Good afternoon and welcome to the ADA Distance Learning series. Today''s session is a special 90 minute presentation on the Best Practices of Organizations Utilizing Disability Management Strategies. The series is hosted by your regional Disability and Business Technical Assistance Center, if you should have any questions about today''s session or the ADA, please feel free to call your regional center at (800) 949-4232. Today''s session will be set up as a presentation to start followed by a segment with question and answers. An outline for today''s session provided by Bruce Flynn one of our speakers is posted to the Great Lakes web site so you can log into the web site and follow along with the session. The web site is www.adagreatlakes.org. You can follow the link for the distance learning series and specifically the link for the session outline. At this time I would like to introduce our panelists. Jennifer Eckel is a consultant formerly with Northeast Disability and Business Technical Assistance Center and Cornell University''s program on employment and disability. Bruce Flynn is a consultant to Watson Wyatt Worldwide and has 25 years of experience in workplace disability programs. Prior to joining Watson Wyatt he was director of disability management for the Washington Business Group on Health or WBGH. He has also managed the Wells Fargo Bank disability management program. Joining Bruce is Brian McMahon, chair of the Rehabilitation Counseling Department at Virginia Commonwealth University and a lead researcher on disability management. At this point I would like to turn it over to our panel and starting with Jennifer Eckel.
Hi, thanks, Jennifer. For those of you who have participated in these sessions over the last year or so, you know that most of them focus directly on some application of the ADA and complying with the ADA. This one is in a slightly different vein, but we think that it has relevancy because it has to do with keeping people with disabilities employed. As a former DBTAC staffer I spend a lot of time talking to businesses, schools and other organizations about the ADA and we can all tell the difference between an organization which something like company A which really wants the information just to keep themselves from being sued. Or maybe company B, which really seems to get it. They have a workplace which is more accessible, they have workers with disabilities, and they seem to have an attitude of commitment. And how does that happen? What is the difference there? How can we do a better job of educating organizations to the business advantages of having progressive return to work programs, accommodation procedures, and ultimately less absences? That is something that I was always thinking about when I would talk to organizations and see the different attitudes. Last year I had an opportunity to go to the Washington Business Group on Health National Disability Management Conference and hear presentations by Bruce Flynn who was at that time director of the conference and also Brian McMahon. They are two people who really seem to be able to make that connection and talk about businesses that get it and businesses that are progressive in seeing people with disabilities as workers and employees that may need some assistive devices to return to work after illness or injury. So without a lot more information about what they are going to speak about, I would like to turn it over to Bruce and Brian. Let them tell you some of the things they found in their research.
Thanks Jennifer and thanks Jennifer, for inviting Brian and I to be part of this presentation today. I''ve been with Watson Wyatt Worldwide now a total of about five months. So I''m still getting accustomed to the world of business consulting. But I have to tell you that the fact that I am here at Watson Wyatt speaks worlds about the fact that disability management and workplace disability issues have really taken a front seat in the human resources and strategic HR planning. In particular for large organizations, but I think increasingly the medium size and even some smaller organizations who are really focused on how do we-once we get the right people on the job, how do we keep them healthy, how do we assure if they are injured or become disabled, that we provide optimal treatment for them? And how do we retain their productive capabilities for as long as we possibly can? In the current labor market there really isn''t one person that any company can afford to waste, if you will, or to lose to a premature retirement due to disability. So over the 20 or 25 years of work that I have done with employers and with employees with disabilities, I think there has been an increasing awareness to the point that now the Watson Wyatt and other large business consulting competitors have recognized that workplace health and disability issues are extremely important to the overall productivity of an organization and to the well-being and satisfaction of their employees. There certainly is no employer out there that is immune to disability, injuries, illness, what have you among their workforce. Those are sort of my introductory remarks. Brian, would you like to offer up some introductory remarks before we go into the meat of the presentation?
Well, I think first of all, hello everybody and thanks to the two Jennifers for including me in this forum. I want to position myself to some extent in the role of a react to Mr. Flynn''s presentation trying to link the matter of disability management programming to ADA implementation, which of course is the mission of the DBTAC''s through which we are able to deliver this message today. So I think I will defer any prepared remarks I have until Bruce is finished and then I will pick up where he leaves off and maybe amplify certain points, thank you.
