Should life insurers engage in rehabilitation?

22 August 2018
| By Industry |
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While some trade unions remain suspicious the Super Review roundtable concluded there was a genuine reason why life insurers and superannuation funds should, in consultation with affected members, play a role in rehabilitation.

Roundtable participants:
  • Mike Taylor (MT) - managing editor, Super Review
  • Col Fullagar (CF) - principal, Integrity Resolutions
  • Suzanne Smith (SS) - chief customer officer, MLC Life
  • Jenny Coleman (JC) - Trustee Advice Partner, NULIS
  • Emma Brodie (EB) - Senior manager, Qantas Super
  • Dr John Aloizos (JA) - Best Doctors
  • Lena Kesoglou (LK) - manager, wellness and recovery, MLC Life
MT So, as we were just discussing, there has been a debate about whether life insurers should be part of the rehabilitation process. Primarily, they focused on TPD. But, let’s look at it from the point-of-view of mental health. And so, I guess, actually – Jenny, I’ll start off with you, on this occasion. Is there a role for life insurers in getting people assessed and back into a normal environment, quicker? Is that going to compromise them, in any way?
 
JC I think you could take the question from two angles. If you take it from the member or the client’s perspective, the best thing for many people is to get back to work, and there are multiple players involved in that process. And, perhaps, part of the problem is, the insurer is, typically, involved at the end of the line, after many, many steps. And, if this is actually about getting someone back to work, for their best health, it’s the doctor. It’s the employer. It’s the worker’s comp process, the insurer, the trustee. And, we need to find a different way. 
 
Instead of going in step after step after step after step, which could have lengthy delays, because the insurer doesn’t get involved until the worker’s comp process is depleted – we all need to be involved at that beginning part, if the objective is to get the person back to work, because that’s the best thing for them – which is not necessarily the objective, as it stands now, where insurance is about providing funding to cover your wealth situation and your funding situation if you are no longer able to work. 
 
So, if everything has gone to pot, then, where does the funding come from? It comes from insurance. So, it’s a different way of looking at insurance. So, I suspect, the conclusion or the solution is far more complex because, at the moment, the product is designed. You pay a premium and you pay a premium so that your funds are secured. We, perhaps, need to think about a different type of product design, whereby the insurer is involved earlier in the process, which is a very long-winded answer, to – saying – yes, I think the insurer should be involved in that early – getting people back to work.
 
MT Lena?
 
LK First of all, insurers already use rehabilitation to support people back to work. And, I think we need to understand that there’s occupational rehabilitation, which is what is currently being utilised and has been utilised for quite a number of years, and treatment rehabilitation, which is where the debate is, in terms of whether rehab should also incorporate some degree of treatment.
 
As I mentioned earlier, I think that having a system where we can support people at their time of need, to get them back into work, is fantastic, but the way we do that is very important. The fact is that it has to be a situation where a person chooses to participate in that – that it’s not an enforceable position – and, that we respect the relationship that they have with their own treating professional. 
 
We have to work collaboratively. I don’t think there is any system that succeeds by trying to enforce, threaten or coerce someone to do something. It doesn’t work. We need to come to the crux of saying, genuinely, “We know this is the scenario you’re in,” or, “Let’s discuss the scenario you’re in. How can we support you? What might that look like for you?” Having those discussions with the treating doctors, as well, and – if that is something that somebody wants to participate in, then, being able to take that journey. I’ve been involved in many scenarios where occupational rehab has made a significant difference on people’s lives. 
 
I had a gentleman who was in his mid-forties – had a stroke. He was left with long-term cognitive deficits, as well as some significant physical deficits. Within 12 months, his wife had left him because of the strain on their marriage and, essentially, saying, “This is not the man I married.” The only thing keeping him alive, when we talk about secondary mental health coming in, was his father. His father had stepped in and he was the one, virtually, there with him, every step of his – you know? And, essentially, I think, keeping him alive. We’d organised an occupational rehab consultant who had experience in working with people with brain injuries. He was able to retain a lot of his previous learnings, but ability to learn new information – short-term memory – was affected. They set up a work trial for him. He was a plumber – working as a plumber – starting three hours, three shifts a week, approximately. Gradually built it up, physically. He was able to retain a lot of his knowledge, though. So, when customers came in and they wanted to talk about, “I need to do these repairs,” et cetera – he had that knowledge. 
 
He was able to move up to full-time work and the employer was so impressed by him that they said, “We want to keep him on”. What he gained from that was not just having a purpose. He actually formed a whole new network of friends, that he had lost when his marriage fell apart and when his friends fell apart. And, psychologically, the impact on him and his family – his parents, et cetera – was tremendous. I always think about him. He’s still on claim with us because he will never earn the amount of money that he was earning previously, and he’ll always be a long-term partial, as he should be. But, what he gained back in his life – and, this was a gentleman – at the start, I thought, “Gosh, what are the chances of getting anywhere, here? What are the chances of getting an outcome with this gentleman?” But, he needed something, and he wanted something, and we were able to say, “Let’s give it a go.” 
 
