10 Causes of Disability Every HR Leader Should Know

When most people consider disability, they picture something catastrophic happening, an ill-timed dive off a high rock, or a speeding car hurtling into theirs—and, for the most part, assume it can never happen to them.

That’s why human resources experts often find it challenging to convince their employees of the importance of disability insurance even though you know it’s a wise investment and more commonly used than most people assume. In fact, if you were to keep track of the 20-year-olds in today’s workforce, you’d find out that nearly 25 percent of them will be out of work for at least a year due to a health condition before they reach retirement age.

The statistic isn’t meant to alarm anyone.  However, it aims to underscore the importance of making sure that your team members realize that disability insurance is for everyone. It can be the lifeline they need in the case of an unexpected condition. Yet, outside of the basic coverage offered through Social Security, at least 51 million working adults go without disability coverage.

That can be downright scary. Considering the precarious financial position of many Americans—and the skyrocketing cost of medical treatment, any of these conditions can rob workers of the opportunity to earn enough to pay their bills – just when they need the extra income the most.

Wondering what the top causes of long-term disability are? Your employees might be surprised to learn that they are relatively common occurrences.

  1. Musculoskeletal Disorders. This is a fancy way of saying “back pain,” something weekend warriors—or even just good Samaritans helping a friend move—can probably see themselves experiencing. It also covers other muscle, back, and joint disorders, such as arthritis. Together, these conditions account for nearly 30 percent of all long-term disabilities.
  2. Cancer. Yes, we can put this in the “catastrophic” category, but it is actually more prevalent than you might imagine. In fact, more than 70,000 people in their 20s and 30s are diagnosed with cancers. This includes diagnoses of lymphoma, leukemia, testicular, melanoma, and breast cancer. Even if they are eventually cured, cancer treatment can decimate a family’s finances as they miss work to undergo treatment.
  3. Pregnancy. It’s hard to consider pregnancy as a “long-term” disability. However, complications associated with pregnancy and childbirth can infringe on work. In fact, about 1/10 of all claims involve a pregnancy-related issue.  By tapping long-term disability insurance, your employee and their little bundle of joy can be covered.
  4. Mental Health Issues. From anxiety to depression, mental health problems can take a toll. Fortunately, people are realizing that mental health is just as vital to treat as physical health. With over a quarter of the population diagnosed with one or more mental disorders each year, it is easy to see how it can be a leading cause of long-term disability.
  5. Injuries. Nine percent of long-term disability claims come from the “injury” category. This covers everything from accident recovery to surgery, broken bones, and even poisoning.
  6. Cardiovascular Issues. From heart attack to stroke, cardiovascular events strike unexpectedly. These events can prevent employees from returning to work indefinitely due to the severity of the event and the nature of the recovery.
  7. Nervous System. This category encompasses a wide range of potential issues that include multiple sclerosis, Lou Gehrig’s disease, Parkinson’s disease, and epilepsy. This also includes a range of additional eye and ear disorders.  Even Alzheimer’s, a condition often considered an older person’s disease, can strike during peak earning years. In fact, about 200,000 people contract the early-onset form of Alzheimer’s, which typically develops in their 40s and 50s.
  8. Infectious Diseases. While headlines trumpet new types of infectious diseases, from Zika to MRSA, this category also encompasses far less-exotic strains. This includes bacteria that cause strep throat and viruses that bring on the flu. When conditions become more resistant to hard-working antibiotics, the threat of work loss to infectious disease grows more prevalent.
  9. Digestive System. Celiac disease, Crohn’s disease, and irritable bowel syndrome (IBS) are just three of the better-known conditions in the digestive diseases category. Altogether there are 40 digestive conditions that plague more than 34 million Americans, causing them to miss work as they wrestle with treatment and prevention.
  10. Respiratory diseases. Asthma is one of the most common chronic respiratory conditions. This also includes a wide variety of other lung-related ailments. It’s not a leap to assume that difficulty in breathing would lead to difficulty in working…illuminating the need for long-term disability insurance.