What I''m going to do is kind of walk through a brief presentation of the results of some survey work that we have done here at Watson Wyatt on disability management. Probably draw some broad conclusions about the impact of disability management programs. There are also some fairly detailed PowerPoint slides that I provided that I believe are also posted on the DBTAC web site and we can spend some time talking about those in detail if people feel that would be an useful use of our time as well. But just to start off, I''ll say that employers really recognized a number of years ago that the costs of workplace disability aren''t really just measured in insurance premium dollars. They all have to pay workers'' compensation costs, short term disability, which we usually abbreviate STD, long-term disability-LTD . Those costs tends to be relatively small in comparison with all of the other kinds of expenses that an organization''s human resources department is responsible for. In fact they are even much smaller than just the direct medical costs for most workforces, usually only about a third of the size of those costs, as a matter of fact. There are other costs associated with workplace disability. Administrative costs, lost time related costs, reduced workplace efficiency, and reduced workplace productivity. Those are more difficult costs to measure, but are probably the most important pay off for employers that embrace disability management and begin developing programs to make sure that employees with disabilities receive optimal treatment, are offered the opportunity to return to work, and that accommodations are made if job modifications are needed. Consequently leading companies, and I certainly would include the company members of the Washington Business Group on Health in that group, they began integrated disability management programs in the mid to late 1980''s. They generally focused on the integration of workers'' compensation, short term disability and long-term disability. That generally took the form of appointing someone inside the organization to oversee these programs and developing return to work strategies, case management strategies, and other programs that assured if and when an employee became disabled, they were going to maximize the opportunity for that person to return to work. They were also going to look at the cost of workers'' compensation, STD and LTD as one bucket. It isn''t just have we reduced our workers'' compensation costs or controlled our short term disability costs, but have we controlled all of our direct disability costs so that we know that we are getting the biggest return on the investment we make in these kinds of disability management programs that have been implemented. Generally there were policies and procedures that were outlined for supervisors, management, and detailed in human resources handbooks for employees in companies that developed disability management programs. And as the years went by, programs tended to look at improvements in health and productivity of their employees as more and more a measure of the success of disability management, not just reducing the direct costs of short term disability, long-term disability and workers'' compensation. The common elements of disability management programs as they evolved through the late 1980''s and early 1990''s were early intervention, coordination of medical care whether the injury or illness resulted on the job or off the job and facilitation of return to work at the earliest medically appropriate time. In the mid 1990''s, the benefits firm of Watson Wyatt Worldwide in partnership with the Washington Business Group on Health started conducting an annual survey of these corporate disability management programs. That actually began in 1995-1996. I was with the Washington Business Group on Health during the years 1997-1999. So I was in on the middle three years of the five years during which we have been collecting data. Now that I have joined Watson Wyatt, I head up the team that will be producing our 6th year of results in the coming year 2001. We have five years of survey data from primarily large, medium sized to large employers, that have been running disability management programs, in many cases for many years longer than we have been surveying. We think we have best practices that are those that have evolved among firms that really are on the cutting edge of running these programs and developed a successful rationale for the funding of these programs. So they are not on one year and off the next. For those of you who work in business environments, you know how difficult it can be particularly in a period of economic down turn, to continue even well intended programs that don''t have a clear return on investment. We all know the stories about really good training programs or really good wellness programs or stress management programs that while they got great kudos from the participants who said "it helped a lot" or "I liked it, it made me much more aware of my health condition," but the disability management programs had really developed a standard set of both direct and indirect cost measures that allowed them to continue those programs even during the early 1990''s when the workforce economics were not as good as they are right now. So from the data gathered over these five years, what we call the Staying at Work Survey, we have developed a portrait of organizational disability management practices. From this research we have learned that the percentage of large companies with integrated disability management programs rose from about 25 percent when we first started collecting data in 1995-96 to about 45 percent in our most recent survey, completed in the year 2000. The direct costs of disability benefits for those companies surveyed averaged about 6 percent of their payroll. These companies were paying out about 6 percent of their gross payroll to pay for sick leave or workers'' compensation for short term and long-term disability benefits. Those are the direct costs that we asked our survey respondents about. Employers saved 15 to 20 percent on those costs by applying disability management best practices. So 15 to 20 percent of 6 percent of payroll is about 1 percent of payroll. Now 1 percent of payroll may not sound like a big number, but for a company with 50,000 employees and tens if not hundreds of millions of dollars in payroll, that means many millions of dollars of direct disability cost savings. Which is, as I was talking about earlier, one of the ways that these programs have survived both the lean as well as the fatter economic times is that by being able to show these kind of cost savings. Four integrated disability management best practices were found to correlate with reduced costs. And for those of you who are interested in the ADA implications of disability management programs, over the entire five years that we have been collecting this data, job accommodation costs always came in as less than 1 percent of payroll. I have to quickly add we don''t actually have any divisions in our data collection instrument that go below 1 percent. So my guess is that when people say less than 1 percent of payroll, in many cases they are talking about way less than 1 percent of payroll. What employers paid out in job modification or accommodation costs in my view is probably far less than they gained in terms of cost savings on their disability. Based on the survey responses. the following represent what seemed to be the best practices from employers that have participated in our surveys. First, best practice is to have a transitional or modified duty return to work program. That seems obvious. Certainly to anybody that is involved with ADA compliance, it makes sense that you would want to have some sort of program or set of policies in place that would facilitate return to work in a transitional or modified duty job for any employee with a disability. The second best practice is disability case management, meaning usually, a nurse case manager, probably one trained in occupational health or a similar field. They manage not just the workers'' compensation cases, but the non-occupational disability cases as well. The third best practice is having a single point of contact for everyone in the employer''s workforce to file a benefit claim. Regardless of whether it is short term disability, long-term disability or workers'' compensation, if you have a claim to file related to disability, you call one number or you call one department. The fourth best practice is having a single manager overseeing all of their benefit plans or programs, I mentioned that earlier. And actually a fifth best practice we added this year is having supervisors involved in the return to work process. That has a big impact on reducing absence rates. In addition companies applying three of five best practices had in fact absence rates of 1.4 percent of their workforce as compared to 5.3 percent for firms without disability management programs. Absence rates are three times as high among firms that don''t use disability management best practices. Then the last sort of general comment that I will make by applying disability management tools, employers not only reduce the cost of benefit program, and reduced absence, but provided accommodations and return to work opportunities for many thousands of employees with disabilities. There was some survey research that we participated in at the Washington Business Group on Health with Cornell University that showed that employer disability management programs contribute positively to ADA compliance in several specific areas. They tend to increase the acceptance of employees with disabilities in the workplace. They provide a mechanism for funding job accommodations. And they increased supervisory awareness of the reasonable accommodation process. In fact what it did was provide a pathway or an organizational means of getting reasonable accommodation in and return to work training out to their line supervisors. That is sort of my overall summary of disability management programs, what features they tend to incorporate, and what the financial results have been. I will defer to the Jennifers, shall I go further at this point or if you want to have Brian offer comments at this point?
