experience, Pacific Resources’

20/20 insight provides innovative solutions in Life,

Disability, Voluntary and other non-medical benefits.

Servicing large, predominantly Fortune-ranked

companies, we find benefit solutions that positively

impact your business and enrich employees’ lives in

enduring and meaningful ways. Just as the solutions

we’ve already provided clients have done for millions

of employees and their families.

To learn more, go to www.pacresbenefits.com

or call 855-PACRES7 (855-722-7377).

Finding hidden employee benefits opportunities takes more than 20/20 eyesight.

It takes 20/20 insight.

Opportunities are rarely visible. At the same time,

your benefits resources are finite. And, as an overhead

expense, they’re subject to extreme scrutiny.

But what if your employee benefits plan had an

attractive ROI? Raised employee recruitment and

retention rates? Led to unprecedented employee

satisfaction and higher productivity?

As an employee benefits advisory firm with over

three decades of experience, Pacific Resources offers

20/20 insight that provides innovative solutions in Life,

Disability, Voluntary and other non-medical benefits.

Servicing large, predominantly Fortune-ranked

companies, we find benefits solutions that not only

positively impact your business, but enrich employees’

lives in enduring and meaningful ways. Just as the

solutions we’ve already provided clients have done

for millions of employees and their families.

To learn more, go to www.pacresbenefits.com

or call 855-PACRES7 (855-722-7377).

FEATURE:BehavioralWellness

Prevention @WorkSuicide

Uncovering a Silent Killer

Consider:• More Americans now die by suicide than die in car

collisions, by homicide or other injury-related deaths.10

• 11 nonfatal suicide attempts occur per every suicide death in the U.S., according to estimates by the Centers for Disease Control and Prevention (CDC).2

• Suicide is ranked 11th among the leading causes of death in the U.S., according to CDC estimates.3 For every fatal suicide, many co-workers, family and friends are left to try to understand what happened. Five years ago, the CDC estimated there were 4.6 million such “suicide survivors” in the U.S.

Considering these unfortunate statistics together, it’s likely that someone within your circle of co-workers knows or is a suicide survivor, or may be at heightened risk of suicide himself.

Consider also that suicide is the most dramatic example of the negative response to stressors. Many more people, while not at high risk for suicide, can benefit from stress-reduction and resilience-building programs being imple-mented in workplaces.

The high incidence of deaths by suicide in our armed forces prompted President Obama to sign an executive order to improve access to mental health services for veterans, service members and military families. While suicide in the military has received considerable media attention, the CDC’s estimate of a high rate of nonfatal suicide attempts indicates that many more are suffering in

“It’s likely that someone within your circle of co-workers knows or is a suicide sur-vivor, or may be at heightened risk of suicide himself… Many more people, while not at high risk for suicide, can benefit from stress-reduction and resilience-building programs being implemented in workplaces.”

Kate A. BurkeAssociate Director of the Partnership

for Workplace Mental Health

uicide has a greater impact on your work-

place than it might appear. S


silence. This isolation creates a gap in our societal response to suicide.

The authors of a study of suicide and injury mortality published in AmericanJournalofPublicHealth10 advocate for a comprehensive suicide prevention campaign. The campaign they envision would follow the model of successful traffic safety measures, like seat belt usage, to stem the tide of losses our nation experiences through suicide.

On September 10, World Suicide Prevention Day, a report of the U.S. Surgeon General and the National Ac-tion Alliance for Suicide Prevention was published. The 2012NationalStrategyforSuicidePrevention:GoalsandObjec-tives for Action report13 demonstrates, and U.S. Surgeon General Dr. Regina Benjamin has reiterated, that we all have a role to play in preventing suicide.

Protective Factors in the Workplace So what is the role of the workplace? The National Strategy report highlights the following five focal points for what businesses and employers can do. 1. Implement organizational changes

to promote the mental and emo-tional health of employees. Ensure that mental health services are included as a benefit in health plans and encourage employees to use these services as needed.

2. Train employees and supervisors to recognize coworkers in distress and respond appropriately.

3. Ensure that counselors in an employee assistance program (EAP) are well equipped to assess and manage suicide risk.

4. Ensure that mental health services offered to employees include grief counseling for individuals bereaved by suicide.

5. Evaluate the effectiveness of workplace wellness programs in reducing suicide risk.

These areas of focus are driven by the Risk Factors and Protective Factors related to suicide shared through the Suicide Prevention Resource Center.12

Additional specifics and other sources can be found through the National Strategy website13 as well as through the National Action Alliance’s Workplace Task Force’s video testimonials6 from CEOs who are building capacity and dedicating resources to suicide preven-tion in their companies. The Protective Factors are listed in a sidebar column; another sidebar contains the warning signs of suicide provided by the Amer-ican Society of Suicidology.1

Moreover, the workplace is where most adults spend half of their waking lives, generally with the same group of people. This environment provides a unique window for awareness and action through the following subset of protective factors that address the National Strategy’s focus areas.

Strong connections to family and community support. Being colleagues and co-workers creates a community where we can take notice of one another. Given the amount of time shared with colleagues we have the ability to observe when our co-workers’ behaviors are changing, at times even more than family members might.

There are many training programs available to teach us all to recognize risk factors for suicide and refer our col-leagues to the help they might need. Two examples of such gatekeeper trainings are: QPR Training,9 modeled after CPR, which teaches how to Question, Persuade and Refer when needed; and the Working Minds: Suicide Prevention Toolkit14 geared specifically to the workplace.

Support through ongoing medical and mental health care relationships. In 2010 a reported 49% of the popu-lation in the U.S. had health coverage through employer sponsored plans.4

Workplaces can use their purchasing power to encourage the use of health

screening questionnaires that include mental health and substance use disorder questions. This carries particular weight as 90% of individuals who die by suicide have untreated mental illness.5

The same approach can be used in existing health, wellness or employee assistance programs, as there truly is nohealthwithoutmentalhealth. In addition to the saving of human lives, facilitating early intervention has a tremendous financial return for employers as well as compliance with federal parity regula-tions. For more information on these issues see the Business Case7 informa-tion provided by the Partnership for Workplace Mental health.

Skills in problem solving, conflict resolution and handling problems in a non-violent way. Many worksite pro-grams have this type of training already in place to combat workplace violence.


Warning Signs of Acute Suicide Risk Memory Device

“IS PATH WARM?”1

Ideation (talk of death, suicide)Substance Abuse

PurposelessnessAnxietyTrapped feelingsHopelessness

Withdrawal from friends, familyAnger, rage, revengeRecklessness, risk behaviorMood changes, dramatic swings

If you see these signs, contact a mental health professional or call 1-800-273-TALK (8255) for referral.