No one wants to sit down with employees to go over a list of illnesses or conditions they may eventually have. However, human resources professionals have the opportunity to educate their colleagues on common causes of disability, as well as, how they can protect themselves. Employers can deliver one of the best-kept secrets in the benefits world—how disability insurance can help prevent them from losing a paycheck just when they need it most.




How Companies Can Ensure Employees Feel Supported While on Leave


By Gene Lanzoni, Marketing, Thought Leadership, Customer Insights 
The Guardian Life Insurance Company of America


 

With the expansion of the American with Disabilities Act (ADA) more than a decade ago, employers have become more aware of their responsibilities with not only how to stay compliant, but the role they play in helping employees return to work. According to the U.S. Centers for Disease Control and Prevention (CDC), lost productivity due to absenteeism in the U.S. cost employers $225.8 billion annually, or $1,685 per employee. In today’s competitive labor market, many employers are looking for ways to retain their employees and adopting leave practices that help employees return to work from an extended absence due to injury or disability is becoming a priority.

As such, employers are responding with more personalized leave management and more robust stay-at-work (SAW) accommodations. Guardian’s most recent biennial Absence Management Activity Index and Study–“The Value of Leave Management Integration,” found three in four employers with a high level of return-to-work (RTW) and SAW programs reported decreased absenteeism, compared to only 40% of companies with no formal SAW program.

Guardian’s study also reveals employers are paying greater attention to the employee experience, one that offers a more supportive environment with additional flexibility, resources, and education. Employers seeking to upgrade their absence management programs to generate positive outcomes like high employee satisfaction and retention should consider the following:

Better Return-to-Work and Stay-at-Work Accommodations 

While it’s important to communicate with employees throughout their disability leave, it’s equally important to provide them with a smooth transition back to work. Employers should establish a strong RTW program that guides employees in a way that makes them feel supported. Guardian’s study indicates 70% of employees who completed an RTW program feel their employer cares about them. Additionally, companies that have four to six RTW initiatives see a 78% reduction in lost time, compared with 48% of companies that have no RTW initiatives. 

Employers have become more aware of their responsibilities under the ADA and are identifying ways to help their employees stay at work following an absence. These activities have expanded beyond traditional vocational rehabilitation to include interactive processes, transitional work plans, and worksite modifications to accommodate employees with disabilities. Providing employees with resources like nurse case management and duration guidelines can help reduce the likelihood of a relapse. Guardian’s study found organizations with the most comprehensive RTW programs appear to achieve greater success reducing lost time and improving employee retention. 


Flexibility and Personalization Go a Long Way 

Today’s technology makes it easy to communicate and inform a company’s workforce through various channels. So, it’s not surprising our study reveals that the accessibility of information has a great influence on employees when they are on leave. Every employee has a preference of how they’d like to communicate with their employer about leave, and Guardian’s study finds the majority of employees prefer to have 24/7 access to personal and mobile communications.

Employers that leverage new technology, including automated dialers, text messaging and chats are leaders in the absence management space because they demonstrate a willingness to accommodate to an employee’s schedule and individual needs. In fact, Guardian’s study reveals 21% of Index leaders use automated dialing technology, compared with 9% that lag on program improvements. The same goes for interactive voice response systems – 16% of Index leaders leverage this technology, compared with only 7% of those that rank lower in the Index. 

At the end of the day, many employees want to work for a company they feel cares about their well-being and that will help them navigate the journey through their disability. The data collected from Guardian’s Absence Management Activity IndexSM and Study supports the notion that employers who prioritize these programs see positive results in employee satisfaction and overall retention.


Unless otherwise noted, the source of all information is from the 2019 Guardian Absence Management Activity Index℠ and Study – “The Value of Leave Management Integration.




