Doctors want what is best for their patients – it is at the core of the Hippocratic Oath. Unfortunately when it comes to disability claims, identifying what is best for the patient can prove both challenging and frustrating. The primary challenge: a lack of essential information, such as the patient’s job responsibilities, the employer’s willingness to make accommodations, and the insurer’s own desire to identify what is best for the patient/claimant. Frustrations include the time and energy required by the disability claims process, the seemingly endless parade of vague, ineffective forms, and even a sense of being pressured by both the patient and the insurance company.
Fortunately, there is a better way. RGA’s Dr. Elyssa Del Valle, who has worked on both sides of the insurer-attending physician relationship, will be sharing her insights on this subject at the upcoming ROSE® (Reinsurance Outcomes and Service Experts) Conference on September 13-15, 2017. We sat down with Dr. Del Valle to discuss how disability providers can develop mutually beneficial partnerships with doctors to achieve positive outcomes for clients.
What is the biggest misconception disability insurers have about working with attending physicians (APs)?
People on the insurance side often assume that the AP does not want to hear from them. It is important to remember that doctors want to be doctors, not disability experts. By providing information otherwise unavailable to the AP – the nature of the patient’s job, the related restrictions and limitations, whether the employer is willing to make accommodations, etc. – insurers can take the onus of making a disability decision out of the AP’s hands. Asking the right questions is part of that process, which can be facilitated using the right forms. As an example, the ROSE program has created form templates for specific impairments that are simple for APs to fill out, yet provide essential information for reaching a claims decision.
What is the best way to get all parties – claimant, claims analyst, attending physician, employers – working together?
As with any collaboration, it starts with aligning incentives. In the case of disability insurance, that usually means working toward one common goal: getting the claimant/patient/employee back to work when possible. Doctors want what is best for the health of their patients, and that includes leading productive, fulfilling lives. Employers want their employees to contribute as much as they can to the business. Claims analysts at insurers want to support their clients in times of need with the goal of moving them toward recovery. That is why an effective case manager is so important: to facilitate communication among all parties, identify these aligned incentives, and produce an outcome that satisfies everyone, particularly the human being at the center of it all.
When and how does the process of aligning incentives start?
Time is essential. It starts by getting all parties involved as early as possible to develop a reasonable return-to-work plan. The focus should be on what the person can do instead of what they can’t do. Collectively, we need to boost the employee’s confidence and encourage a return to work, outlining the financial and personal benefits. This may involve vocational training and exploring new fields of employment. We need to advocate with employers for job modifications, such as part-time work, additional workplace flexibility, and ergonomic accommodations. And we need to work with APs to expedite treatment, including advocating for timely treatment from specialists to whom they have referred their patients. The sooner we get started, the sooner people return to work and to a better quality of life.
What can attendees expect to learn from your presentation at the ROSE Conference?
I will be discussing the roles of the various players in a disability insurance claim and how all parties can best work together. We will explore a variety of related considerations – from occupational restrictions and limitations to the non-medical factors affecting claims. Topics will be supported by real-world examples from my own experience, and I will elicit additional examples for analysis from attendees. I will also walk step-by-step through a return-to-work scenario using lower back pain as an example, highlighting tools and resources at a claims analyst’s disposal. I intend to make it a valuable discussion that will provide practical insights that can be put to use right away.