American Society of Suicidologyhttp://www.suicidology.org

This risk management training can be expanded to include understanding of self-directed violence. Materials and training related to resiliency are also ways to build on the protective factors that exist in the workplace and focus on prevention.

The Naval Center for Combat & Operational Stress Control11 has com-prehensive resources related to resiliency and specific actions to take for various levels within an organization, and families, in response to where a person may be on a stress continuum. This stress continuum creates shared and accessible language to address emo-tionally charged topics. Many parallels can be drawn from these materials to various levels of workers at any work-place.

Provide HopeThrough focus on the whole health of your workforce and awareness of risk and protective factors of suicide, we can intervene early, before your colleagues reach a crisis point. In addi-tion to the resources and links in the National Strategy, the Partnership for Workplace Mental Health has collected Employer Case Examples8 of how your organization might implement the suggestions above. We all have a role to play in preventing suicide.

Contact Kate Burke at [email protected] or 703.907.8586 for more information about the Partnership for Workplace Mental Health’s programs.

References1. American Society of Suicidology,

Washington DC. Warning Signs. http://www.suicidology.org/web/guest/stats-and-tools/suicide-warning-signs

2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta. Web-basedInjuryStatis-ticsQueryandReportingSystem(WISQARS). 2012.

3. Centers for Disease Control and Prevention, Atlanta. NationalVitalStatisticsReportsontheNationalCenterforHealthStatistics.2007.

4. Kaiser Family Foundation, Menlo Park, CA, and Urban Institute, Washington, DC. AnalysisoftheCurrentPopulationSurvey,March2010and2011.2012.

5. Moscicki EK. Epidemiology of completed and attempted suicide: toward a framework for prevention. ClinicalNeuroscienceResearch, 2001; 1: 310 – 23.

6. National Action Alliance Work-place Task Force, Washington DC. Executive testimonial videos, 2012. http://www.actionallianceforsui-cideprevention.org/task-force/workplace

7. Partnership for Workplace Mental Health, American Psychiatric Foundation, a subsidiary of the American Psychiatric Association. Washington, DC. 2012. http://www.workplacementalhealth.org/Business-Case.aspx.


Broadspire’s fifth anniversaryas part of the Crawford family

Celebrating

Broadspire is claim, medical and absence management services that are all about you.

MDGuidelines™

Comprehensive toolkit with return-to-work & treatment guidelines, FMLA & more

LeavePro™

Best in class software lets you administer employee leaves with ease

Expert Case ManagementAbsence administration from the industry's most trusted RTW experts

Everything You Need to Reduce the Cost, Risk and Complexity

of Absence Management

Contact Us Today

866.218.4650

[email protected] | www.reedgroup.com®

8. Partnership for Workplace Mental Health, American Psychiatric Foundation, a subsidiary of the American Psychiatric Association. Washington, DC. 2012. http://www.workplacementalhealth.org/Pages/EmployerInnovations/Search.aspx

9. QPR Institute, Spokane, WA. Trainings. http://www.qprinsti-tute.com/about.html

10. Rockett I, M Regier, N Kapusta, J Coben, T Miller, R Hanzlick, K Todd, R Sattin, L Kennedy, J Kleinig, and G Smith. Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000 – 2009. American Journal of Public Health. September 2012.

11. The Naval Center for Combat & Operational Stress Control. San Diego, CA. 2012. http://www.med.navy.mil/sites/nmcsd/nc-cosc/Pages/welcome.aspx

12. The Suicide Prevention Resource Center, Waltham, MA. 2012. http://www.sprc.org

13. U.S. Department of Health and Human Services, Office of the Surgeon General and National Action Alliance for Suicide Pre-vention. 2012NationalStrategyforSuicidePrevention:GoalsandObjectivesforAction.Washington, DC. September 2012. http://www.actionallianceforsuicidepre-vention.org/NSSP

14. Working Minds Program, West-minster, CO. http://workingminds.org/training.html

KateA.Burke,AssociateDirectorofthePartnershipforWorkplaceMentalHealthattheAmericanPsychiatricFoundation,asubsidiaryoftheAmericanPsychiatricAssociation.


Protective Factors Help Prevent Suicide

•Restricted access to highly lethal means of suicide

• Easy access to a variety of clinical interventions

• Effective clinical care for men-tal, physical and substance use disorders

• Strong connections to family and community support

• Support through ongoing medical and mental health care relationships

• Skills in problem solving, conflict resolution and handling problems in a non-violent way

• Cultural and religious beliefs that discourage suicide and support self-preservation

www.suicidepreventionlifeline.org

FEATURE:BehavioralWellness

PAINAct Local—on Injured Tissue—to Prevent Pain from Going Global

Such cases often involve disproportionate pain, which may become a focal point of efforts to help the patient recover and regain function.

Even if a candid conversation with the claimant is possible, the case may still look like a “black box,” with case managers wondering, “What is driving this pain?” Chronic pain can involve many factors, including subjective psycho-social issues like co-worker conflicts or secondary gain (seeking attention or paid time off).

In complex cases like this, chronic pain can look as much like a “behavior” as a diagnosis.

Medical research is showing that pathological physical changes occur with chronic pain, so complex that “be-havior” may be an appropriate description, especially since these changes may occur in parallel with psychosocial issues. The neurological system has complex responses to intense stimuli (a.k.a. “pain”) at several levels: in the injured tissue, interacting with the dorsal horn (spine) and in the central nervous system (brain).

In “The Fear of Pain and the Pain of Fear,” a pre-conference session at the 2012 DMEC Annual Interna-tional Conference, Dr. Marco Vitiello, CEO of CMAP Interpretive Services, explored the physiological changes producing pain that medical providers and case managers work with as they guide a claimant toward healing and closure.

“Medical research is showing that pathological physical changes occur with chronic pain, so complex that ‘behavior’ may be an appropriate description, especially since these changes may occur in parallel with psychosocial issues.”

very case manager has seen cases that appeared

likely to resolve quickly, but instead became

extended chronic cases, falling outside disability

guidelines, with multiple issues. E


Opioids and PainOpioid prescriptions can reduce pain for patients during acute stages after an injury by affecting the way sen-sory input is processed in the brain. Research has shown that opioids cannot always prevent the sensory processing that produces “pain.” Opioids affect the way the brain processes incoming pain signals. But opioids don’t end pain sensory processes in the injured tissue, or the processing that occurs in relation to the spine, or the transmission of pain signals to the brain through multiple neural channels.

Vitiello said that when a person uses opioids over a longer period and develops a tolerance, “receptors in the brain actually change shape and become insensitive to opioids so they have diminished potency.” If these changes continue and the opioid dose is increased, opioid-induced hyperalgesia can occur, where recep-tors in the brain actually amplify pain signals transmitted through nerve fibers from the injured tissue.