Single Women’s Guide to Financial Wellbeing



If you’re a single woman today, you’re in good company: The number of single adults in the U.S. continues to increase—from 39 percent in 2007 to 42 percent in 2017, reports the Pew Research Center. The rise shows no signs of abating. Many people are choosing to wait until later to get married, if at all. Although there is freedom in spending your money as you wish, as a single woman you might be slightly apprehensive about your financial future. A study by MassMutual finds that indeed women are more anxious about their current and future financial status than men—more apt to worry about household finances now and less confident in their eventual retirement security. But the good news is that there are several doable steps that single women can take to feel financially confident


SIX Ways Single Women Can Watch Out for Their Own Financial Wellbeing: 

  1. Have a Plan for Retirement Savings

Most couples find it easier to save because they have two incomes coming in—and they are sharing costs such as housing expenses, which can make it easier to allocate more for savings. However, single women need to approach their savings goals as aggressively, and it seems they aren’t. The MassMutual study found that women were three times more likely than men to say that they couldn’t afford to contribute to their retirement savings plan. But, that can be catastrophic because you will potentially not have someone to share bills with now or in the future. In fact, it turns out that women need to save more for retirement in the first place—simply because they are more likely to outlive men. The Centers for Disease Control and Prevention finds that women tend to live about five years longer than men.

  1. Boost Your Financial Literacy

A survey for Merrill Lynch found that half of women lacked confidence in managing their investments—a gap of 16 percent between women and men—even though they reported feeling nearly equally capable as men in other financial tasks, including budgeting and paying bills. In fact, 61 percent of women would rather talk about their own death than money, the study reports. But learning about investing is not only necessary—it can be fun and fascinating.

Vow to sit down with a financial advisor. Discuss vehicles that might be right for you, from IRAs to mutual funds. Ask your human resources department if they offer any financial education; it’s quite likely they do as it’s a growing benefit—today 83 percent of employers offer a financial wellness program, up from only 20 percent in 2015, finds a study by the Society for Human Resource Management (SHRM).

  1. Regularly Contribute to Your Emergency Fund

Planning for an emergency is wise. As we know, taking a loan or putting an unexpected expense on your credit card can just extend the pain in the form of interest rate payments. If you are single, you might need a more ample emergency fund than your married counterparts. In fact, a recent article in Kiplinger says that some financial planners recommend single women, specifically, keep between nine and 12 months of living expenses available, compared with only three to six months for couples.

  1. Take Care of Crucial Paperwork

A wedding often spurs couples to consider their financial future. From living wills to power-of-attorney forms, it forces them to focus on serious life considerations. As a single female, you should make sure you have updated sets of paperwork; you can access advance directives specific to your state here, and a sample power of attorney can be accessed here. Your doctor may also have a form you can fill out specific to that hospital and practice. Talk to a financial advisor to find out about other paperwork you should have. Be sure it is notarized as appropriate.

  1. Buy a Home If and When It Makes Sense for Your Situation

If you’re contemplating a home purchase as a single woman, you’re not alone: Women now are the second largest homebuying group following couples, surpassing single male homebuyers, finds the National Association of Realtors®’2018  Profile of Home Buyers and Sellers. Just make sure you’ve thought through all the costs related to a home, including maintenance and insurance, to ensure that it’s a financially savvy move, compared with renting.

  1. Don’t Skimp on Insurance, Including Disability Insurance

In a new survey of the awareness and ownership of disability insurance across today’s workforce, The Council for Disability Awareness (CDA), uncovered that among all single women in the U.S. whether never married, divorced or widowed – nearly 1 in 3 said they were “extremely unprepared” for any period of disability if they should lose their income. That number equates to roughly 10-million women in America. What would you do if you were forced to take a leave from your job because of an accident or extended illness?

Without a partner to cover the bills, this work lapse can be devastating to a single woman. That’s why disability insurance may be even more important for single women, considering that more than a quarter of today’s young adults aged 20 will likely be out of work for at least one year at some point in their career. Make sure to talk with your human resources department about your options as a way to safeguard your income.While single women often have more freedom with their finances, that comes with responsibility as well. Take care of your financial wellbeing is a gift you give yourself.  




