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Part 1 - Path to Health: Disability Claims Management Redesign

One of the unique aspects of the 4 disability income plans we administer is that they are self-administered, self-insured, and self-adjudicated. This means that we don’t use an insurance company to manage long term disability benefits. We self-insure our own risk and we have adjudicators embedded in our team who adjudicate disability claims. My team works hard every day and are experts at what they do. But we always knew with more resources – both human and financial – we could do so much more. Our adjudicators were managing caseloads of 220 to 260 files per adjudicator. I know someone out there just fell off their chair reading that number. In an insurance company, an adjudicator would typically manage a case load of 60 to 100 files. It’s clear from the numbers that we simply didn’t have capacity to “do more” no matter how much we wanted to.

Over the next few weeks, I’m going to share the story of how we are redesigning the way we adjudicate our disability claims and share some early success stories. First, I have to give you a spoiler alert – we are 1 year into our 3 year initiative. What I hope is that sharing the story of how we got here, the changes we’ve made, and the results we are seeing so far, will inspire you to know that better is possible.

In this first installment, I’m going to tell you how we got our stakeholders from understanding the magnitude of our problem to making a significant financial investment in our project.

One of the first steps we took was engaging our consultant to do a market scan of industry best practice for disability claims management. This allowed us to easily identify all of the places where our processes did not meet industry standard.

Next, at an education event, we led our stakeholders through some disability claim case studies. We asked them to play the role of the plan member and go through the application process. Then we asked them to play the role of the adjudicator and assess disability claims. There is nothing like walking a mile in someone else’s shoes!

There were many other reports, discussions, and presentations along the way. On January 10, 2019, we held a Visioning Day. We invited executive leadership from both unions and employers, physicians, physiotherapists and other practitioners, our entire leadership team and adjudication team (which we call Claims Services), and most importantly we invited our plan members who had been through our disability claim process. We had 60 participants in all. Never underestimate the power of your customer’s voice. If you think you know what your customer wants – you are wrong. For the first half of the day, we asked everyone to tell us ALL of things that are wrong with our process. (Warning – this part is not easy. It is humbling and haunting. It is 100% necessary.) People started out slow on this because they were afraid to hurt our feelings. I told them: “Don’t tell me about the good stuff we do, I don’t need to fix that. Tell me the bad stuff and don’t hold back.” The feedback we got was so consistent from everyone – forms are terrible, everything takes too long, too much paper, and we don’t talk to people. Pure gold! In the afternoon, we moved to gathering feedback about what our process should look like. Together we built a vision statement: “to build collaborative support with beneficiaries on their path to health”. Simple yet profound. We want a process where we build trusting relationships with our plan members and support them through their claim until they return to work or to their normal course of life.

From visioning day, we built a 3 year strategic plan and full business case for our Trustees. On April 3, 2019, the Path to Health Claims Management Redesign Project was approved by our Board of Trustees.

Once we had approval, we mapped out our 52 week work plan for Year 1 that includes 8 concurrent work streams such as recruitment, building a new case management plan, simplifying our forms, an RFP for a new rehab consultant and much more.

Coming up next week in Part 2… how we started building relationships of trust with our plan members from the time the very first piece of their disability application form is received.

To wrap up this week… “Collaboration gives the freedom to come out from the narrow scopes of life to the field of endless possibilities.” Engaging stakeholders and building the vision together is the key to gaining support for your project.

Wishing you a collaborative week filled with possibilities, 


Alana Shearer-Kleefeld is Director of Employee Benefits at 3sHealth and Volunteer Content Creator for CPBI Saskatchewan.

CLICK HERE to learn more about CPBI Saskatchewan!

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