Other neural processes can also cause hyperalgesia. In cases of severe and prolonged pain, pain signals trav-eling from the region of the injury to the spine may induce what is called a “wind-up” phenomenon. In such cases, specialized “nociceptor” nerves have a lowered threshold to transmit pain signals, and other nerve fibers that usually don’t transmit pain signals may become able to generate and transmit pain signals. Once these pathologic changes have occurred to create hyper-algesia, it can be difficult to correct.1

Vitiello notes that in unresolved injuries extending beyond duration guidelines, where higher doses of opioids have been used, the risk of hyperalgesia is high. This risk can be mitigated by replacing opioids where possible with other pain management tools to reduce local tissue inflam-mation, a primary cause of pain.

In short, “acting local” can keep pain from “going global.” The CPDM course developed by DMEC states that pain-averse patients may need education and encouragement to accept a limited role for opioids, coupled with more aggressive use of other pain management alternatives.

What’s Happening in This Tissue?A low-cost, efficient tool in assessing a patient’s recovery status is range-of-motion testing. By showing a key aspect of functionality in affected body parts, range of motion can be combined with other data to help physicians assess the patient’s recovery status.

When recovery is delayed, or a party to the case disagrees with the doctor’s assessment, other tools come into play.

Functional capacity evaluation (FCE) provides more thorough testing of range of motion, strength and endurance, often focused on physical capacity requirements of essential job functions. “Any appli-cation of technology to return to work, whether workers’ compensation or not, is an ADA case,” comments

Roy Matheson, President of Mathe-son. To stand up in federal courts, Matheson said, any testing protocol must meet federal standards estab-lished in response to Daubert v. Merrell Dow. This includes whether the expert’s technique or theory has had peer review (in most cases) and is generally accepted in the scientific community.

“The usefulness of an FCE depends on who’s doing it, and afterwards, who is evaluating and interpreting the results,” said Judy Lemm. Judy Lemm Consulting provides disability management services to school districts and other public agencies, including facilitating interactive process meetings which usually involve a review of extended-duration claims.

“It’s best if the FCE findings are reviewed by an orthopedist, physiatrist, occupational medicine physician or a well-trained occu-pational therapist,” said Lemm. “Those professionals have the expe-rience to validate the FCE results, compare them with other findings and make a revised treatment plan. FCEs do have a place, but you have to be careful about the interpretation,


It all starts simply enough – an employee is absent from work.

But what happens next can turn a routine absence into a complex, costly

claim – one that increases exposure and drains productivity. Finding ways

to manage employee absences can be challenging for many employers.

Sedgwick’s disability administration and absence management team can

help. We have the technology-enabled services and a world of expert

resources to support and improve the health of your valuable workers

and the productivity of your organization in an e�cient, compliant,

cost-e�ective manner.

Sedgwick proudly supports the DMEC

www.sedgwick.com | [email protected]

and putting all the testing pieces together.”

Magnetic Resonance Imaging (MRI) provides an image of conditions in tissue, including the ability to detect inflammation when used in conjunction with intravenously injected MRI con-trast agents. MRI is too expensive to use frequently, however.

Nerve conduction studies (NCS) provide data about neural activity in individual muscles, facilitating an understanding of dynamic processes in muscles. Regarded as the “gold standard” by the American College of Neurology, NCS data facilitates diagnosis of disorders of muscle and nerve. NCS testing of a muscle can be more expensive than MRI, and is in-vasive, using electromyogram sensors with needles that must pierce skin and enter muscle. Lemm commented that in the San Diego area where she op-erates, she’s more likely to find nerve conduction studies already have been performed on upper extremity claims, and FCEs less often, “but that may vary from region to region.”

Surface electromyography (SEMG) gathers data from muscle groups to assess range of motion. The Official Disability Guide states SEMG testing is validated for diagnosis of segmental rigidity in cases of low-back pain, and can provide data about a patient’s readiness to engage in stabilization, endurance or strength training activi-ties.

One such tester is Med-Tek, using an examination protocol developed by Comprehensive Muscular Activity Profiler (CMAPTM) that incorporates SEMG. Data from examinations is interpreted by CMAP Interpretive Services (CIS). Vitiello of CIS claims the new digital sensors used by Med-Tek gather data sufficient to identify whether injured muscles demonstrate acute or chronic conditions. This is a key issue in treatment and claim clo-sure decisions, and litigation. SEMG

testing is non-invasive, and its cost is roughly half the cost of needle EMG.

Getting to ClosureFortunately, not all cases that have extended beyond projected durations have developed full-blown chronic pain; in many such claims, case managers may have the opportunity to prevent that. For extended-duration claims, “I want to know, first and foremost, if people are genuinely hurt and what we can do to help them. In the event they are not injured, the question becomes how can we get them back to work,” said Malcolm Dodge, AVP Risk Services Program Manager, Sedgwick. That question, in fact, has driven many of the pilot projects and implementations that Dodge has participated in during his career.

In a 2008-09 pilot, Dodge investi-gated the CMAP testing system using surface EMG (SEMG) sensors to facili-tate the “further treatment-or-closure” decision in extended-duration claims. The pilot focused on upper extremity workers’ compensation claims that were six to eight weeks from the injury date.

“In our experience in managing expensive but non-catastrophic cases, we’ve noticed that four factors are fairly common,” Dodge said. “Those were cases involving surgery, longer-term narcotic use, longer-term physi-cal medicine services, or extended disability duration. In the pilot, we wanted to get to cases with an inter-vention timed to precede these fac-

tors from developing.” The 44 cases in this study generally had a profile of not having resolved within six to eight weeks but they had not yet reached a point where some of the costlier factors had already occurred.

All cases were managed by Sedgwick for one employer, applying the same utilization review, case management and bill review processes. All but one of the 19 cases referred for SEMG evaluation received treatment in Kai-ser’s Oakland facility, where the staff was trained and the program installed. The 25 control cases that didn’t receive SEMG evaluation were treated in other health care facilities.

Up to the point of entry in the study, it appears both groups had similar severity of injury: $12,375 in costs for cases referred for SEMG evaluation vs. $11,651 for controls.

Part of the challenge in upper extremity cases is that pain may be felt in one location, but the disease process may be occurring elsewhere. Pain location and other symptoms may suggest carpal tunnel syndrome, and conservative treatment may partially alleviate those symptoms. But the actual cause may be muscle inflam-mation in the neck, compressing the median nerve where it exits from the spine before passing down the arm and through the carpal tunnel.