Podcast: Living and Working With Endometriosis



Introduction

Carol Harnett [00:00:00] Hi everyone, this is Carol Harnett. I’m the president of The Council for Disability Awareness. Welcome to our show: the Financial Health and Income Network.  I am very excited to launch what we hope will be a continuing series with people who are working and living with chronic conditions, illnesses and diseases.  I am so pleased to say that our first topic will be on endometriosis.

 


You can hear the full podcast or if you’d rather read than listen, we captured the transcript from the conversation below.


 

Carol Harnett [00:00:32] I’ve worked in and around healthcare my whole life, and worked around the data in healthcare my entire career, and I have never thought about endometriosis as a separate category.  What brought it to my attention is my guest, Tawnia Jacobson. She is a nurse who has a master’s degree in Science with a concentration in Biology, and is also a Certified Nurse Anesthetist.

I often put firewalls between the different parts of my life. This is one of those times when I let the different parts of my life blend together. Tawnia is also my CycleBar instructor, and that is how I came to know her. She did something that I think has a high degree of impact for everyone around health and particularly for women with endometriosis.

During the month of March, which is an awareness month for endometriosis, she shared publicly through her Instagram account, her experience with endometriosis along with a lot of very important facts. The one that captured me the most is that 1 in 10 women in the United States have endometriosis, which is the same as the diabetes rate in the United States.

When we think about the amount of time and energy that we put around diabetes, which we should, we don’t put any time and energy around addressing endometriosis. So, Tawnia, thank you so much for being willing to join us today and talk with us and educate us on this topic.  

Tawnia Jacobson [00:02:05.40] Absolutely Carol. Thank you so much for having me.  This is an extremely important topic for everybody, but obviously near and dear to my heart with personal experience.

Carol Harnett [0:02:18.42]: For that reason, I want to turn a lot of the show over to you. I would love you to start, if you don’t mind, first with grounding people with a definition of what endometriosis is, and then your story as it relates to that.

Defining Endometriosis

Tawnia Jacobson [02:37.08]: Endometriosis, by definition, is a systemic disease that occurs when tissue that normally lines the inside of your uterus is found elsewhere in the body, mostly in the pelvis or the pelvic cavity. But it can also appear on the bladder,  the bowel, the lungs (into the diaphragm) , and even the brain, in worst-case scenarios.

It causes pain, organ dysfunction, and infertility. The cause of endometriosis is unknown, but there are many theories surrounding it.  Genetics, stem cells, blood and lymph system distribution are all possibilities. Inflammation is a key factor, and they believe that maybe some environmental toxins may be linked to it.  Again, no definitive cause, and the diagnosis unfortunately takes a very long time. As Carol mentioned, the prevalence is extremely high, it’s 1 in 10 women. So if you yourself don’t have it, absolutely somebody you know has it or may not even know that they have it, but are experiencing signs and symptoms of having endometriosis.

A Challenging Diagnosis

Tawnia Jacobson [0:04:00.16]: A lot of people ask why it takes so long to diagnose and it’s mainly because most obstetrics and gynecology doctors themselves don’t even know that much about it. The average patient will see eight to ten doctors before they receive an actual diagnosis. After years and years of pain and suffering, many patients are told that it’s “in their head”, that it’s just “IBS” — irritable bowel syndrome — because so many of us have so many bowel symptoms that go along with this.

When it’s confused to be a GI issue, you might be sent away from your GYN (gynecologist), to a gastroenterologist and go through every process and procedure known to man for that, and really that’s not the initial cause. With a lot of confusion and pain, it becomes a mental battle and game for many patients and it’s very frustrating.

I can now back up and talk about my story.

