The 1988 Paralympic Games in South Korea changed my outlook on disability - and ultimately helped shift the focus of my group benefits career to disability income insurance and instilled a strong belief in an advocacy-based approach.

At the time, I was a group underwriter with Hartford Life. I also was a pretty serious competitive wheelchair athlete. While I played just about everything - basketball, tennis, skiing - it was in wheelchair racing that I became good enough to compete on a national and then international level, eventually earning a place on the '84 and '88 U.S. Paralympic teams.

In Seoul, I was struck by the fact that the athletes I competed with were often significantly more disabled than many of the non-athletes receiving long-term disability benefits for the cases I underwrote at my job. I wanted to better understand why. What I learned in the process was that a different approach to the disability claims management process could potentially generate better results for everyone.

I talked to a lot of people with disabilities - athletes and non-athletes alike - who were living active, productive lives. What accounted for their success, given the significant challenges they faced? Two common themes emerged, centering on expectation levels and support systems. The folks who were successful had a high level of expectation for themselves. Interestingly, those expectation levels often did not begin with the individual. Sometimes it was another person with a disability who served as a positive role model and often provided a kick in the pants; other times, it was a core support system that offered a vision of what was achievable and the tools to get there. The bottom line was that the level of success people with disabilities ultimately achieved was closely tied to expectations - much like it is for people without disabilities.

Acquiring a significant disability is almost like being re-born. Everything about you and your life can change in an instant. If the messages you consistently receive early on aren't positive, it's going to be difficult to emerge from that environment and focus on what's possible. The disability claims process can feed low expectations, as more time and energy are focused around the loss and what can no longer be done versus what is possible.

Think about it. A person with a new disability often is dealing with the medical community in a significant way for the very first time. There are new terms to understand and treatment options to consider. Initially, an individual may be dealing with physicians who are focused exclusively on a narrow portion of near-term acute care and not necessarily looking at how successful the individual can become in living a full life in the long run. The rehabilitation specialists who are focused on the future generally aren't on hand until after this stage.

This presents a problem. If low expectations are set early on, it can inhibit the scope of what someone will achieve - unless and until something or someone comes along to change the focus to what is possible. Absent that motivation, many people simply never move beyond the new challenges a disability often poses. That's why the right support system is so important to achieving a successful future.

The question for insurance carriers then becomes: How can we develop programs and plan designs that will incent people with disabilities to set higher expectations for their individual success and avail themselves of all available services?

 

Advocacy-based approach

An advocacy-based approach to the disability claims process begins with investing time and effort to understand the whole individual. It eventually evolves to identify and address the barriers to returning to and contributing to the workplace. It's easier said than done.

When the disability claims process is focused on having an employee prove his or her inability to work - whether to physicians, organizations or insurance companies - in order to receive a disability benefit, it's not surprising that people often end up convincing themselves that there is no way they can possibly work. There's little motivation to change if you think your only sense of security comes from the DI benefit.

An advocacy-based approach works with the employee in a different way: "Yes, you have a condition that is affecting your ability to work today, but let's look at the things you can still do and figure out how to get you back to work down the road."

This approach can be applied both to the short-term disability and long-term disability claims process. While STD claims involve shorter leaves and less severe conditions, it is still important to set expectations for return to work early in the process. This frequently begins with recognizing that the affected individual may be facing multiple issues, not just the underlying clinical condition.

This can be a challenge if the process is focused solely on acquiring the clinical documentation to support the claim - and if the employer believes the employee must be 100% fit and ready to work before they return to the office.

First, it's important to understand all of the issues an employee is facing. Maybe he or she has had back surgery, but also is experiencing unrelated family issues causing significant stress. What counseling or support services are offered through the company's Employee Assistance Program?

Second, how flexible is the employer? Even if an employee isn't able to physically return to the office, online training classes could be one road back to productivity. It is all about people making a contribution and reinforcing the bond with the workplace.

In the early 1990s, I crashed and broke both of my wrists competing in the Boston Marathon. I couldn't blow my nose, so you can imagine all of the other things I couldn't do! But I returned to work in just three weeks. The experience reinforced my belief that when it comes to effectively dealing with a disability, expectations, motivation and creativity all play a role. Different people are incented by different things, so you have to create the right "wins" to motivate the individual to take the risks to return to work sooner. There's no one-size-fits-all solution. That's why an advocacy-based model is so important.

 

Challenges and solutions

The last few years have brought a number of changes to the disability marketplace. The biggest change is the shift from a relatively narrow focus on disability insurance toward a broader perspective that encompasses overall disability and leave management programs.

Employers must deal with increasingly complex regulations when it comes to administering the Family and Medical Leave Act, not to mention various state and municipal leaves and how these programs overlap with short-term and long-term disability plans and employer-specific leaves.

With the recent economic downturn, Human Resources departments have become smaller in many companies. HR staffs are doing more with less and feeling increased pressure to support a high-performing workforce.

Benefits brokers and group disability plan carriers and administrators can help employers and their HR staffs achieve higher overall employee productivity and manage compliance risk by working together on an effective disability and leave management program - one that is focused on compliance and getting employees back to work at the right time.

I can't overemphasize how important FMLA and leave management is in today's business environment - even for small employers, for whom, arguably, getting people back to work as safely and quickly as possible may be a make-or-break proposition. In a company of 100 employees, even eight short-term DI claims in a year would have an impact on overall productivity.

Balancing the needs of the employer and the employee can be tricky, but with an advocacy-based approach to disability claims, benefits brokers and carriers can help achieve a win-win.

What's the best outcome for an employee who acquires a permanent, significant disability? Is it for them to try to live on 60% of what they earned last year for the rest of their life? Or is the best solution finding a way to get that individual back into the work environment so that they can receive a regular paycheck and fully participate in retirement savings programs and other benefit programs?

How about employees with a significant, but short-term disability? An advocacy-based approach that identifies roadblocks and provides tools to move beyond them gets employees back to work sooner, reduces the chance of recurring or new disabilities, and contributes to improved morale and more positive employee relations.

By keeping employees at the center of the process, setting high expectations for their success and providing the necessary resources to support their return to work, those of us in the disability insurance business can create better outcomes for employers and be a positive force in the lives of employees who acquire a disability.

Foran is Symetra's vice president of Group Life and Disability Income Insurance.

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