Balancing the Yin and Yang of Integrated Disability and Absence Management: Best Practices and Trends
By Megan Holstein, Esq., SVP, Absence and Claims Product, FINEOS Corporation
Achieving equilibrium between tried-and-true best practices and emerging industry trends in integrated disability and absence management (IDAM) can be challenging. Layers of complexity in IDAM create friction. For example, federal, state, local, and employer policy compliance are fraught with complexities, and multiple processes create challenges (including eligibility checks, certification documentation reviews, request determinations, proper correspondence and notices, and case completion).
This article will outline a few examples of when it is useful to adopt an emerging trend while maintaining established processes.
Integrating Types of Claims
Leave requests follow a set course. A series of workflows start with a request for time off (intake), which includes an approval or denial determination and ends with an employee’s return to work or transition to long-term disability, if applicable. While there are tried-and-true aspects of the process, a few areas are ripe for automation.
Best Practice
When employees seek time off for health conditions that implicate short-term disability (STD), paid medical leave benefit payments, or workers’ compensation, the proxy-approval process represents a tried-and-true practice. With proxy approval, paid benefit approval determination serves as the approval for unpaid leave entitlement, such as the federal Family and Medical Leave Act (FMLA), state family medical leave (FML) laws, and any employer plan or policy equivalent. For an employee, this health condition is a single life event, which is typically a diagnosed illness or injury. The unpaid job protected leave entitlement under the FMLA and state FML laws typically have lower thresholds to qualify as a serious health condition compared with STD benefits.
Therefore, approvals for one or more paid benefits automatically apply to one or more job-protected benefits. If there is a denial of benefits, a compliant best practice is to separately review and determine unpaid entitlements rather than allow a proxy denial of entitlements from a denial of paid benefits.
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