There was one slide in your presentation that I think we should touch on. We should probably go through it just in case anyone didn''t get this via mail or have access to the web site right now. It is the popularity of disability management activities. Just so people understand the range of programs that people including disability management programs.
We talked about the fact there were four or five best practices that seemed to evolve through our research as the ones that had the greatest impact on reducing costs and absences. Those were drawn from a much longer list of program activities that are utilized by many other employers. Some of which are harder to draw that direct line between reduced costs and a best practice. And I think that is one of the reasons why they didn''t end up, if you will, in the top five. And others that are just so infrequently utilized that it is difficult to get really good cost benefit data. But the complete list of program activity that we looked at, at least in our last survey, were transitional modified return to work programs; safety and injury prevention programs, in other words the traditional kind of safety training, OSHA regulation kind of training; behavioral health intervention are being linked to disability management programs, as they tend to reduce absence and reduce disability costs associated with behavioral health disabilities. Case management we talked about; employing independent medical examiners, this usually occurs within the disability plans in order to obtain information needed to figure out what limitations an employee with disability has or how they might be best accommodated. Education of medical providers. About half of our survey respond dents have reached out to their physician provider networks and said hey, we want you to know what we are doing at the workplace and we may come back to you and frequently for information about how to best to accommodate someone with an illness or injury, because that is what we do. We are a return to work oriented company. So it won''t be sufficient for you simply to treat the person and send them home. We want to know how we can accommodate, how we can get people back to work, keep them productive as long as possible. We also see paid time off programs, employers are rolling together sick leave, vacation leave other kinds of paid leave into banks, a leave that employees basically can use for any reason, but it is their bank of days. So instead of having one bank of sick leave and one bank of vacation leave, it is one single bank of paid time often. Many of the employers that we have studied have found that it actually improves utilization, meaning people don''t tend to call in unless they really need to be off work because they know it is going to come out of their bank. But it also improves tracking of time off once you establish a paid time off bank that the employer has a data management program linked to. We mentioned line supervisor involvement. Work family programs. Certainly when an employee becomes disabled it can create problems at home. Or if on the other hand, the employee is not the person with the disability, if their spouse or child is disabled, it creates problems for the employee and they may not be able to be at work. So work family programs often have a big impact on managing disability related absence. Many employers are starting to include performance standards for their vendors related to time loss. I know of a number of examples of employers that have gone to their short term or long-term disability carriers and said we would like to see a decreasing trend in absence and we are willing to make sure that we have modified and alternate jobs available, but it is going to be your job to find those cases among the people applying for short or long-term disability who can come back to work. Charge back programs for creating incentives inside an organization. There is nothing more effective than saying to a supervisor or a manager or a plant director: All of your employees that draw either short term disability or workers'' compensation are going to-the costs for those benefits are going to be charged back to your business unit. So it is incumbent on you to find ways to bring people back to work or else it is going to draw your costs up. Employee cost sharing. There are a couple of examples where when employers have had success, say, with safety training or paid time off programs, to reduce absence the savings that are realized by the employer are shared with groups of employees. Now this is not like the old days of safety training where they would say oh, well, if you go through a month with no injuries we will have a pizza party at the end of the month, I have to say those don''t necessarily have the effect that an employer would want to have. It may have the effect of that plant or store hide injuries when they occur. Rather the more innovative approach is to look at disability costs to plot your trend, to figure out what your disability costs would be if you did nothing differently, then to institute a return to work program. If you save $ 1 million on the overall projected costs of disability for the next year, share that $1 million with the employees, usually through collective bargaining unit. Other activities that we get feedback from our employer respondents are on return to work training for supervisors, per effect at ten dance programs, the use of disability trend data in business units so they know how many employees in their plant or in their store or their location are off work at any given time. Disease management. Actually we can spend quite a while talking about some of the really innovative programs that are going on in linking disease management programs for people with, say, heart disease or diabetes or asthma. With disability management and last, but not least, joint union management committees that develop disability management programs through the collective bargaining units and use feedback or collective bargaining unit feedback to shape the programs to the needs of employees. So four or five best practices I talked about earlier are drawn from that rather exhaustive list of best practices that we see going on among our employer respondents.
I just have a question about the employers that you are surveying. What is the smallest size employer? What is the largest size and what is the average size in your survey?
The most recent survey data I have was from 1999-2000 survey. We had 178 companies respond to our survey that year. 52 percent of them were or had 1,000 to 4,9999 employees. 18 percent had from from 5,000 to 9,999 and the 10 percent were over 10,000. That is pretty typical of the responses we get year to year
So of our your employers responding to the survey all of them have at least a thousand employees, is that right?
