Brokers and agents need to know something important about how U.S. group long-term disability (LTD) claims management has changed: Over the past two decades, the responsibilities of the vocational rehabilitation specialist (VRS) in LTD claims have contracted considerably.
In the 1990s, VRS professionals had a central role in claims management, maximizing the ability of U.S. claim management teams to meet the needs of both employers and disabled employees.
These experts worked closely with medical and claims experts as part of a multidisciplinary team. Their role combined medical and vocational case management and was actively focused on claim duration management, claimant functional capacity, vocational assessment and optimizing claimant recovery and return-to-work outcomes.
The VRS role now is far more narrow and much less active and collaborative. Medical case management is no longer part of the role – indeed, at several U.S. companies, VRS professionals now report to the medical team. VRS departments are now also far smaller, and often the staffers are no longer directly involved in initial claims assessments. Their primary claim assessment role now is mostly technical: performing the occupational analyses and transferrable skills assessments that enable claims assessors to make benefit eligibility determinations. At many companies, the VRS is not able to, or is not even tasked to, conduct vocational assessments until claimants reach medical stability. Precious time is lost.
Why this contraction occurred is not completely clear, but root causes include: corporate shifts in claim management philosophy; moves to improve efficient use of claims department resources; and a lack of understanding of the value vocational rehabilitation, and the specialists who provide it, can bring to the management of LTD claims.
Where the challenges lie
Disability insurance is really all about the capacity to work as a function of the occupation definition. Vocational specialists are the experts here.
Brokers, agents and insurers need these subject matter experts to help analyze jobs, occupations and tasks as they relate to the various definitions of disability, including the disabled worker's own job and his/her own occupation or own specialty. They can provide guides to allow agents, brokers and claims examiners to successfully explain policy language during the sale process. They can also analyze post-claim data for the benefit of all.
Today's claims management model does not even begin to scratch the surface of realizing the potential benefits from this undervalued and underutilized resource. Several challenges, however, exist around U.S. insurers developing fuller VRS utilization – challenges related to definitions of occupations within group policies; employability assessments to determine viability for work; and having resources to pursue positive return-to-work (RTW) outcomes for claimants.
- Most U.S. group disability claim operations today use a medical model. Nurses and physicians dominate, claims examiners mostly gather medical records, and vocational rehabilitation needs are essentially absent from initial assessments. The collaborative value of consistent use of an interactive multidisciplinary team of claim, medical and vocational experts has been lost.
- Most claims examiners do not understand the differences between a claimant's actual job duties and the "own occupation" as defined by the group LTD policy. (That the definitions in the U.S. Department of Labor's Dictionary of Occupations Titles have not been revised in about 50 years definitely does not help.) This disconnect can significantly affect assessments of a claimant's eligibility as well as the return-to-work outcome.
- Smaller VRS departments mean less likelihood that claimants will receive vocational rehabilitation services.
- The VRS must wait for claimants to achieve medical stability before providing their services. Earlier incorporation of VRS professionals into the process would address claimant functional capacity earlier, matching worker and job function to enable speedier disability recovery and generate stronger return-to-work outcomes.
- A return-to-work focus is significantly absent.
Improvements are emerging
