Part 2 - Path to Health: Disability Claims Management Redesign - Building Relationships of Trust


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Part 2 - Path to Health: Disability Claims Management Redesign - Building Relationships of Trust

For my second 'Path to Health' installment, I’m going to start at the very beginning of the process: the initial application for disability benefits.

Before we started our re-design project, we didn’t often talk to a plan member about their claim. We waited to get their paper, we read the paper, we recorded our decision on paper and then we sent them a letter and another form to fill out (otherwise known as more paper). The #1 reason people called us was to check on the status of their claim wondering if, or when, they would receive their disability benefit payment (where is my money?).

When we re-designed our process we knew we needed to start building a relationship of trust with our plan member right from the very first piece of paper. This would lay the foundation for all of the work to come in their disability claim including recovery and return to work. And so the initial expectations call was born.

Our new process: as soon as the very first piece of an application for disability benefits is received in our office, whether it is a complete claim or not, we telephone the plan member for the initial expectations call. The purpose of the call is to tell the plan member just what they need to know now and the next step. Our conversation informs the plan member that:

  1. We have received their claim.
  2. What, if any, information we are waiting for and how to get it.
  3. We can help them fill out any remaining forms.
  4. How the process will work once we have their complete claim and the timeline.
  5. When they will get paid and how often they will get paid, if their claim is approved.
  6. What the next step is.
  7. They can call us any time if they have more questions or need assistance.

We conclude the initial expectations call by asking the plan member if they would like the information we just shared in writing. If the plan member says yes, we email (or mail) the same information.

Following the initial expectations call, once we have the complete disability application and it is set up on the system, we call the plan member again to let them know that their claim is complete, it is moving to their adjudicator, and they will be contacted by their adjudicator within 3 business days. Simple but comforting.

Each initial expectations call takes about 10 minutes to complete. It is an investment of time and resources. But now our plan member knows who we are and how to contact us, understands the process and the timelines, and most importantly knows what will happen next.

People who are applying for disability benefits are in a vulnerable state of health and their entire livelihood is hanging on our decision. That is a big burden to them and a big responsibility for us. No wonder plan members feel anxious and nervous and want to understand where there claim is at! Wouldn’t you?

So what is the impact of the initial expectations call? Comparing January 2020 to January 2019 – a 72% reduction in the number of status update calls we received from our plan members. It’s still early in our journey but so far the results are looking pretty favourable!

Next week in 'Path to Health' Part 3, I will share how we built our new disability case management checklist with inspiration from the World Health Organization.

Final thought for this week comes from Stephen Covey: “Trust is the glue of life. It's the most essential ingredient in effective communication. It's the foundational principle that holds all relationships.”

Wishing you a week filled with the comfort that comes from a trusting relationship,


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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