Right. When I talk about medium sized employers, I''m talking about, it may not be what everybody thinks of as a medium size but I''m talking about a group 1,000 to 5,000
I think there are a lot of people coming from small organizations, they may only have 20 or 30 employees. One of the questions I have for you is: Do you see any differences in trends between smaller employers and the larger employer. I guess the point I''m trying to get to is, just to say you are a small employer doesn''t necessarily mean that you are not following along these best practices. Is there potential popularity of smaller organizations ranking very consistently along with five best practices that you listed?
I think there are lots of opportunities for smaller employers. They have been slower to come to integrated disability management because the models of programs that evolve first were among larger employers and required a fair amount of initial investment. If you have an internal manager and a case manager and call center all that sort of thing, you are talking about a pretty significant investment on the organization side to making a disability management program functional. What we have seen over the last few years is that small employers are being approached by their insurers or brokers if they work with insurance brokers who are saying look, we know of integrated insurance products that are out there. In fact, we can negotiate deals where your health insurance, your short term disability insurance, your workers'' compensation, it is less common for workers'' compensation, but sometimes workers'' comp and LTD are all handled by the same insurer or the same third party administrator. They provide some of the services like case management and single point of contact for your employees to call in. They take the responsibility for tracking these disability trends and provide you with feedback. All we would ask of you is that you make accommodations and job modifications available even within your small firm to the degree you are able to do that in order to reduce the likelihood that you are going to incur a catastrophic long-term disability claim that will drive up your insurance rates. I think small employers certainly can educate their supervisors, they can provide accommodation opportunities, they can even talk to their brokers or insurers and say look, we would be interested in looking at integrated products, but you tell us what is our health or disability experience and where are we going to get the biggest bang for the buck if we spend a little more to get an enhanced insurance product? Incidentally I will also mention a group in San Francisco called the Integrated Benefits Institute has done some research and has some data about the integrated benefit and disability management interests of small employers. I regret that I don''t have the data right in front of me today, but suffice to say that although lower percentages of small employers indicated an interest, it was still in the range of 40 or 50 percent of them. Publications are available through Integrated Benefits Institute. Their web site is www.ibiweb.org
That is great. I also wanted to add that we will be posting with the transcript, a list of resources of organizations that do integrated benefit services. Brian, can we hear from you?
Well, as I promised when I was introduced, I will try to put this matter of disability management into an ADA context. Let me begin by saying, I had an interest in disability management and did some work in publishing in the area long before there was an ADA. And as ADA came along I kind of shifted gears and went head long into the ADA world and became involved with a lot of training, probably about 175 training dates and probably about 15,000 employers. And I can''t remember a single training date where these kinds of issues were not raised by employers. So I then began to set about studying the matter even closer and tried to generate some publications that looked at the interface of the ADA with workers compensation also with Family and Medical Leave Act and also with disability management programming, and that is kind of where I''m coming from today. I do think, if there is a limitation, I don''t disagree with one word that Bruce has said, but I do think there is a limitation in terms of the applicability of disability management to employment and disability in general, and ADA in particular. Jennifer has hit upon it, and that is, that DM programs are still the pride and property of rather large employment organizations. So what we have learned from them vis-a-vis ADA, is a fair amount about accommodations and a fair amount in particular about injured workers because that is the origin of their history in accommodations of injured workers. Already they have had limited impact on reducing the labor force problem we have for Americans with disabilities in the workplace, because 90 percent of all hiring activity occurs in small employment organizations of 200 employers or less. These are not just absent from the samples that Bruce Flynn talked about, but absent from aggressive DM, at least in our history. Still there is a still a lot of promise in what Bruce is talking about. I would like to just back up a bit. I always like to talk a little bit about the history of the ADA and the history of DM. Think for a moment about what you heard from Mr. Flynn and then think about what we all know here or most of us know, particularly our wonderful resource people out there in the DBTAC''s, about the history and spirit and intent of ADA. Is not ADA Title I intended to expedite worker job fit? Are not the architects of the ADA somewhat anti-medical in their approach to disability and employment solutions? Do they not insist that we have the right kinds of doctors involved and doctors who are there to evaluate people in terms of their abilities and disabilities and look for a way to make the worker job fit work as opposed to looking for reason to exclude people because of their disabilities or histories. Do we not ask that we have all people that are involved in employment-related decision making focused on abilities and not disabilities? Do we ask that these people not make presumptions about one''s future incapacity because of a chronic illness or melt condition that they have today? Are we trying to get out of the business of gate keeping and inordinate screening and artificial and arbitrary and capricious mechanisms and tools that exclude people from employment? Well, it wasn''t lost upon me as ADA came in to being that this is 100 percent entirely what disability management is all about. Hence what a wonderful useful fit we have. I can''t think of anything that was in place that came about in the late 1970s and 1980s and then began to grow that was so ADA consistent as disability management programming. I don''t know what explains that other than to some extent just good luck. So along came the ADA with wonderful and good intentions in terms of Title I, believing that because it was predicated on the Rehab Act of 1973 and Title V, with a specific provisions of Section 501, 503 and 504 and the approximately 187 legal decisions that we had to test some of the definitions, that Title I would in all likelihood, succeed. But few people had