Close Close

Life Health > Health Insurance > Health Insurance

Returning to a brick wall

Your article was successfully shared with the contacts you provided.

Organizations that study return-to-work programs generally assume that employers are eager to get disability insurance claimants back on the job.

The guiding principle is that the claimants are the ones who want to lounge around at home collecting benefits, and later working off-the-books jobs as lumberjacks after Here Comes Honey Boo Boo reruns lose their appeal.

The first private long-term disability insurance claimant and Social Security Disability Insurance (SSDI) beneficiary I ever met was using the windfall (for Guillain-Barre syndrome) to finance a second career as a union organizer, and a third career as a part-time utility pole protester.

Sen. Tom Coburn, R-Okla., recently reported at a hearing on the SSDI program, that a man he hired to trim his own trees was collecting SSDI. A reader wrote to point out that a little yard work isn’t necessarily incompatible with collecting SSDI. A worker who has qualified for SSDI can earn some income — typically, $1,010 per month — without losing the SSDI benefits. But one wonders: How disabled can a man who’s capable of trimming a tree really be?

But, on the other hand, the third SSDI beneficiary I ever met was “Glenda.”

The details are changed here to conceal the identities of the parties involved and to make up for gaps in my knowledge.

Glenda and Jane worked as secretaries in an office in Pennsylvania.

Glenda was a great worker with a pleasant attitude who learned how to manage the complicated office telephones and office computer network. Jane spent all day complaining about having to work in the horrible office. Then, while Glenda was working day and night helping her employer switch to a new telephone system, she had a heart attack. While she was recuperating, the economy slowed.

When Glenda was ready to return to work, the employer was downsizing. The employer axed Glenda, apparently on the assumption that she could use the company’s group long-term disability (LTD) insurance plan as a long-term unemployment benefits program. The employer kept Jane on as the secretary until she finally made good on one of her promises to quit.

So, what percentage of the short-term disability (STD) and LTD claimants who fail to return to their old jobs are catastrophically disabled, what percentage are deadbeats, and what percentage are throwaways?

Finding the numbers to answer that question is difficult, but the Bureau of Labor Statistics reports that the 2011 unemployment rate for U.S. residents ages 16 to 64 with disabilities was 16 percent, or almost twice as high as the 8.8 percent unemployment rate for people in that age group who do not have disabilities.

When America’s Health Insurance Plans (AHIP) commissioned a survey of commercial disability insurance claimants, it found that 71 percent of the survey participants who had not yet participated in a return-to-work program wanted to do so, and that 64 percent were interested in workplace accommodations programs.

Rosemary Gousman, a managing partner at Fisher & Phillips, a law firm that represents employers, said she sees many cases of employers struggling to get disability claimants to return to work throughout the course of a typical year along with a few claimants per year who are fighting to get the employers to take them back.

Kate Freund, a disability case manager at Medcor, said she helps with about 95 return-to-work claims per month for a large disability insurance client.

“In those cases where there is difficulty in managing the return to work, I would estimate it is split fairly evenly between the employer and either the worker or the worker’s health care provider, as far as who is responsible for creating that difficulty,” Freund said.

Mary Lushina, a senior vice president at Employers Occupational Health, a company that helps workers’ compensation claimants return to work, said claimant characteristics affect how eager the employer is to want to take the claimant back.

Narcotics use is one major obstacle, and lack of education is another, Lushina said.

Freund and others listed employer-related barriers facing STD and LTD claimants who want to return to work:

The employer is doing poorly.

The employer has trouble making the accommodations needed to get the worker back to work.

Labor union rules interfere with making the necessary accommodations.

The employer worries about what will happen if the worker comes back to work and then gets hurt, or gets sick.

The employer is afraid of the effects of one of the many federal or state laws that govern employee leave time, accommodations for workers with disabilities, and prohibitions on discrimination against people with disabilities.

Today, because of the way federal laws, state laws and LTD policies interact, “it is often more difficult to bring an employee back from a long-term disability situation than to accommodate a new employee with the same disability,” Nadine Vogel, a Mendham, N.J., disability employment consultant, testified in September at a House Ways and Means Committee subcommittee hearing.

Disability policy specialists said SSDI — a government insurance program for people who are classified as being unable to find meaningful work anywhere in the national economy — also conflicts with return-to-work efforts, in part because qualifying for SSDI benefits takes so long.

Many people who have SSDI benefits are reluctant to try to take “meaningful work” and risk the possibility that they might lose their jobs and have to go through the determination process a second time, the policy specialists said.

Historically, worker’s comp insurers have used the threat of big rate increases to get employers to support return-to-work programs. The employers “need to think of what the consequences will be if they don’t cooperate,” Lushina said.

Gousman agreed that, in general, the workers’ comp community has been better at getting workers’ comp claimants back to work quickly than the non-occupational disability insurance community has been at getting STD and LTD claimants back to work.

If an employer will have a valid reason to refuse to take a claimant back, a producer should make sure the employer starts planning for that possibility and documenting the circumstances as early as possible, Gousman said.

If, for example, the employer will have to lay an employee who is collecting LTD benefits off because of the state of the economy, “you better make sure you don’t just have a layoff of the one person who’s collecting disability,” Gousman said.

Employers can show that taking an employee back would be a hardship, but doing so can be complicated, Gousman said.

For disability insurance producers who want to help reduce the odds that an employer client will end up in an awkward return-to-work situation, the first step is to make sure that the employer understands what the rules are, Gousman said.

Freund said producers could start talking to employers early about the kinds of return-to-work accommodations that might be needed, such as a position suitable for a claimant who can handle restricted work.

“Some employers have an established list of light-duty jobs within a department or work area that can be readily assigned when an employee is released with restrictions,” Freund said.

In some cases, Freund said, simply explaining to managers why working matters can speed up the return-to-work process.

Producers can help employers understand that work itself can be therapeutic, she said.

“Being at work provides purpose, pride and teamwork,” Freund said.

David Stapleton, a senior fellow at Mathematica Policy Research, made a similar point about the importance of getting SSDI beneficiaries back to work when he testified at the Ways and Means subcommittee hearing.

Stapleton testified that one of his colleagues at Mathematica is deaf, that one has a severe vision impairment, and that two are unable to walk.

If those colleagues stopped working, they could all qualify for SSDI, but they all have the education, skills and access to technology they need to keep working, he said.

“My colleagues choose to work, rather than rely on benefits, because their careers are much more rewarding than a lifetime of dependence on public benefits,” Stapleton said.

Today, he said, SSDI eligibility rules base typically benefits on the conditions individuals have rather than what the individuals can do.

“Our support system essentially funnels people with severe impairments who do not have all of the advantages of my colleagues into a life of dependence on public support rather than helping them to become self-sufficient,” Stapleton said. “Instead of helping people achieve their full potential, the current disability support system has created a poverty trap.”

For more from Allison Bell, see:

PPACA: 19 states missed essential benefits deadline

Disability insurance observer: Snow

About those hybrids …


© 2023 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.