2009 General Meeting ● Assemblée générale 2009 Ottawa, Ontario ● Ottawa (Ontario)

1. 2009 General Meeting ●Assemblée générale 2009 Ottawa, Ontario ● Ottawa (Ontario) L’Institut canadien des actuaires Canadian Institute of Actuaries Session/séance : Group LTD Claim Audit Findings Speaker(s)/conférencier(s) : Kevin Braybrook

2. Background Initial Liability Decision Claim Management Change of Definition Staffing Presentation Outline

3. Common LTD Claim Audit Findings LTD Claim Audit Focus: Initial Liability Decision Claim Management Change of Definition Background

4. STD to LTD transition Eligibility Verification: Covered member; Actively at work; Prior Carrier; Proof of age; Pre-Existing Condition Investigation. Initial Liability Decision

5. Accurate Benefit Calculation: Verification of prior earnings; Reduction of benefits to match billing statements; All Source Maximum Calculations. Initial Liability Decision

6. Job Description and Physical Demands of the job Internet Searches Initial telephone interviews Initial Liability Decision

7. Review coverage information Disability definition verification Medical: Over “medicalizing”; Timing; Medical Consultant making claim decisions. Appropriate Offsets Acceptance Letters Initial Liability Decision

8. Claim adjudication vs. processing Caseload prioritization Claim Management

9. Claim management plans Short-term focused; Next steps; “Checklist” approach. Claim Management

10. Claim management tools: Independent Medical Examinations; Functional Claim Evaluations; Surveillance; Home Visits; Rehabilitation; Lump-sum settlements. Claim Management

11. Similar to initial liability decision Timing of investigation Medical documentation Document decision Change of Definition

12. Adjudicator empowerment Realistic and manageable caseloads Routine audits Staffing

13. QUESTIONS ?