thought of how ADA might interface or possibly conflict with such things as state specific anti-discrimination statutes, such as state specific worker compensation statutes; such things as National Labor Relations Act or the Family Medical Leave Act or the federal law that provides civil rights and protection to older workers, ADEA; not to mention 94 and 142, I could go on and on. But with all of our good intentions with ADA, we did not stop and think of these flash points. I suppose-I think you have had other people talk about these flash points or the way ADA interfaces with workers'' compensation. So I don''t want to belabor that, but all those things are relevant when it comes to this discussion. Because disability management programming represents in some ways what I like to call the ultimate accommodation and the ultimate prevention strategy. I would even go so far as to say the ultimate ADA implementation strategy vis-a-vis injured workers. Again if we go back a few years, I have always been fond of studying ADA litigation trends, it took us about three or four years when we looked at approximately 20,000 complaints a year under Title I under the EEOC and another 7,000 under state statutes you would have to pay not too much attention to see two things that jumped out at you. One thing was almost 75 percent of the claims were orthopedic, lower back and repetitive motion injuries. The second thing was that over 80 percent of the claims were from currently employed people as opposed to seeking employment. Well, that spelled injured workers in no uncertain terms and everybody on this conference call who is ADA literate knows when the architects of Title I of the ADA crafted it, they had no conception that it would end up being a playground for injured workers. But in terms of litigation, that is precisely what it had become. Now, what position did that put the trainers like myself and Rick Pimentall and Chris Bell, what position did that put us in? The first thing we had to do was write, lecture, teach, get out on web sites in every shape and form we could that there was a heck of a big difference between an injured worker and a person with disability as ADA defined the terms. Specifically the overwhelming majority of injured workers while they did have an impairment, did not have an impairment that was substantially limiting as the ADA intends. Therefore the best defense on the part of each and every employer faced with an ADA complaint by an injured worker was to take pause and check to see that that person did in point of fact, meet the ADA definition of disability. When the Courts did that, and the EEOC did that upon investigation, they had no problems whatsoever in rather quickly dismissing the majority of these claims. But employers because of their lack of information at the time about this very important distinction, frequently would begin processing the matter as an ADA matter. And begin the process of considering accommodations or making accommodations and then they were if you will, guilty of providing the injured worker with the protections of the ADA because the employer was now in point of fact regarding the person as disabled. So you had an injured worker who on the medical merits of their status vis-a-vis ADA definition of disability, would not meet the definition, now meeting the definition of disability because the employer was in fact regarding them as a disabled American. Well, this was quite a quagmire, if you will, and it took a number of years to begin straightening things out. But you see a more educated human resources component, DM component and a more educated employer constituency because the number of claims and the number of successful claims of an ADA nature by injured workers is very rapidly plummeting. The second teaching point I think that we all try to make as trainers vis-a-vis this issue is when an employer stands up and says what does ADA mean for injured workers? I basically like to take this response: Who are you, what company do you represent? How many employs do you have? And do you or do you not have a disability management program? Is it alive and well? Is it effective? Because if you do, you-I''m not going to say you don''t have ADA problems with injured workers-but you have minimized them dramatically. Let me make a parallel example that may be more of us can understand. Certainly many of you people on this conference call do ADA training. And you get similar questions about alcoholics and substance abusers. You know that those answers can be kind of delicate or kind of tricky, that ADA does not give people who are chemically dependent the same protections as it gives people with other disabilities. And for employers to just think about implementing ADA in isolation of other matters, vis-a-vis substance abusers, frankly can be a very, very complicated process. Therefore, you know, I would always ask an employer are you familiar with a Drug Free Workplace Act? Do you have a Drug Free Workplace Act policy? Is it alive and well? Is it really alive at your place of employment? Is it fully implemented and last but not least do you have an employee assist sys stance program? If you have these things you have little to fear from the ADA by way of complaints from chemically dependent employees. And so it is with disability management programming. If you have solid sound disability management programming, you have very little to fear from the ADA in terms of dangerous litigation from injured workers. The real common denominator between DM and ADA is this: Both are heavily committed to the injured worker communicating directly with the employer and getting rid of the middle person. The middle person might be the insurance company, it might be the third party administrator, it might be even the case manager, regrettably in some instances. But getting, maintaining that communication link, particularly between the injured worker and the primary supervisor on the job. Where do you see that in ADA? You see that in ADA where they put it in incentive such as this: If you as an employer will enter into a good faith discussion with an applicant or worker with a disability about the accommodation process, if you will engage in interactive discussion about accommodations, and you were to mess everything up, everything else up, you would be held harmless from punitive damages. Well, that is a heck of an incentive for an employer to accommodate. And you could see the crafters of the ADA were dead serious about getting employers to talk openly with their workers about their abilities and about their accommodation needs. Disability management programs operate the same way. The real theme to it all, the key to it all, is let us keep the employer and the injured worker or STD claimant or LTD claimant in ongoing meaningful accommodation about the possibilities for reemployment and never let that link breakdown or never let it be deferred to somebody else. So that I think completes my reaction to Mr. Flynn''s very excellent remarks. And I do have a lot more specifics, but I would prefer to wait to see whether or not they raise themselves in the the form of audience questions. So that we don''t guess wrong about what is important to you all out there. And we speak to your information needs.