I think about him all the time, and they’re the people that – where rehabilitation makes a difference, and where you see the power of good work, and return to work, to a person. But, like I said, the way we schedule this and set this up – the way we go, in the future, is very important. We need to have the person’s involvement and agreement. And, if they say no, it should not have any impact on their entitlements, I believe. And, also, I think we need to respect that relationship with the treating doctors. So, I can understand why people might be fearful about how that might work.
 
The other thing that hasn’t been spoken about, with this, is – we need to ensure that, ultimately, it’s going to be sustainable for insurers, in the long term. Once you start entering into the arena of paying for treatment – if that’s not well-managed, that could result in a scenario where, for insurers, it becomes financially unsustainable, in the long term. And, what’s that going to mean for everybody?
 
MT John?
 
JA This is the sort of thing I touched on earlier, where – it’s important to think of that approach from the very beginning. What you outlined is the difference it made for that person because, at the right point of intervention, there was a programmed approach which integrated all the things around the patient’s report – the coexistence. And, I guess, that’s often where these gaps appear. There’s nowhere to turn, no one helps to navigate them, to coordinate that and bring that all together. And, the risk is that they get worse and deteriorate, and that’s a very poor outcome. I’m not quite sure whether there are barriers to that happening, now. But, if there are, it’s completely worth looking at. 
 
I get a sense, because I see it in my work, that an increasing number of people fall back on their superannuation because they’ve exhausted other forms of income. They’ve run out of sick leave. They’ve run out of Centrelink payments. There is nothing else to help sustain, other than going to their superannuation fund, and they mightn’t be approved. But, that actually makes the mental health worse.
 
SS Well, financially, resilience becomes a real issue. How will you be resilient for the rest of your life?
 
JA So, in a time when – an ageing population – more people will be resorting to that, because it’s an increasingly common thing. So, that’s just another scenario. I don’t know how you deal with that. And, I mean, from our perspective, which – many health professionals try to coordinate, but – I think it’s worth thinking, in terms of partnership, at the beginning, in terms of how a person is navigated or introduced to the alternatives for getting better. It actually doesn’t mean the insurance company needs to pay for all the care.
 
People are really struggling, in a country like ours that has a very good health system, to actually understand how the health system works. And, they aren’t necessarily getting the best advice from even my own colleagues, or the medical profession. So, I think that’s something people feel let down by, as well. I’m not saying it’s the insurer’s role and responsibility to do that, but they’re part of a mix of – part of the solution that would make things better.
 
JC John, we would often have issues where we’re trying to seek additional evidence, to support the claim, and we will struggle to get information from doctors, because they’re so busy. Is there a better way of talking to doctors, so that we can work more together?
 
JL Unfortunately, no one’s really cracked that nut. It gets back to – often, the individual doctor needs to write the report, or address that, and, yes, they are busy. It may well be understanding what’s to be gained. It’s not a ‘one request fits all’ type of approach. It’s almost like appealing to the doctor, through the patient, about the reason why this information is important. And, patients do come in, at the same time, to respond to those claims. Maybe there’s a different approach to how that happens. So, it doesn’t turn up just as a letter from the insurance company, saying, “Can you provide a referral?”
 
JC Fill out this form. That’s right.
 
CF I think, if you want to get information out of doctors – to start going for clinical notes, rather than going for a meaningful report, is dangerous, because all you’re doing is going fishing. I’m happy to justify that. As far as – if I wanted to be a cynic – perish the thought – I would say, if you want to get people back to work, send them for an IME (independent medical exam), because the IME will imply, in the report, that there’s been a road to Damascus conversion. They’re all well and they should go back to work, even if that’s flying in the face of all the opinions of the treating specialists and doctors. This is my world. Now, you say, “Yeah, we should get into rehabilitation,” and that’s all great. But, that’s not the reality. The reality is, when people are going through that assessment process, way too often, it’s butchery.
 
SS So, you’re saying, just treat people as humans, right from the start, and give them the respect they need. Get back to basics?
 
CF You’re entering into a relationship with someone who’s sick, injured or grieving. And, you’re saying, from day one, “Here I am. I’m an insurance company. I’m an assessor. Trust me. Embrace me. I’ve got a smiley voice,” and all that sort of stuff. Not going to happen, and it shouldn’t happen. If you want trust, you’ve got to earn it. So, how do you earn it?
 
