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Interpreting the Reports

It is important to remember that CR&A provides many ways to view claim information and each reportrevealsonly part of the total picture. Your role in interpreting the reports is contingent upon your ability to understand the data; know how the data relates to the uniqueness of your company or industry; and recognize the influence that management interventions can have on total incidence, lag, duration, and lost work time.

 

The first step to interpreting the reports is understanding the data details. The details reflect the design of the report and the choices that the user makes when constructing the report. The Understanding the Data Details section and the Data Detail section for each individual report will be valuable to help select the right report and interpret it correctly.

 

The next step to interpreting reports is recognizing the effects of the uniqueness of your company or industry. Said differently, the general demographics of an employee population and business-related factors can affect claims experience. Demographic information (e.g., gender, age, tenure, job responsibilities) is particularly important when comparing your claim experience to that of your peers. For example, the Disability Compare - Age report shows the percent of your claims in certain age categories and compares that experience to your industry and the rest of the Unum block. If this report shows that claimants with higher ages have more claims than your industry peers, it could be for one of two reasons:

  1. A higher percent of your older employees are receiving disability benefits, and/or
  2. Your employee population is older.

As you can see in this example, it is important to know the demographics of your employee population in order to draw any conclusions.

 

Another example of the effects of your company or industry on your claims experience can be merger or acquisition activity. Significant swings in the data may be reflective of an organization in transition. Other possibilities for shifts could be a result of seasonal upswing, downturn in business orders, or differences in the demographics of your employee population (e.g., higher numbers of part-time employees when compared to the industry). Additionally, benefit plan design often plays a role in when claims are submitted and how long they last. In general, the overall question to consider is "What is unique to my company or industry that could be contributing to claim experience?"

 

The last piece of the puzzle is recognizing how the actions of your company and its employees can influence total number of claims, lag, duration and lost work time. CR&A reports can provide a view into areas where employer actions could make a difference in incidence and durations of certain types of claims. To help you interpret your reports, we have provided questions to consider, in the following high-level categories:

 

Interpreting the number of claims — STD, LTD and all Disability claims

 

STD CLAIMS — Interpreting a higher or lower number of claims than expected

Demographic, plan design, and environmental factors can influence the total number of claims, either positively or negatively. Sometimes it is important to look at STD claims independently, as they often have characteristics that are different than LTD claims:

  • Has the workforce recently expanded?
  • Is there a potential layoff, merger, or downsizing planned?
  • Is a shorter or longer elimination period contributing to duration and/or incidence?
  • How does the company's sick leave/PTO policy integrate with the disability plan? An employer with a generous (100% paid) sick leave policy that covers the entire elimination period may experience more claims than an employer with a less generous sick leave policy.
  • Is there a problem with employees submitting multiple claims?
  • For customers with self-managed STD plans, are physicians' assessments of restrictions and limitations compared to essential job functions for STD claimants?
  • What is the company's early intervention strategy for management of disability claims? Does the company have formal stay-at-work and return-to-work programs for employees with both work-related and non-work-related disabilities? How does the percent of employees returning to work after a disability compare to that of your peers?
  • Does the company offer back lifting and proper body mechanics classes for new employees and employees returning following a period of disability?

 

LTD CLAIMS Interpreting a higher or lower number of open claims, when compared to total number of LTD claims

Demographic, plan design, and environmental factors can influence the total number of claims, either positively or negatively. Sometimes it is important to look at LTD claims independently, as they can have characteristics that are different than STD claims:

  • Are claims isolated to a particular occupation or tenure (years of service) group?
  • Are the disabilities more or less severe?
  • If a predominance of claims are in the 50 plus or 60 plus age group, is LTD being used as a retirement vehicle?
  • Is there a low percentage of claimants returning to work?
  • Are there established return-to-work and/or safety training programs?
  • Short Duration LTD Claims:
    1. Are quick closing LTD claims related to a substantial claim lag during the STD period (preventing appropriate early claim management)? Are less serious STD claims reaching LTD without proper remedial interventions?
    2. Is the current LTD elimination period appropriate for the type of claims experienced?
    3. How does the company's sick pay and STD plan relate to short duration LTD claims?
  • Are all work-related disabilities that have completed the LTD elimination period submitted for LTD consideration?
  • What is the company's termination policy? Are employees terminated after a specific period of disability, thereby decreasing eventual return-to-work potential? Is this policy the same for both work-related and non-work-related disabilities?
  • Is the eligibility for other benefits contingent on disability (e.g., pension plan, continuation of medical benefits)?

 

All disability claims — interpreting a higher or lower number of claims in relation to the demographics

Sometimes it is important to look at all claims, regardless of benefit type, because the reason for the claim is related to employee experience (e.g., at a particular location, in a particular job).

  • What are the demographics of the claim group?
    1. Do disabilities associated with male or females fall in a certain age group?
    2. Is the claimant population predominantly older (age 50+) with limited retraining opportunities?
    3. Is there an older claimant population or claimants with more severe disabilities, both of which might impact return-to-work success?
    4. Some long-term older employees who are at the higher end of the salary spectrum may be an issue for the company. Typically this employee group has limited employment opportunity outside the company where they have spent their careers. There may be more of an incentive to choose disability.
  • How do employee occupations affect incidence?
    1. Are employees on production lines rotated on a basis to other positions on the line?
    2. Are employees with occupational disabilities offered transitional or light-duty work?
    3. Do the physical natures and longer work hours of some jobs contribute to a burn-out factor?
    4. Are safety and prevention programs in place? Are work processes and tools reviewed by safety teams? These programs could translate to lower Workers' Compensation rates.
    5. What job accommodations or light-duty work accommodations could be implemented to facilitate transitional return-to-work? Do shift requirements or specific work duties prohibit return-to-work?