Let us go ahead and open up to questions. While we are waiting for the first question, I want to go back, maybe I misunderstood what you were saying Brian, I don''t have a lot of experience with disability management. My understanding of disability management is that it is really open to all employees, all injured employees, that might not necessarily meet the definition of disability under the ADA. Is that correct?
Yes, that is correct. The DM program in terms of its view of disability uses-it would use the term impairment, I think, as we would understand it in ADA, in other words it is much broader and much more generous than the ADA definition. I don''t want to anticipate your question, but while it does pertain to not just worker compensation but also short term disability and long-term disability, the real strength and history of the DM programs is with injured workers. That is why I singled that out. The business of integrating DM programs to deal with people on workers'' comp, STD, LTD and even protected by group accident and health insurance is rather resent in its origins.
This is Marilyn from Indiana University. Thank you. All of this discussion has dealt with the issues related to acquired disabilities. I was wondering if the same best practices or similar practices are involved with people who have had life long disabilities.
The fact that disability management programs really don''t distinguish between ADA covered disabilities and injuries or illnesses that might not be considered ADA eligible, is I think, paramount to saying any employee whether the disability arose before their employment, after their employment, in the course of, or rising out of employment, all of those disabilities, if they hold the potential of time loss or increased medical costs or reduced productivity all potentially targets for disability management intervention in the most progressive of companies using these programs.
Great thanks for your question, Marilyn. Jennifer Eckel, feel free also to follow-up with questions as well.
Jim in Minneapolis. Thank you. I''m going to inquire about one of the best practices that you identified, the transitional duties positions which a lot of us refer to as light duty. In the context of workers'' compensation that makes sense to most of us. But can you talk about the light duty positions for those who are not injured at work and in particular, the ADA has some guidelines to follow where those positions are not considered to be permanent positions with respect to the requirement the employer has to transfer or demote somebody to a vacant position under the ADA guidelines. If the speakers could respond to those questions.
I will take the first stab. I''m going to break it into two ADA questions. First, there are a number of interesting ADA court cases around transitional employment which have clarified that there is no obligation for an employer to create a transitional employment program where none existed in the past. I think that is very important. Because that does require some systems change, it certainly requires where you are at, Jim, up in the Minneapolis area, some involvement from organized labor. They are not something management can put in spuriously without the cooperation of the union. If there is a transitional employment program, ADA would expect that a qualified individual with a disability be provided with access to that program and that things like exclusionary criteria, for example this program is only available to injured workers, that an exception be made to that as a matter of accommodation. The second part of your question really is somewhat different. It has to do with reassignment to a vacant position. When the ADA speaks about reassignment to a vacant position, it is not talking about transitional employment programs. The ADA has emphasized over and over again that transitional employment programs that are a part of a disability management program be transitional. That they be time limited and that workers are not allowed to park their-there indefinitely and preempt seniority rights of other workers in an organized environment. So, reassignment to a vacant position is an accommodation that has the following nuances: One it is an accommodation of last resort. Two, it is not subject to a wage loss provision in ADA. If the vacant position comes with a lower wage, the person would be subject to the lower wage. Three, the vacant position is also subject to accommodation. And four, it is never been definitively resolved which major law takes precedent, the ADA or the National Labor Relations Act, meaning is the disabled individual entitled to the vacant position as an ADA accommodation or as a nondisabled individual entitled to that position by virtue of seniority rights? I can tell you, though in three out of four court decisions that have reviewed the matter, the NLRA has prevailed over the ADA. That is the current state of affairs, but there is still no definitive position on that. Let us say in the form of a Supreme Court decision. There may be at some future point. I will let Mr. Flynn may have some additional comments.
I agree with everything you said, Brian. And I will add simply one comment. To the degree that employers using disability management programs find that they are successful, and find that they in fact do promote the productivity of their workforce, it may make sense for them in those situations where they can do so without undo hardship to use an ADA term, to move someone from a transitional job status into a permanent modified job status. And by that I mean if they are working on a transitional job, they find that they have an ongoing need for those services, those things to be done around the workplace. It doesn''t create an undue hardship either in the form of a policy exception that they are going to get in trouble with their union about, or that it makes it impossible for them to fill the other positions that they need filled that the person with the disability left. They may decide to go ahead and do that purely from a productivity standpoint. But I think the ADA cases that I am familiar with again as Brian said, have made it relatively clear that transitional employment programs are just that. They are temporary, I avoid the use of the light duty or the terminology light duty because it implies less and it implies a physical aspect to the job that in fact may not really be what is being accommodated. But transitional employment is just that, transitional. Modified jobs and alternate jobs assigned as permanent accommodation may, or may not be, one and the same as those transitional jobs.
Hi, this is Nicole I was going to ask a question about return to work training for supervisors. Is there any model training programs out there to address the components that should be discussed with supervisors?