The first thing is, you don’t ask for it. I would think, crucially, you must work – you get permission to communicate with the treating specialist and you earn their trust. And, once you have their trust, you’re on your way. And, that’s why I get in the middle. And, only when I know the assessor is, to my mind – as flawed as I may be – if I feel the assessor knows their stuff, is respectful, is going to treat this person with respect – then, I will say to that person, “I think I’m redundant. How about you fire me? I will happily get out of the way.” But, by heck, if I think the contrary, there is no way on this Earth I’m going to get out of the way, until the client tells me to.
 
MT Emma?
 
EB I’m just trying to think where we’ve ended up in this conversation. I guess, the additional layer of getting people back to work that we haven’t talked about already, that I see, as a corporate fund, is the employer side of it. Qantas being a very safety-sensitive workforce – and, clearly, there are some roles that people cannot work in, unless they are fully fit. So, that is often a struggle. Fundamentally, we’d have someone that could work – not in their normal role, though. They could do something else, or maybe they could work part-time, and all of that will actually help speed up their recovery, to be fully fit for work. So, I guess, from my angle, that’s the extra layer that we see, in trying to get people back to work – is, often, the manager might not be that overwhelmed with wanting them to get back to work, because they just see the risks of them coming back to work before they’re fully fit – versus us trying to say, “If you at least let them do something, that will give them the purpose. That will help build their confidence.”
 
SS Like a fit certificate, rather than a sick certificate. What they’re fit to do.
 
EB Exactly, exactly. So, there’s – someone who used to work at MLC, who is now the medical officer at QANTAS, has an excellent story of a flight attendant who hurt her – she badly cut her hand – really badly – and was off work, and couldn’t do her role, in terms of – even just simple things like the pouring of drinks to be bought.
 
They wouldn’t let her back. There was no alternative role available, at the time. And, what he did was say, “Okay, well, you can’t go back to work. Let’s simulate that.” So, they actually built a trolley, if you like, at home. And, basically, she went through the role of pouring the drinks and doing that, as if she was at work, over a number of weeks. And, that built up her confidence and her strength, that – she then returned to work. That was one of those things that stuck in my mind, a bit like your case. Thinking outside the box. It doesn’t have to be paid work, necessarily. It just has to be a purpose, to help, if that – can’t work. But, clearly, not everyone is willing to go that extra mile, and do that. It’s not just the normal – 
 
JC And, it can’t be, or be perceived to be, an alternative to paying a benefit.
 
EB No, no. So, clearly, that person was on claim the whole time, until they did return to work. But, ultimately, it shortened the period that they were on claim.
 
CF Can I throw – the left field – to a certain extent, anyway. I think part of the problem is the nature of the products that you have designed. I think they’ve been driven by the wrong beast. The beast they’ve been driven by is risk research, rather than what the client actually needs, in a situation where they’re ill or injured. And, I think the way in which they’re being sold is to focus on the positives. “This will do this, that, and the other.” And, therefore, there is, potentially, an entitlement from the insured that, when something goes wrong, this, that, and the other is going to happen. That, potentially, flies in the face of what you, the insurer, think should happen. You’ve got a whole lot of disconnects out there.
 
LK And, I think, TPD is one of those areas, if you’re talking about particular products. Like you mentioned, there’s been some debate about using rehab in TPD because, normally, occupational rehab has never stepped into TPD. It’s a matter of, “Do you meet this definition or not? Do you get a payout or not?” And, that’s it. And yet, really, what sort of message are we sending? Particularly if you’ve got younger people – suggesting, “You’re never going to work again.” Well, we know that. That’s not what the definitions are saying. Some of the definitions out there are now changing to incorporate things like reasonable retraining, et cetera. But, is that going far enough? As in, I think – Jen, you and I have discussed the scenario where – let’s say, someone is claiming TPD. There’s a reasonable retraining definition and we say, “Yes, if you want to take this reasonable retraining, you could work, therefore, don’t meet this definition.” But, if that course is $10,000, $20,000, and the person says, “I can’t afford it,” there’s potentially a role – to be able to say – well, if, by providing some rehabilitation through training and supporting them to get back to work – would that not be a better outcome for everybody?
 
JC So, that talks to fundamental redesign of products – 
 
LK Yes.
 
JC - in terms of the definitions that apply, and the types, and the nature, and the frequency of payments, because TPD is a rather limiting definition, you know? Nobody actually wants to be totally and permanently disabled, but that might be the bar that you need to meet, so that you can afford the treatment that you need, or the training that you need, or the X, Y, Z that you need to just exist.
 
LK Absolutely. And, look, that’s not to say that there’s aren’t also some medical conditions on that spectrum that John was saying, where – I’ve also worked with people who really, desperately want to work, and their condition is so severe that it almost becomes incredibly, incredibly difficult. 
 
EB But, if you bring it back to the mental health angle, again – if you are – from trying to get the TPD benefit, you’re having to convince yourself that you are TPD, and you’re convincing the insurer that you’re TPD. Then, that becomes a self-perpetuating thing.
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