When an insurance company assesses a claim for disability benefits, it typically weighs many factors. These include not only medical information but also the claimant’s functional abilities. At the beginning of the claims process, a claim may be approved for a period of time. Later the insurance company will ask for additional medical information to see whether there have been any changes to treatment plans. These can be modified with new test results or as treatment progresses.
Insurance companies also uses guidelines such as Disability Duration Guidelines (DDG) or Occupational Disability Guidelines (ODG) to help them determine the standard recovery times for injuries and illnesses. These guidelines allow the insurer to compare the claimant’s medical information with the standard recovery timelines according to the nature of the work (heavy, medium, light or sedentary). For each of these types of work a standard recovery timeline is assigned. The guidelines also allow for complications and symptoms so that insurers can extend benefit payments.
As health care providers you may not be aware of the possible accommodations an employer can provide at each workplace. However, the insurer will weigh the possibility of accommodations in assessing the claim. If the employer has an extensive return to work program and can accommodate a patient in a variety of jobs, then it is important for you to understand these options as part of your patient’s medical and functional recovery. The employer and insurer will work with you to identify any possible accommodations and may even propose a return to work plan for your review. The employer’s role is to identify suitable accommodations to
help your patient return to work in a safe, productive and timely manner.
It is in your patient’s best interest from a financial and social perspective to resume ‘normal’ activities during treatment. If you can help your patient understand this then they will likely to be more open to accommodation offers from their employer, which will enable them to return to work. The best return to work strategy involves all stakeholders supporting an individual in their recovery and working towards a common goal of successful return to work.