Well, I certainly think your local DBTAC would love to provide you with their ADA related supervisory training materials which should and could become a part of an overall supervisor training program on disability management. In our most recent publication we have, for the Staying at Work Survey, Watson Wyatt has put out a sort of a brief list of things that should be covered in a disability management training program for supervisors. Things like what is transitional work, what is an accommodation, how do you make a job modification? Where do you go for information about the limitations and abilities of an employee with a disability? And perhaps most importantly, where do you go within the company to get additional help if you need it? Because many companies even if they don''t have a specifically designated disability management program, may have a human resources person who is experienced in the area of transitional work or modified work, that sort of thing. As far as model programs, most employers are a little reluctant to share their internal training materials. But what you could do would be to review the Washington Business Group on Health conference materials from the last couple of years. They sell their agenda or their conference proceedings and there are numerous examples of supervisor training programs that are outlined there.
I just want to add, also, that Cornell has on their web site a directory of disability-it is more a bibliography I should say, of disability management resources. It includes contact information, it also includes some best practices information and it is by category. So the caller could look at that web site and find the category relating to best practices and probably use that to get some preliminary information. That web site is www.ilr.cornell.edu/ped then just look under subject areas and within the subject areas is disability management.
Bruce, and Brian this is another question that comes to mind. I''m fascinated when you drive down the street by the number of now hiring signs that are still hanging in the window and how low our unemployment rate is. I know that many of us can look back to the 1970s and how high our unemployment rate was at that point. Has the unemployment rate and and the fact that we have a smaller pool of applicants to choose from, do you think that this has sped up the growth of disability management programs at all? Has it impacted the growth at all?
I don''t think there is any question. I have been in voc rehab for about 26-27 years, and we used to refer to workers'' compensation as the biggest out placement program in the world. Once a worker became injured and represented the least bit of a problem for the employer, by way of attendance or productivity, worker comp became a mechanism or a vehicle to get rid of that person. The reemployment of injured workers and other people incurring disabilities coming off of short term disability, long-term disability, everything except SSDI, is at an all time record high. And this is directly related not to our good work in disability management or voc rehab, certainly not related to ADA, I think all those things are minor contributors, but this is simply and directly related to the fact that the employer needs every worker he or she can come by, if not fully qualified, then even with training potential. And that-those definitions get stretched further and further along. I''m sure all of you have heard Mr. Pimenthall make the remark in an employees waiting room in HR today there are people who 15 years ago we would call security on. Now we can''t wait to see them and are begging them to join our workforce. So that is a bit of an exaggeration, of course, but it is all the more embarrassing then that we still have record high levels, I should say so low levels of labor force participation by Americans with disabilities when we have 4 percent unemployment in the United States, 3.9 percent last month, keeping in mind full employment is 6 percent. In my state of Virginia here we have 2.6 percent unemployment. So to have these large numbers of Americans with disabilities and especially SSDI recipients out of work, is not something I take any pride in as a certified rehab counselor. Mr. Flynn? Would you care to expand?
I simply will add there are some statistics, I believe one source of that information is the most recent issue of the Iowa law journal an article by professor Peter Blank that indicates labor force participation among people with work injuries has gone up during the years post ADA. He attributes that directly to the impact of return to work and disability management programs in the employer arena. Whether disability management programs have sort of a larger effect seeing interest in and capacity for hiring new employees with disabilities, even employees with relatively severe disabilities is yet to be shown but is certainly intuitively a sensible proposition because employers have made accommodations for their own employees. Again, even their own employees with relatively serious disabilities to bring them back from long-term disability, are more than likely going to have a greater probability of looking favorably on a new employee with a disability who presents themselves in that waiting room that Brian so graphically described as presenting themselves as a potentially productive employee. Whereas a few years ago employers basically could say well, we are going to wait for the most able and, you know, able bodied folks to walk through the door, even though a hidden disability like diabetes or epilepsy or something like that could well have been present. There still was probably a lot more of the quick decisions to hire the "visibly healthy person" than someone with a visible disability as opposed to current labor market which is hire whoever can possibly do this job.
Jennifer, did you have a follow-up you wanted to make?
Bruce just hit that. I was looking to see if there was a correlation between companies with DM programs and those with a favorable history in hiring people with disabilities. I think he just answered that.
The Cornell study does provide some early indications that because employees with disabilities are more accepted in companies with disability management programs, supervisors are more aware of accommodation issues, accommodations funding processes are in place, we think that it isn''t a big logical leap to say so, it is reasonable to assume that these employers would also be more likely to hire new employees with disabilities. But since we did not have access to hiring data when we did that survey I can''t say that with certainty.
I have one concluding remark, we appear to be winding up. That is I was just thinking as Mr. Flynn was running down all the list of DM components and activities, that if you didn''t know anything about DM you could recognize that as an obvious list of accommodations. That again shows the marriage, if you will, here between good DM programming and good ADA implementation. Finally I would like to mention that at VCU we have a portal committed to disability and employment issues and there is a button on there for DM programming. That URL is very simple to remember, it is www.worksupport.com That will take you to our web site at Virginia Commonwealth.
I think I have one on line question that piggybacks what Brian said, the question says we don''t have a disability management program in place. Where is a good starting place? How do we get started?
I think the four best practices that I spend almost all of my consulting and presentation time talking to our prospective customers about have to do with start developing an internal return to work policy and program. Create a single manager to oversee all disability programs. If you can do it, if you have resources to commit to it, create a single point of contact and device unified case management programs to manage cases when people are off work to come back to work. Those four practices, two of which are primarily internal program and policy development, and two of which are external or require additional commitment of resources are clearly the four best things that you can do first.