 

Claim submission lag — interpreting negative lags and longer lags

Claim submission lag (typically referred to as lag) is a measurement of the number of days between the disability date and the date the claim is filed with Unum. Longer lag times can be problematic, as last minute claim submissions may not be complete, causing delays in liability decisions to occur until further information can be obtained. Additionally, delay in claim submissions can reduce opportunities for intensive claims management efforts. There are many factors that can affect lag times. Here are some questions to consider:

  • Are claims being submitted in a timely manner?
  • Do employees have adequate information about the claim submission process and is the process for submitting claims easily understood?
  • Is the process for reporting claims the same in each division/reporting group?
  • Are there a high number of pre-planned surgeries? When claims are filed early, there is a greater ability to manage absences at work. However, pre-planned surgeries can also speak to the medical benefits that are available. Is there a common diagnosis that is related amongst the claimants filing early claims?

 

Duration — interpreting shorter and longer durations

The duration of claims is obviously a large factor in the expense of disability payments. Accommodations for certain types of disabilities can make dramatic differences in durations. Here are some questions to consider:

  • Do durations correspond to a substantial claim lag? A longer lag reduces opportunities for prompt claim intervention.
  • Are there any circumstances (e.g., downsizing, outsourcing or company policies) that may be contributing to extended durations?
  • Does the company offer back lifting and proper body mechanics classes for new employees and employees returning following a period of disability?
  • Do longer durations correlate to higher ages and/or more serious diagnoses? As a group, older claimants tend to have more severe, chronic types of disabilities.
  • Do shorter durations correlate to a higher return-to-work rate?
  • Are plan design features contributing to extended duration (e.g., high Benefit Percent, rich definition of disability, or high Cost of Living Adjustment)?

 

Interpreting diagnostic information — influencing claim experience by targeting diagnoses

The high-level information listed below is meant to target certain diagnostic categories where employer actions can influence the number and duration of claims. For more information on how to manage lost-time expenses for specific diagnoses, please refer to the Proactive Analytic Service (PAS) reports.

 

Important Note:

There is no diagnostic information at the individual claimant level for any fully-insured STD or fully-insured LTD reports. However, there are reports, which both fully-insured and self-insured customers can access, which provide aggregated diagnosis information. The diagnosis information in the Understanding the Data Details for All Reports identifies the diagnostic codes associated within each diagnosis category.

 

Back-Musculoskeletal Disabilities

(Note: Back injuries are categorized with all other injuries in the "Injury/Poisoning" category.)

Back-related disabilities as a group lend themselves to accommodation and rehabilitation intervention, in part because the conditions are rarely life-threatening. An employer can play a role in controlling these impairments and their associated costs. The willingness to accommodate individuals plays a major role in durations and incidence. Here are some questions to think about:

  • What are the demographics of the majority of the claimants filing these types of claims?
  • Does the company offer back lifting and proper body mechanics classes for new employees and employees returning following a period of disability?
  • What are the work schedule patterns? If there are a large number of back and musculoskeletal claims, do these disabilities correlate to 12-hour work schedules?
  • Do the individuals responsible for Workers' Compensation and disability claims share and coordinate information? Is one individual responsible for managing and/or overseeing both functions?

 

Cancer and Neoplasm Claims

The likelihood of getting cancer increases with age. As the average employee age continues to increase, cancer-related health benefit and productivity loss costs can become an increasingly greater problem for employers. Employers can reduce these risks and improve outcomes through strategic management programs that are discussed in greater detail in the PAS report on Cancer and Neoplasm.

If your company is experiencing a higher number of cancer claims, here are some general questions to begin the examination of these claims:

  • What are the demographics of the majority of the claimants filing these types of claims?
  • Does the company offer a flexible work schedule for employees who may need time off and/or modified work schedules/duties?
  • Does the company offer educational programs or cancer screening exams in the workplace?

 

Maternity-Related Disabilities

Most maternities are uncomplicated and result in healthy mothers and babies. The amount of lost-time is fairly predictable. However, expectant women have the potential for pre-delivery, delivery and post-delivery complications that result in extended lost-time. The number-one question to think about is:

  • How is maternity managed in your environment?

 

Mental and Nervous/Stress-Related Disabilities

Stress is a significant component of many mental and nervous claims. Because these claims occur frequently and can have extremely high disability costs, they represent a significant financial risk to employers not only in terms of disability payments, but more importantly lost time and productivity in the work place.

Accommodation of mental and nervous conditions often requires low or no-cost actions on the employer's part. Approaches such as flexible scheduling, reduction of workloads, or adjustment of required hours can be extremely effective. Furthermore, the availability, accessibility, and scope of EAP services could make a difference in stress claim incidence.

 

Lost work, time, and costs — adding up the lost time and associated costs

All of the factors listed above play a role in the lost work time and costs associated with employees who are out on disability. CR&A reports can help you measure the costs and answer the following lost work time and cost-related questions:

  • How much did the company pay in disability payments last month?
  • What is the combined cost of my STD and LTD claims over a 2 year period?
  • How does the claim experience at my company compare with my peers?
  • In any month, how many employees are typically disabled and out of work?
  • Would instituting a health program, which is specific to a particular diagnosis that is contributing significantly to lost work time, help reduce costs? (If the average daily full time equivalent out on STD is 30, multiply that number by the average salary for individuals to determine the expense for having these employees out of work.)