In the Sedgwick pilot, SEMG testing was applied both to the affected arm and the corresponding neck region, and the patient’s other arm and neck region, and this data was compared


Life and Disability products underwritten by Anthem Life Insurance Company. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

22216MUEENLBS 7/11

Look at us now.Find innovative group life, disability, integrated health and absence management from one reliable source.

with the CMAP testing database. Testing included an FCE protocol for the upper extremity, gathering data on range of motion, and dynamic pro-cesses in muscles including circulation and inflammation.

From the intervention to the six month follow-up, average incurred cost in the referral group was $10,750 (SEMG testing and evaluation in-cluded), a decrease of 13.1% com-pared to pre-intervention costs. Over that same period of time, the control group increased 14.2% to $13,307 average incurred. The most significant savings, though not quantified, might be driven by the 63% closure rate in the referral group, compared to the 48% closure rate in the control group, at the 6-month follow-up.

Dodge concluded, “We found in using CMAP that favorable case out-comes were achieved; namely, cases cost less and they closed quicker. For longer term cases with neuromuscular features, CMAP may also prove helpful to a treating physician in devising a modified treatment plan to achieve a better outcome for the patient.”

When claims go into extended duration, many studies have shown that psychosocial factors can play an important role, and deserve review and possible action by case managers. But complex neural processes affecting pain also can extend a claim beyond disability guidelines. Closely monitoring what’s happening in injured tissues can pay off for case managers and employees recovering from injuries.

References1. Vadivelu N, Sinatra R. Recent

advances in elucidating pain mechanisms. CurrentOpinioninAnaesthesiology.18 (5): 540 – 7. 2005.


Special inStructionS:none

Q6664_FMla_3-5X9-5_mg.indd

client: Liberty MutualDescription: FMLApublication: DMAC Program BookScale: 1:1print Scale: None

live: 3.25” x 9.25”Frame: N/Atrim: 3.5” x 9.5”Bleed: NoneGutter in Spread: N/A

art Director: ShaughnessyStudio op: Van Riperusername: Rachel Van RiperprojectManager: Morseproduction: NeilsonFile Status: Mechanicalart Status: Approvedresolution: 300 dpi

Job colors: CMYK

ink name: Cyan Magenta Yellow Black

Font Family:Arial, Arial Narrow

liBr-cMaD-Q6664 1-13-2012 4:55 pM page 1

lM_Masterbrand_horiz_cMYK.eps (...Mutual:DAM:Brand Assets:1_Logos:Liberty Mutual:Liberty 2012:Master:Horizontal:K:KO:Process:LM_Masterbrand_horiz_CMYK.eps), linkedin_in_cMYK.eps (images RO:Ll:Logos_Common:Linked In:LinkedIn_IN_CMYK.eps), twitter_newbird_blue.eps (images RO:Ll:Logos_Common:Twitter:twitter_newbird_blue.eps), Q5855_1107051_00180215_143_combined_Mg.tif (...ages RO:Ll:Liberty Mutual:DAM:Retouched:Q5855_FMLA:MagazineSWOP2006_Coated3v2:Q5855_1107051_00180215_143_Combined_Mg.tif), Q5855_1107051_00200245_Mg.tif (images RO:Ll:Liberty Mutual:DAM:Retouched:Q5855_FMLA:MagazineSWOP2006_Coate

Follow Liberty Mutual Insurance. @lmbizinsurance

GROUP BENEFITs

LIFE

sTD/LTD

LEAVE

c A s E s p E c i f i c s :

When a large financial services company was losing

customers due to attendance issues in their call centers,

they turned to Liberty Mutual Insurance for help with

managing their family medical and other leave programs.

Our experts, aided by proprietary technology, then applied

a solution to streamline absence reporting and ensure

consistent tracking and management of all their leave

programs. Expertise and innovative solutions — that’s

how we help support your business. To learn more, visit

libertymutualgroup.com/workforce

i n d u s t ry: FINaNcE

c u s to m E r : cONsUMER FINaNcIaL sERVIcEs cOMPaNY

c A s E o b j E c t i V E : sTREaMLINE PROcEss aND

LOWER LOss-TIME

tHAt’s notAt WorK isn’t

E X ActLy A forcE.

A WorKforcE

© 2

012

Libe

rty

Mut

ual I

nsur

ance

ABSENCEMatters


Interplay: Behavioral Health Issues and the FMLA

Over the years, the fine line between poor job performance and FMLA protection has become blurred in many areas, but

especially with respect to behavioral health con-ditions. So, when is an illness an excuse for poor job performance versus a qualified FMLA need? Consider the following court decisions for guid-ance on how to best react in behavioral/FMLA scenarios.

Behavior might be a trigger for notice under FMLAA number of courts have found that changes in behavior can be considered FMLA notice of need for leave due to a mental condition. In Stevensonv.HyreElec.Co.,505F.3d720(2007), a stray dog entered an employee’s workspace, and her extreme emotional and physical response con-tinued for approximately a month, when she received a termination letter. The court found it was possible the employee herself was unaware she was suffering from a serious medical condi-tion until she went to the emergency room, but even after that she did not request leave. The court found her behavior was so bizarre that it amounted to constructive notice of the need for leave.

In Byrnev.AvonProducts,Inc.,DocketNo.02-2629,7thCir.(2003), John Byrne, a night-shift engineer, was a model employee until security cameras caught him frequently sleeping at work. His supervisor called Byrne at home to discuss this, but his sister said he was “very sick.” Byrne agreed to a meeting, but didn’t show up. He was fired for sleeping on the job and skipping the meeting. After two months of treatment for depression, he was ready to return to work. The company refused to reinstate him, so he sued. Although Byrne never gave FMLA notice, the 7th Circuit held that when notice is not feasible

because of the employee’s condition, such notice may be excused. In fact, the court said, Byrne’s dramatic change in behavior could be notice enough of a serious FMLA-qualifying medical problem.

But behavior change does not excuse poor job performanceIn the case of Throneberry v. McGehee-DeshaCountyHospital,DocketNo. 03-3822, 8th Cir.(2005), 10-year employee Sandra Throneberry had received above-average employment evaluations and was given increased responsibility. In 1998, her mental and emotional health deteriorated after a divorce and her father’s death, and her job performance began to suffer. In August of that year, Throneberry’s supervisor recommended she take a month’s paid leave of absence to “get herself together.”

During the month of leave, she continued to appear at the workplace, acting disruptively. She was asked to resign and ultimately did, but Throneberry said she would have continued employment had she realized she may have been entitled to additional FMLA leave. After her res-ignation, the Hospital found she had ignored job responsibilities, costing the Hospital nearly $40,000. Had these facts come to light prior to the resignation, the Hospital said, she would have been fired.

