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Underwriting and Claims

Is Work Good for You?


Employee Benefits meeting 2

The answer to this question may not be as obvious as one would think. During a time when we enjoy good health, earn a salary roughly commensurate with our duties, interact with like-minded colleagues and have a boss who is reasonable, or when we have a profitable business, the general consensus would be, yes, work is good for us. However, when any of the above mentioned conditions are threatened, we may start doubting the general consensus.

In this article, I focus on one of those conditions that affects the insurance industry: enjoying good health. One study concluded there is strong evidence that work is generally good for physical and mental health and well-being. However, in the insurance industry we experience on a daily basis that policyholders become claimants because of their firm belief that it is no longer safe for them to work, or that they do not enjoy sufficient health to continue working. There seem to be two main areas of concern: the perception that one has to be 100% disease- and symptom free to be considered fit for work, and the lack of engagement and understanding from clinical medical practitioners who are in a position to address this misperception.

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What does "health" mean?

A 1948 definition of health by the World Health Organization (WHO) still rings true today: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Could it be that the industry's search to identify and objectify a strictly medical cause as a reason for absence from work (or performing occupational duties) is causing unintended consequences for claim drivers? Actually, the opposite seems to be true: self-belief and how people perceive their health aggravate and perpetuate illness and disability. The challenge, therefore, is to convince policyholders that work is good for them, and in order to achieve this, a move to a bio-psychosocial model, rather than the industry's traditional biomedical model, should be considered. In retail insurance the insurer has an additional, important role to play as formal employer for self-employed individuals. In an employee benefits scenario, the insurer needs to work together with all stakeholders, including the employer, clinicians and the employee.

Changing the perception of unfit for work to fit for work

In 2008, Dame Carol Black presented a review of the health of Britain's working age population, "Working for a healthier tomorrow", that considered the economic cost of ill-health to Britain. Her paper proposed a number of recommendations, including changing the view that it is inappropriate to be at work unless one is 100% fit. Acknowledging that the general practitioner is often the first to shape the claimant's perceptions about his or her illness, and whether absence from work or duties is warranted and for how long, she recommended that the sick note should be replaced by a ‘fit note', thus focusing on what the person is able to do. Black also recommended the development of a strategy for early intervention that incorporated a holistic care approach, involving multidisciplinary teams and case managers.

The South African insurance context

Here in South Africa, in the absence of a comprehensive national health service and significant state benefits, private life insurers can expect to fill this gap that cost Britain £100 billion annually in lost productivity due to worker illness, with taxpayers covering more than £60 billion in benefit costs, additional health costs and lost taxes. In Australia it is estimated that group insurers are paying out in excess of $160 million annually for income protection and permanent disablement claims, and that is only for mental illness claim causes. So why are we not telling insureds that work is good for them, given the high cost of their remaining unfit for work? Admittedly, it is no easy task to challenge long-held assumptions and beliefs, but here are a few recommendations on how to start the conversation:

  • Acknowledge the fact that psychosocial factors are claim drivers and incorporate them in our assessment and case management principles.
  • Educate the insurance sales force, policyholders and various other stakeholders such as clinical medical practitioners on the benefits of returning to work and earning an income.
  • Promote early intervention by engaging with policyholders to help shape their personal beliefs and attitudes about health and their ability to work.

Accepting the responsibility and owning the process, we can convince policyholders that "work is good for you."


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The Author

  • Marilda Kotze
    Head of Claims
    RGA South Africa

Summary

This article addresses the question of whether work is good for us. Ms. Kotze asserts that yes, work is good for us, challenges insurers and re/insurers to change our communications to all stakeholders – claimants, policyholders, and the medical community – and offers a few recommendations for how to begin those conversations.


  • Attending Physician Statement
  • personal wellness
  • claims investigation
  • antiselection
  • claims