Everyone returning to work after a long illness or injury faces a challenge. They know they will be watched to see if they can still do their job. They also have more basic worries. Will my desk have moved? Who has been doing my work in my absence? Have they altered the team I work with?
In more serious cases, workers may have to change their occupation and their employer. They will then need all the help they can get.
Sadly, the UK lags behind other countries in getting people back into employment. Work-orientated rehabilitation is far more advanced in the US, Sweden and Australia, but rehabilitation has never held a high place on the NHS agenda. This was recognised by Anne Gibson, a speaker at the recent ABI/TUC conference on getting people back to work.
Gibson, chair of the TUC’s rehabilitation committee, says, “The NHS has mostly failed the tens of thousands of working people who have been forced out of their jobs by illness and injury.
“The provision on offer is often too late because of waiting lists, too little because the NHS needs to get on to the next case, and too unreliable, with provision varying widely from one part of the country to another.”
In many cases, the system itself is to blame. Before a condition can be treated, it must be correctly diagnosed. Under the NHS, a number of factors tend to get in the way of early diagnosis. As general practitioners cannot be experts in everything, patients often need referral to a specialist. They may have to wait several months before the appointment with the consultant. GPs may even be reluctant to refer because of budget constraints, so that treatment is continued within the practice.
When the consultation has taken place, the patient then has to join a waiting list for treatment. This results in patients lapsing into chronic conditions and losing their confidence.
Far quicker intervention is needed, and if the NHS cannot act quickly enough, it is up to employers and insurers to set the ball rolling.
The vast majority of claimants under income protection policies want to be functioning members of society again. Very few would prefer to spend the rest of their lives on benefit. The same is true of victims of industrial and road traffic accidents, although they usually want a large sum of money into the bargain. The key to the problem lies in making early contact.
Peter Jeffs, head of income protection claims at Zurich Life, comments: “Insurers are increasingly coming round to the idea of early intervention. We’re trying to work with employers so that they notify us of absences. Where the insurance has a six month deferred period, we aim to visit the absentee after three months.”
Pre-admittance visiting – home visits before a claim is admitted – represents a departure from income protection insurers’ previous practice. Absolutely nothing used to be done during the deferred period, before the claim came in. Unfortunately, this often allowed the window of opportunity to pass. The afflicted person drifted into incapacity.
Early intervention is vital for rehabilitation to succeed, as the longer a person is off work, the less likely they are to return.
The case is clearly made by the national epidemic – backache. Someone off with a bad back for six months has a 50% chance of returning. Someone off for two years has almost no chance of ever working again. But the traditional remedy of bedrest and painkillers does not succeed.
The Spring Medical active rehabilitation centre in Chiswick does exactly the opposite. It puts groups of patients through a strenuous exercise programme. Better results are achieved by increasing mobility rather than concentrating on the symptoms of pain.
Spring’s marketing director, Victor Last, says: “The group mechanism is very powerful. Where programmes overlap, newcomers can see the improvement in people who’ve been on the course for a week. By the end of the programme, 90% of people are on course to achieve the goals they had when they arrived.”
The cost of a three week programme at Spring Medical is £3,275. But this is far less than the cost of paying an income protection claim until retirement age. Several income protection insurers have used the company’s courses, including Norwich Union, Legal & General, Allied Dunbar, Friends Provident, Royal & Sun Alliance (RSA), and Zurich. And there are several other specialist rehabilitation centres around the country, dealing with everything from brain injuries to repetitive strain injury and chronic fatigue syndrome (ME).
Rehabilitation has so far been employed mainly in connection with income protection. But it is also highly relevant to PMI, employers’ liability (EL) and motor insurance.
Royal & Sun Alliance’s liability account manager, Gary Faulkner, is keen to speed up the process. “Currently,” he says, “employers liability is fraught with difficulties. An employee seriously injured at work must enter the minefield of lengthy debate with the employer, followed by a claim process that may take years, not months, to resolve.” Faulkner is planning a back to work scheme which will see the light of day next year. The idea is for an independent counselling and legal service which would bridge the gap between the two parties. It would be linked to EL and personal accident products.
“I envisage much more than a helpline,” says Faulkner. “It will involve face-to-face contact between the injured party and an independent counsellor.” The counsellor would be either outsourced completely or provided by FirstAssist, a company within the RSA group.
But physical rehabilitation is only part of the solution. Even if a person is physically better, they cannot be made to return to work if psychologically unable. Motivation is central to the process. After an absence, people’s confidence needs building up. They may also require vocational guidance and retraining. This is the time for disability counselling.
Loss adjuster, Crawford THG, operates a counselling service through its healthcare division. Zurich and Generali are also to the fore in this area. But UNUM, which set up its service as long ago as 1986, probably has the longest track record. UNUM’s disability counsellors try to visit the absentee within the deferred period – before a claim is made – wherever possible. Most of their time is spent in initial visits, though they follow up at least once a year once a claim commences.
The counsellors’ basic objective is to find out who is most willing and able to get back to work. They then concentrate on those with the best prospects. The process has little to do with medical rehabilitation. It is more concerned with pre-vocational assessment. Where a return to the previous job is impossible, assessment concentrates on the skills and abilities the claimant still has. Claimants get help with writing a cv, filling in application forms, and learning how to succeed at interviews.
Examples from UNL; M’s casebook reveal a variety of ways in which counsellors have helped.
A quantity surveyor was required to drive to different sites in order to perform his occupation. He was struck down with multiple sclerosis, gradually losing his eyesight until he was no longer allowed to drive. UNUM paid for a personal assistant/driver so that he did not have to give up work despite his disability.
Another case concerned a manager who suffered a severe mental breakdown. He was unable to return either to his former job or any alternative position with his employer. UNUM referred him for assessment to Open Door, a service provided by the charity, Rehab UK. They identified skills and interests which led to a teacher training course. This led to a new role teaching foreign students.
Rehab UK also runs the Disability Assessment Unit (DAU), which is supported by a number of insurers, including Northern Star and Highway Motor policies at Lloyd’s. The DAU has so far processed only motor claim cases, but is planning to widen the net to other classes of business.
Of course, the new approach to claims management is not one developed by insurers purely out of altruism. They expect to make savings on claim payments. The other parties involved all stand to benefit too. The sick or injured person regains self-respect through being helped back into work. The employer gains where a trained worker is able to resume their job. Even the broker can benefit through having a more contented client.
Yet not everyone favours rehabilitation. Some claims managers are afraid that rehab providers are there to make money out of them. There are legal obstacles too. Personal injury lawyers have historically concentrated on getting the maximum award for their clients. The longer the client is off work, the higher the claim for loss of earnings. So they have not encouraged measures to ensure an early return to work.
Fortunately, there are signs that a more holistic approach is now being taken. The focus is moving towards improving the claimant’s quality of life, rather than securing the maximum damages at all costs. And the challenge is on to make sure all parties work together to this end.