Throneberry sued the Hospital, alleging interference with her FMLA rights. The Court found that the FMLA “simply does not force an employer to retain an employee on FMLA leave when the employer would not have retained the employee had the employee not been on FMLA leave.”

Bryon E. Bass, CPDM Sr. Vice President

Absence Management Practices, Sedgwick

BEHAVIORALMatters


Avoid Employee Productivity Pitfalls by Knowing the SignsThere is an increasing emphasis on pre-

vention in the health care industry as organizations work to change the system

from one that focuses on treating people after they become ill, to one that focuses on preventing sick-ness in the first place. And while not all medical problems that lead to a disability absence can be predicted or prevented, many can be identified sooner with the right training and resources in place.

Employers have a financial incentive to implement effective ways to prevent disabilities and keep employees healthy and on the job. Ac-cording to a study published in the Journal ofOccupational andEnvironmentalMedicine, the overall annual cost of poor health in the workplace is estimated at $1.8 trillion.2

The first signs of a potentially disabling injury or illness often surface through an employee’s emotional well-being. Some of the most common, “hidden” influencers of a possible disability occurrence are behavioral, emotional, social and work-related issues.

But these early warning signs aren’t always easy to identify—especially if managers aren’t trained to look for them or employers don’t offer resources to help their employees cope with what’s troubling them during difficult periods in their lives.

Workplace programs like employee assistance programs (EAPs), behavioral health services, and vocational rehabilitation each play a vital role. By integrating health and wellness programs—including those for behavioral health—into a comprehensive absence management program, employers can help identify workers who may need early intervention to help prevent dis-abling illness and injury.

For example, for customers who used Cig-na’s EAP in 2011,1 the company found more than 90 percent of individuals surveyed reported improved productivity at work, and about 83 percent reported that the EAP had improved their work attendance.

There is also a positive benefit to integrating EAP and behavioral health benefits. The same survey revealed that employees who used EAP services saved an average of 7.34 hours—time they would typically have spent looking for help or resources on their own. Offering an EAP decreased the need for employees to visit the doctor and in addition, there was as much as a 20 percent lower behavioral health cost versus people with medical benefits only and no EAP access.

Family medical leave can also be a potential front-line indicator of future disability leave absences. Cigna’s own book of business shows that employees on family medical leave were five times more likely to have a subsequent short-term disability claim compared to those who were not on leave. In addition, employees on leave for a family medical reason were 50 percent more likely to have a subsequent short-term disability claim for behavioral illness than those on leave for other reasons.

Comprehensive absence management pro-grams can make a big difference for employers. Having the right resources and systems in place to catch warning signs of disability early can help employers prevent disability absence, and help keep employees healthy, productive and on the job.

References1. Cigna. AnnualInternalSurveyofEmployee

AssistanceProgramParticipants. (Unpublished internal survey). Cigna, Bloomfield CT. 2011.

2. Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K. Health and Produc-tivity as a Business Strategy: A Multiemployer Study. JournalofOccupationalandEnviron-mentalMedicine. 51(4):411 – 428. 2009.

Dr. Robert N. Anfield, MD, JD, FAAFP

Chief Medical Officer CIGNA’s Disability

Business

All employers are challenged with effectively managing their workforce to gain maximum productivity.

Whether your company is small or large, using internal resources or relying on vendor expertise, Spring can help.

Our customized solutions integrate benefits, create process efficiencies and consistently reduce costs across disability, workers’ compensation, FMLA, health management and other initiatives.

Learn how our solutions can help.

617.589.0930www.springgroup.com/dmec

Total Absence ManagementIntegrated Disability ManagementHealth and Productivity Management

Who or What is missing...

from your puzzle?

Count on The Hartford to help you navigate the complexities of absence management and guide you through the management of your employees’ leaves. You’ll get access to resources to help boost productivity, tips for improving efficiencies and an integrated approach to tracking who’s out and why.

The Hartford’s Absence Management

© 2012 The Hartford Financial Services Group, Inc., Hartford, CT 06155. All Rights Reserved. The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including its administrative services company, Hartford‑Comprehensive Employee Benefit Service Company and issuing companies Hartford Life Insurance Company, Hartford Life and Accident Insurance Company and Hartford Fire Insurance Company. All non‑property and casualty policies sold in New York are underwritten by Hartford Life Insurance Company. The home office of Hartford Life Insurance Company is Simsbury, CT. All property and casualty policies are underwritten by Hartford Fire Insurance Company, Inc., and its property and casualty affiliates, Hartford, CT. This document outlines in general terms certain benefits and services that may be afforded under a Hartford policy or service contract. In the event of a conflict, the terms and conditions of the policies and contracts prevail. All Hartford policies and services described in this document may be offered by one or more subsidiaries of The Hartford Financial Services Group, Inc.4367 NS (12/11)

Contact your Hartford representative today or learn more at thehartford.com/productivity.

With The Hartford behind you, achieve what’s ahead of you.®

Manage absenteeism.DON’T LET IT MANAGE YOU.

HEALTH&Productivity


Got EAP?Are you getting the full value from your

Employee Assistance Program? For most of the folks I talk to in risk manage-

ment or human resources, the answer is “no.” Most employers have not coupled their EAP with their disability and workers’ compensation programs. If you have not taken this step, you may be missing an opportunity for high value benefit synergy and better utilization of your behavioral health investments.

A good, in-depth EAP includes services which help employees cope with stressful events. These services may include telephonic or in person sessions with a psychologist or a counselor on how to cope mentally with these events. They may include specialized services which help the employee contact community based programs for practical aid, such as transportation while disabled or short term childcare.

Many employees who have a new disability event—work related or otherwise—don’t think about their EAP. The EAP was one of those items in that blizzard of paper the employee got during open enrollment. Since the EAP did not have a large price tag attached to it and it did not involve selecting a physician panel, the employee probably did not spend much time thinking about it.

Now that same employee is suddenly disabled. His or her monthly income just went down. Getting back to work is uncertain. Much of the person’s support system—the people he or she knows and trusts at work—is cut off. In many cases, family dysfunctions that the person coped with when everything was “normal” now loom much larger. Practical problems suddenly pop

up such as how can I take care of my family when I can’t drive and I feel loopy from the drugs I’m taking? Everything is topsy-turvey.

This is STRESS, writ large.

Here’s where the employer can make a big difference. If you have not done so already, talk to your STD and workers’ compensation ad-ministrators about how they can include EAP information in the new claim acceptance letter. The simplest implementation is this—you craft a generic letter on company letterhead to the newly disabled employee (to be included with the proof of loss letter) which reminds him or her of the EAP services available and how to contact the EAP.

