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Mental Health claims: JEIS and LTD Approach

Public Education Benefits Trust Conference November 26, 2013. Mental Health claims: JEIS and LTD Approach. Early Assistance Process. Why an Early Assistance process and is it helpful with members with symptoms of a mental illness?

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Mental Health claims: JEIS and LTD Approach

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  1. Public Education Benefits Trust Conference November 26, 2013 Mental Health claims: JEIS and LTD Approach

  2. Early Assistance Process Why an Early Assistance process and is it helpful with members with symptoms of a mental illness? • the quicker we identify the issues and provide assistance, the more likely it is that we can help a member back to work and to a productive life Who are Desjardin’s Early assistance team ? • DFS's team consists of 8 Health Care Management Specialists (HCMSs) throughout the province. Backgrounds of the team include Kinesiologists, Rehab Specialists, Activation Specialists and Human Resources. We are a close knit team and are skilled in working with individuals with many different types of disabilities

  3. Our Unique approach • We do what makes sense. • We look "outside the box" for the right plan for each member. • We apply an individual approach to each situation • How does this work with members with a mental illness in the workplace?

  4. What to expect in the Early Assistance Process It all starts with a conversation between the member and the HCMS. We focus on: • Building relationships, trust and rapport – all crucial particularly with members who are experiencing mental illness. • Gathering information from all stakeholders (areas of concern – what and why do we need to know?) • Family support and how do we help? • Connection with the family doctor - why is this important?

  5. Is this a Work Related Issue or is it Mental Illness? • Why do we need to know? JEIS program does not work with Work related issues • What are the challenges? Often a performance or work related issue is actually caused by symptoms of mental illness and it can be a challenge to really understand the cause. • What steps do we take to make this determination? The HCMS will speak with the member at length and all stakeholders including union, management, physician and even family members if given permission.

  6. Case Management Plan – "Blue Print" to successful return to work • HCMS assess the member's current level of function vs. job demands • HCMS will identify the actual barriers for a successful RTW - with mental illness there are often special circumstances which need to be considered. • Develop a case management plan based on all of the information gathered and in conjunction with the member • Focus on the right services at the right time - plan needs to be pro-active, timely and always focused on the individual member's needs.

  7. What Kinds of Services are Used in the JEIS process? We apply a common sense approach and assess what the member needs to be able to return to work. Examples of the resources utilized: • Physiotherapist • Occupational Therapist • Life coach • Activation therapist • Psychologist For individuals experiencing mental illness, services will often include (but are not limited to) Cognitive Behavioural Therapy (CBT), EMDR, Activation programs, and group therapy.

  8. LTD Hand-off from Early Assistance seamless (don't have to tell story twice) Guide them through Initial interview – we listen Other info – we take responsibility Medical Consultant Common sense approach –we take responsibility for good decision (IME, home visit, clinical notes,) Decision

  9. Why Would an LTD Claim Be Declined? Long Term Disability

  10. Long Term Disability Why Would an LTD Claim Be Accepted?

  11. Our Rehab Focus in the LTD Process • Our overall Strategy for successful Rehabilitation in the LTD period: • Focus on current function (ability vs. disability) • Removal of barriers preventing successful RTW • Common sense approach – what makes sense? • Provide the right resource at the right time • Set clear goals and attainable benchmarks • Monitor progress and maintain communication • Revise the plan as needed –remain flexible • Celebrate small victories and keep small issues in perspective

  12. What are some of barriers we address in the Rehab Process? • Modifying job duties • Flex schedules • Concentration tips • Memory tips • Working relationships • Handling stress • Coping with change • Managing deadlines – how to organize

  13. Questions Questions?

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