I would like to add to that, even in a small or medium sized company when the CEO, president or owner is seen first. You know writes it in a newsletter in his or her own hand and is seen making a presentation saying that beginning today our policy is if you are injured at work or if you incur a disability in any way, shape or form, we want you back at work. Then those individuals with disabilities and injured workers will lead the company in program development. But the employee has to hear that and believe it. And as they then demand that the company make good on that commitment or promise from very high levels of management, these activities will fall into place. What Bruce has done in their fine work and research at Watson Wyatt and with the Washington Business Group on Health, is layout if you can only do one or two or three or four things, do these four things because you will get the biggest return on your DM investment, thank you.
I want to make sure we don''t have any questions hanging on the line. After that I will turn it back to each of you if you have a brief closing comment.
This is Lee Hansen. What has been the experience in DM with employees who have psychological impairments or limitations such as stress, depression, ADHD, conditions like that that in some cases may be exacerbated by working conditions?
I will tell you that that has continued to rank at the top of the, most vexing issues for employers during the entire five years of our surveying. There are no quick fixes for behavioral health problems, particularly a couple of the ones you mentioned. However, because of some advances in pharmacology, particularly treatment for depression and bipolar illness, those kinds of behavioral health disabilities, linking an employee assistance program as sort of your first point of contact and early intervention contact with disability management, case management and return to work support, can really make a huge difference in both the medical costs and the lost time related costs in say depression related disability. A program that the Washington Business Group on Health developed a number of years ago called DART which stands for Depression Awareness Recognition and Treatment, is a model of early intervention and depression treatment and return to work facilitation which looks at the medical costs of depression in particular as a behavioral health disability, and at the lost time in productivity costs related to depression. Their conclusions are that employers that implement DART style programs save, I think the last figure I saw was something like 20 to 40 percent on their behavioral health costs over the course of an 18 month follow-up. So it is possible to have a really good outcome even with difficult to manage disabilities like behavioral health conditions. The fact that there are really effective treatments available for things like depression, makes it all the more important that disability management be implemented so that you make sure that people are getting to the right sources to get the most effective treatment that can render them capable of returning to work. But I also don''t want to down play the difficult and personal level issues that are related to people with behavioral health problems coming back into the workplace. There is a component of DART which talks about the perceptions of people with mental illness and behavioral health problems. Tries to deal in a realistic way in training supervisors and managers on having expectations for people with behavioral health problems returning to work. But in some cases, that is the biggest hurdle. Not getting the proper treatment for depression, not managing that treatment, not in facts even creating the return to work accommodation. But helping people get over the stigma of having someone with a behavioral health disorder in the workplace. Brian, did you have some comments on that?
I wanted to add, I know your colleagues at DBTAC can help you with accommodations. But both the Job Accommodations Network and the EEOC as recently as 20 months ago promulgated guidelines on accommodating people who have psychiatric conditions. And without of course specifying whether these are reasonable or whether they represent an undue hardship to you as an individual employer, these are-these documents are very well done and I know that your DBTAC people have them at their fingertips.
I will also piggyback on that. We have an upcoming session in March with Kim McDonald Wilson, she is going to talk about accommodating employees with psychiatric disabilities in the workplace. That is scheduled for March 20th. Kim is from the Center for Psychiatric Rehabilitation at Boston University, we are very excited to have her join us in the coming month. We are coming up at the close of our time today. So I will turn it back to each of you. If you have final brief closing comment for us and I''m sure that there were a lot of questions out there that we didn''t get to answer. I would encourage people if they do have further questions, to contact their regional Disability and Business Technical Assistance Center at (800) 949-4232. Jennifer Eckel I will turn it back to you and Bruce and Brian, if each of you have a brief closing comment for us.
My closing comment is to say thank you to Bruce and Brian for being on with us today.
Thank you for the two Jennifers for the opportunity, I have had a wonderful time, coming to D.C. Thank you.
I would like to echo the thanks to the Jennifers and DBTACs for sponsoring this. I wanted to throw out two other words. Those words are "aging workforce." The challenges for disability management programs in the coming decade will not really revolve that much around sprains, strains, falls, slips, the usually kinds of things that workers'' compensation programs have dealt with and in fact that disability management programs early on, that was their primary focus. But the biggest challenges for managing disability in the workplace will be chronic illnesses like depression. Like heart disease. Like diabetes. Like asthma. The big five or six diseases that you see on any list that the centers for disease control publish that have huge medical burdens that they impose on the American public. Well, you can be sure that the medical burdens are far out weighed by the prospective productivity impact of poorly managed chronic health conditions like those I mentioned and others. So for those of you who are employers who are looking down the road, I will just say creating links between your disability management programs and your health promotion and disease management programs will be the biggest favor you can do for your workplace disability management efforts. And again thanks very much. It has been a pleasure.
Thank you Bruce, Brian, Jennifer. We are glad you could take time out of your schedules to join us today. Thank you to all of you at our sites, we had more than 75 sites dialing in. We are thrilled you joined us. We hope to have you back in January for our next session "Home Sweet Home" January 16th with Kathy Gips joining us talking about the interplay between the ADA and Fair Housing Act.