If you have more than one EAP, list all of them and which regions each one serves. If you have many operating divisions with different names, use the letterhead of the top organizational level—the enterprise name. Naturally, corporate legal will have to review the wording to make certain that the nature and limits and applicability of the EAP benefit are precisely expressed. If you have significant numbers of employees who do not have the EAP, you may need to work with your comp administrator so the letter is included only with appropriate proof of loss letters.

Bottom line—your employees will be getting mental health and related assistance precisely when they need it most and your return to work success will improve—a win for all parties.

Guest Columnist: Gary Anderberg, PhD

Practice Leader for Analytics and Outcomes,

Broadspire Services a Crawford Company

In Chicago on March 19, the DMEC Lead-ership Series, sponsored by Liberty Mutual Insurance, will address the Americans with

Disabilities Act Amendments Act (ADAAA).It will be the first part of the annual, em-

ployer-only series with a focus on the ADAAA. Continuing the series protocol, the on-site meeting will be followed by a national webinar. The discussions will be summarized in a white paper to be released at the 2013 DMEC Annual Conference.

The Leadership Series will provide employer insights and experience in incorporating ADAAA compliance with overall disability and return to work programs.

“In talking with customers and producers, everyone is concerned about compliance with the ADAAA,” said Heather Luiz, Disability, Life and Leave Product Manager for Liberty Mutual Insurance Group Benefits. “This is very much like FMLA was in the mid-1990s, when employers were faced with understanding federal leave laws and maintaining compliance,” she noted.

Passage of the ADAAA gave new impetus to the original ADA by shifting the focus away from disputes over whether a person has a qualifying disability under the ADA. It accomplished this by expanding the definition of disability dramatically. This moved the ADA from a contained compli-ance mandate to a question mark for employers, who must devote new resources to the interactive accommodation process required by the ADA.

“ADAAA needs to be incorporated into an employer’s absence and return to work programs as there is overlap in federal and state leave laws with ADAAA regulations,” said Luiz. “Just because an employee has exhausted all of their available FMLA and/or state leave doesn’t mean you don’t need to consider additional leave as an ADA reasonable accommodation.”

The ADAAA is continuing to evolve through legal precedents set by court cases. In 2011, the agency monitoring compliance of the ADAAA, the Equal Employment Opportu-nity Commission (EEOC) promised to provide guidance on the area of when accommodation by further leave would be required. The EEOC has not followed up, however, leaving employers with many unanswered questions.

The Leadership Series will provide employer experience and expert advice about the latest ADAAA developments to bolster employers’ com-pliance efforts. For more news about the Leader-ship Series registration and agenda, watch for announcements on the DMEC website at www.dmec.org.

HR Business Process Outsourcing

Absence Management Delivered Right

Aon Hewitt’s holistic delivery system integrates absence with your health care solutions, streamlines your employees’ experiences, and leads to the improved health of your workforce. It does this while also providing positive outcomes, reducing lost workdays between 10% and 25%, and adhering to all relevant legal and regulatory requirements.

To learn more about how to effectively administer absences and the FMLA, visit aonhewitt.com/absence.

DMECNews


Leadership Series Theme Announced: ADAAA

We Serve Plan Administrators and Plan Sponsors:

Compliance Services and Audits

Evaluation of Procedures

Review of Organizational Structure

Appeal Review

System Selection Consulting

Expert Testimony

Drafting/Updating FMLA Policies & Procedures

John C. Garner, CEBS, CLU, CFCI, CMC is the National Leg-islative and Government Affairs Advisor to DMEC. He is considered an expert in disability, FMLA and ADA issues.

Our Audit Edge: Our philosophy is positive.

Our aim is to improve service to the client. Our approach focuses on opportunities for improvement.

Our reputation: tough, but fair. We like it that way.

630 N. Rosemead Blvd., Suite 300 Pasadena CA 91107

(626) 351-2300 Fax (626) 351-2331 www.garnerconsulting.com

Their absence is your lossIt’s no secret. When employees miss work, productivity suffers. Mercer offers a full range of absence management solutions, including FMLA and disability policy design, life and disability audits and outsourcing services for companies of all sizes.

Want to know more? Contact Mercer:[email protected] | +1 415 743 8820www.mercer.com

CHAPTERNews


Atlanta Chapter Kickoff Meeting Nov. 15

Adding another new local resource for DMEC members, an introductory meeting was held in the Greater Atlanta

area on Nov. 15, to launch a new East Coast chapter.

It was a great opportunity for Atlanta absence management professionals to network, plus learn more about the ongoing startup campaign for a GA/Greater Atlanta chapter. That process continues as sponsors and local employer leaders emerge to develop chapter programming for 2013, around DMEC’s Annual International Conference at the Omni Hotel in Atlanta, August 18 – 21.

The meeting included an extended network-ing reception sponsored by Lincoln Financial Group, a new DMEC member. Lincoln Financial Group offers group insurance products for em-ployers including short-term disability, long-term disability, accident, life and employee assistance programs.

Return to Work (RTW) was the meeting theme. John Early, Delta Air Lines Benefits Manager, presented “Delta’s RTW Program—Meeting employee needs, accommodation, the interactive accommodation discussion, and the ADAAA.” Early provided a sequenced walk-through on a typical absence, beginning with intake communication with the employee, through claim management, and beyond the disability claim to the employee’s return to work. Early said he’s excited about networking opportunities in the GA/Greater Atlanta chapter.

Yolanda Harper, The Home Depot Senior Manager, Medical Health Management, pre-sented “Embracing Our THD Philosophy... begin with an end in mind in relation to RTW.” The Home Depot has a tradition of innovations for workplace safety, including a program to manage workspace accommodations through its RTW process. The Home Depot was an early leader in employee use of back braces, and went beyond policy and promotion of back braces to participate in extensive research validating the benefits of back brace use.

The meeting provided two continuing edu-cation units (CEUs) toward maintaining the CPDM professional designation for absence and disability management. CEUs are just one of the many benefits afforded attendees at all chapter meetings.

For further information about leadership opportunities and to participate in the Greater Atlanta chapter, contact Chapter and Volunteer Liaison Sharon Milligan at [email protected] or call 800-789-3632, ext. 103.

Register online today at www.dmec.orgJob Seekers» Find jobs targeted at your specialty without having to

wade through thousands of irrelevant postings—for free.

» Never miss new opportunities! Set up email alerts that will notify you of new job postings meeting your criteria.

» Post your resume anonymously—stay connected to the employment market while maintaining full control over your confi dential information.

Employers» Put your opening in front of the largest pool of

qualifi ed candidates on the planet. By using the DMEC Career Center, you gain unparalleled access to our unique membership.

» Job broadcasting puts your ad in front of more job seekers quickly.

» You can browse all of our anonymous resumes, before you pay a cent.

DISABILITY MANAGEMENT EMPLOYER COALITION5173 WARING ROAD · SUITE 134 · SAN DIEGO, CA 92120-2705800.789.3632

Thank You to our 2012 National SponsorsDiamond SponsorsMetLife | The Hartford

Platinum SponsorsAon Hewitt | Broadspire | CIGNA | Liberty Mutual | Med-Tek | Mercer | Pacific Resources | Prudential | Sedgwick CMS | Spring Consulting Group | The Reed Group | The Standard | Unum

Gold SponsorsAetna | Anthem Life

INDEXofAdvertisers


Aetna ................................................5

Anthem Life ...................................15

Aon Hewitt ................................ 21

Broadspire .......................................11

CIGNA ...........................................24

Garner Consulting .......................22

Liberty Mutual ..............................16

Med-Tek ..................................... 22

Mercer .............................................22

MetLife ............................................12

Pacific Resources ........................ 8

Prudential .......................................24

Reed Group ................................ 11

Sedgwick CMS ..............................14

Spring Consulting ........................19

The Hartford ..................................19

The Standard ..................................2

Unum ..............................................6

Your company is like no other. That’s why Cigna gets to know your organization and helps you tailor your plans accordingly. Our integrated disability and health care solutions can help you improve your employee health and productivity – and your business health too. To learn more, contact us at [email protected].

© 2011 Cigna. All products and services are provided by operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Life Insurance Company of New York, and Life Insurance Company of North America. The registered mark “Cigna,” the “Tree of Life” logo and “GO YOU” are owned by Cigna Intellectual Property, Inc. 836568 a 10/11

A compAny like no other shouldn’t hAve A heAlth plAn like All the others.

T:3.5 in

T:4.75 in

1 PS8/6/12Job No: CGLI-A4186

Job Name: DMEC Disability Ad Pub: DMEC@Work Issue Date: Prod: 1/4 page/4c Trim: 4.75 x 3.5

________ ACCOUNT

________ WRITING

________ DESIGN

________ CREATIVE

________ TRAFFIC

________ ART RIGHTS

________ PROOF READING

________ SPELL CHECK

Prepared by

Prudential Advertising,

213 Washington St

Newark NJ, (973) 802-7361

Fax (973) 367-6173

WITH 60 YEARS OF GROUP DISABILITY EXPERIENCE, PRUDENTIAL HAS THE STABILITY CLIENTS TRUST.

• Our Long Term Disability Insurance protects more than 2.8 million employees

• Our Short Term Disability Insurance protects more than 1.8 million employees1

Visit us online at www.prudential.com/gi to find out more.

1 LIMRA, 2011 Annual U.S. Group Disability Sales and Inforce Survey. Number of employees covered based on certificate in force.

© 2012 Prudential Financial, Inc. and its related entities. Group Disability Insurance coverages are issued by The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102. Prudential, the Prudential logo, Bring Your Challenges and the Rock symbol are service marks of Prudential Financial, Inc., and its related entities, registered in many jurisdictions worldwide.0225937-00001-00

http://www.aetna.com

http://www.anthem.com

http://www.aon.com

http://www.choosebroadspire.com/

http://www.itstimetofeelbetter.com

http://www.libertymutualgroup.com/lmgroupbenefits

http://www.med-tek.com

http://www.mercer.com

http://www.whymetlife.com

http://www.pac-res.com

http://www.prudential.com/group

http://www.reedgroup.com/dmec

http://www.sedgwickcms.com

http://www.springgroup.com

http://www.hartfordlife.com

http://www.standard.com

http://www.unum.com

Newly revised edition –� e comprehensive guide you’ve been looking for!Newly revised edition –

FOUNDATION FOR OPTIMAL PRODUCTIVITY:

The Complete Return to Work Program Manual

� is 190 page resource is a must for every employer who wants to better manage absence, improve productivity and positively impact the bottom line with an e� ective RTW program. Features best practices and case studies from real life situations.

Best practices and case studies from real life situations will provide all levels of absence management practitioners real situations to draw from programs that work.

KEY FEATURES

• Identify the best process for returning impaired or disabled employees to work• Understand the regulatory pitfalls of RTW/SAW• De� ne the importance for benchmarking your program• Learn the issues to sell your program to upper management • E� ectively communicate RTW to employees• Sample letters • Tips and facts to assist employers handling of employees with behavioral health conditions • 18 case studies• Sample forms including: job functions, medical release, history and current treatment, assessment of illness and function, work function assessment

P a g e | 11

Intervention or Trigger Points

Although lost time is

the typical trigger fo

r RTW initiatives, s

avvy employers recognize the value of

intervention even before an absence begins. For example, an ergonomic assessment for an employee

experiencing neck pain may not be a lost time event, b

ut it certainly does pertain to RTW philosophies

and best practices. R

egardless of th

e terminology used, proactive processes may be effective in reducing

overall spending even though the savings m

ay initially be difficult to

implement and track. Documenting

all trigger points is

important so they can be easily

transferred from a plan feature into a process.

From this perspective, RTW is q

uite basic.

Figure 1.2

Complexities expand when employers, employees, a

nd their vendor partners b

egin to change existing

core processes to achieve the best o

pportunities for R

TW even if full ti

me, full d

uty is not an option.

Adjusting existin

g habits and sim

ple methods will likely translate into a more comprehensive RTW

program and more significant gains. C

onstant program monitoring, analysis, and attention to detail a

re

important. As noted earlier, e

very RTW process is diffe

rent but below is a summary of th

e core RTW

process considerations.

Figure 1.3

The entire process is important. However, when establishing a core plan or revisin

g a current RTW

program, consider the following as high priority

:

initiatives, savvy employers r

ecognize the value of

ce begins. For example, an ergonomic assessment for an employee

t, but it

certainly does pertain to RTW philosophies

ed, proactive processes may be effective in reducing

overall spending even though the savings m

ay initially be difficult to




nd


pportunities for

Adjusting existin

g habits and sim

ple methods will likely translate into a more comprehensive RTW


onstant program


very RTW process is di

process considerations.

The entire process is important. Ho


:

initiatives, savvy employers r

ecognize the value of

ce begins. For example, an ergonomic assessment for an employee

t, but it

certainly does pertain to RTW philosophies

ed, proactive processes may be effective in reducing

be difficult to




nd


pportunities for

le methods will likely translate into a more comprehensive RTW


onstant program


very RTW process is di

The entire process is important. Ho


:

P a g e | 42

Introduction

When implementing a new return to work (RTW) program or modifying an existing one, resistance and

obstacles exist and must be overcome at all levels within the organization. With RTW, as is the case with

many companywide initiatives, the commitment must be present from the top down. From there, plans

and processes must engage stakeholders and be clearly communicated. Although not all challenges can be

anticipated, considering the following in advance may ease the hurdles associated with RTW:

• Manager/supervisor concerns

• Employee motivation

• Role of the treating physician

• Bargaining unit positioning

• Organizational commitment

• Shifts in control

o Turf wars and combating silos

o Repairing a broken program

o The effect of downsizing

o Repairing a broken program

• Culture of RTW

Manager/Supervisor Concerns

Managers and supervisors are under increased pressure to deliver more with less. Many believe

modifying jobs or physical work environments may be a barrier to getting the job done. They also

perceive that injured workers—not performing at full capacity—may slow down production. Strong RTW

programs respect this perception but educate managers/supervisors about productivity and modified duty.

In practice, most jobs can be easily modified to accommodate the physical limitations an employee

experiences; however, direct superiors may need help identifying modification opportunities and support

tools for ongoing RTW efforts. An RTW Coordinator is a strong resource for managers /supervisors

assuming mutual trust and respect exists. Line management should be reminded that few people work at

100%, and an experienced person at 80% is more valuable than an inexperienced person at 100%.

One of the most critical stakeholders in the success of an RTW program is managers/supervisors. Without

their daily application of RTW efforts and their ongoing communication with employees, even a strong

program will not succeed. Ideally, line managers and direct supervisors should be involved in the earliest

stages of program development. This will educate them on the complexities of the program as well as

Americans with Disabilities Act (ADA) and workers’ compensation (WC) requirements. In addition, they

can spearhead educational sessions and tools to dispel myths and foster shared goals. Productivity and

cost-center incentives often motivate supervisors to leverage the RTW program, but they will also be

engaged and supportive if they know the organization is committed to RTW and monitoring outcomes.

Employee Motivation

An employee who cannot immediately RTW can easily become disengaged or disconnected from the

workplace. The longer an employee remains off work, the more likely it is that this detrimental separation

will occur. Maintaining regular supportive and caring communication will help reduce the probability of

unnecessary and lengthy lost time. From the onset of the disability, supervisors, along with an RTW

Coordinator, should explain the RTW program to the employee. It is important to lay a foundation of

flexibility surrounding schedule and duties if the condition does not allow for RTW at full time, full duty.

Stressing an employees’ value, even in a reduced capacity, will support the overall RTW goals.

and current treatment, assessment of illness and function, work function assessment

P a g e | 42

When implementing a new return to work (RTW) program or modifying an existing one, resistance and

obstacles exist and must be overcome at all levels within the organization. With RTW, as is the case with

many companywide initiatives, the commitment must be present from the top down. From there, plans

and processes must engage stakeholders and be clearly communicated. Although not all challenges can be



anticipated, considering the following in adva

Manager/supervisor concerns

Role of the treating physician

Bargaining unit positioning

Organizational commitment

Turf wars and combating silos

Repairing a broken program

The effect of downsizing

Repairing a broken program

Manager/Supervisor Concerns

Managers and supervisors are under increased pressure to deliver more with less. Many believe

modifying jobs or physical work environments may be a barrier to getting the job done. They also

perceive that injured workers—not performing at full capacity—may slow down production. Strong RTW

programs respect this perception but educate managers/supervisors about productivity and modified duty.

In practice, most jobs can be easily modified to accommodate the physical limitations an employee

experiences; however, direct superiors may need help identifying modification opportunities and support

tools for ongoing RTW efforts. An RTW Coordinator is a strong resource for managers /supervisors

assuming mutual trust and respect exists. Line management should be reminded that few people work at

100%, and an experienced person at 80% is more valuable than an inexperienced person at 100%.

One of the most critical stakeholders in the success of an RTW program is managers/supervisors. Without

their daily application of RTW efforts and their ongoing communication with employees, even a strong

program will not succeed. Ideally, line managers and direct supervisors should be involved in the earliest

stages of program development. This will educate them on the complexities of the program as well as

Americans with Disabilities Act (ADA) and workers’ compensation (WC) requirements. In addition, they

can spearhead educational sessions and tools to dispel myths and foster shared goals. Productivity and

cost-center incentives often motivate supervisors to leverage the RTW program, but they will also be

engaged and supportive if they know the organization is committed to RTW and monitoring outcomes.

Employee Motivation

An employee who cannot immediately RTW can easily become disengaged or disconnected from the

workplace. The longer an employee remains off work, the more likely it is that this detrimental separation

will occur. Maintaining regular supportive and caring communication will help reduce the probability of



unnecessary and lengthy lost time. From the onset of

Coordinator, should explain the RTW program to the employee. It is important to lay a foundation of

flexibility surrounding schedule and duties if the condition does not allow for RTW at full time, full duty.



Stressing an employees’ value, even in a reduced

P a g e | 170

value, illustrated by both the global acceptance of RTW programs as well as the evolving role RTW

programs play as part of a larger Integrated Health and Productivity program.

Watson Wyatt Worldwide’s 2007/2008 Staying @Work reports40 conclude that RTW programs are an

important part of an effective health and productivity (H&P) program resulting in decreased lost time,

reduced medical cost, and healthier employees.

Figure 14.1

58%

60%

62%

68%

71%

36%

45%

10%

23%

15%

20%

34%

19%

34%

16%

18%

38%

42%

30%

47%

22%

34%

6%

25%

18%

0%10% 20% 30% 40% 50% 60% 70% 80%

Effectiveness of Top Five H&P Practices

Increase Productivity Improves Employee Satisfaction Improves Employee HealthReduces Costs Program in Place

Work/Life Balance

Operational Mgr. Involvement in Absence Mgmt.

Fitness Subsidy/ On-site

Written Transitional Return-to-Work Plans

Ergonomic Workstations

Furthermore, their 2007 Canadian report specifically cites that written transitional RTW plans are one of

the top five most effective H&P practices and rate highly in regards to reducing costs, improving

employee health, improving employee satisfaction and increasing productivity.

In a special report prepared for the New York State Department of Labor (2008)41, RTW programs

“would encourage the continued contribution of these injured workers to society, help control disability

program costs and protect the competitive vitality of the State’s economy… .” The report went on to

recommend a number of components and strategies important to an effective RTW program including

RTW education, communication, improvements in the physician’s role, incentive programs to encourage

hiring of disabled workers, improvements in data collection and others.

The Government of Western Australia conducted a literature review of “best practices” for employers,

health care providers and employees.42 This report emphasized employee psychological health and well-

being and the powerful impact of simple strategies on the success of RTW programs. These strategies

Purchase online at www.dmec.org

behavioral wellnessdmec.org/wp-content/uploads/@work-magazine_december-2012.pdfmetlife the hartford...

Documents