Tawnia Jacobson | Symptoms: Pain, Heavy Menstrual Bleeding, Fatigue, Migraines

Tawnia Jacobson [0:05:05.25]: I would say that this whole thing probably started for me when I started menstruating at the age of 16. With heavy, heavy bleeding, I missed many days of high school. I was fatigued. I would get headaches. My mother actually had a history of very heavy periods as well, and had a hysterectomy at the age of 30 because of heavy bleeding. She couldn’t handle it anymore. At the time, whether they knew or not that she had endometriosis has really been left to be discovered, but it doesn’t matter. They performed a hysterectomy to treat her pain and bleeding, and that’s all I know. My mom kind of just said, “Yeah, I had really bad periods, too,” and we went about business and life. When I moved to college, the pain was worse. I would be knocked out for at least a week at a time in addition to the week of premenstrual symptoms.

One Solution | Birth Control

Tawnia Jacobson [0:06.10.01]: I finally started seeing a GYN (gynecologist) early in college who suggested birth control. She diagnosed me with menstrual migraines. She thought if we could even out my hormone swings it would prevent my migraines. Then, obviously, if I wasn’t bleeding, I wouldn’t have as much pain or symptoms of cramping and bleeding.

I went on birth control early on, probably by the time I was 19, and stayed on birth control for about 7 years. I came off birth control at about 2008; (we can talk a little bit more about how birth control can suppress endometriosis symptoms later).

Without being able to remember too much, in general, I just always felt crappy around my period. I was exhausted. There were probably days — many days — when I called out of work. But the bleeding was so intense that I would have to take extra clothes with me everywhere I went because I would easily bleed through what I had on.

Again, I was just always told it was normal. Even my GYN was like, “Yeah”, some people just get this. This is normal.” She offered me narcotics to deal with the pain. I never took them as I am not the type of person who would even take Ibuprofen regularly. So I spent a lot of time in bed, a lot of time sleeping with heating pads, and just dealing with it.  This continued for years and years.

Next Step | Trying to Conceive

Tawnia Jacobson [0:07.45.76]: I think the next step in my journey came when my husband and I decided to start trying for a family. Probably around 2014, we became more active in trying. And even though I had been off of birth control since 2008, we were obviously not preventing pregnancy, but it hadn’t happened. But 2014 is when we started to try a little bit more actively.

I was feeling a lot more left lower quadrant pain, and I think once you become hyper-focused on your schedule and looking at a calendar all the time,  you start to become very in-tune with your body. I was just noticing so many things. So I sat down and talked to my GYN about it. She said, “Let’s start by getting some labs and do an ultrasound, so that we can  rule out cysts.”

At the time I didn’t have any signs or symptoms of ovarian cysts other than just pain which seemed to be focused in my left lower quadrant.  Labs came back and showed that I had a low AMH, which is an Anti-Müllerian hormone. This test is fairly new. They’ve been using it maybe 10 to 12 years. So again, six years ago or five years ago, or however long it was I got this information, my GYN  didn’t feel that comfortable with dealing with it. She said, “With this information, it means you have a low ovarian reserve, and I’m not really sure how to treat you moving forward. I need to send you to a fertility specialist.”

This was obviously devastating news, and not what you want to hear when you’re just starting your journey.  But I thought, “Great! This is a specialist, somebody who is going to listen a little bit more to my symptoms and put a little more thought into my cycle and what has been going on for years.”

A Specialist, and Diagnostic Laparoscopy

Tawnia Jacobson [0:09.36.93]: We went on that journey, and have been on that journey for the past four years. It has been equal parts devastating and frustrating, but it was during that time that we all, as a team, made the decision that I probably most likely had endometriosis. The only problem was, the only way to diagnose endometriosis is via invasive surgical procedure. You have to have a diagnostic laparoscopy in order to obtain a sample of tissue to send to pathology for diagnosis. It was years of frustration and a lot of changes to my cycles, (very short cycles). Another thing to add is that after we were told we wouldn’t conceive naturally, I did conceive naturally.  Unfortunately I sustained a miscarriage at about 10 to 11 weeks. It was at that point that my cycles seemed to be even more sporadic and painful. It was then that I finally said, “Okay, I have to do something, so let’s have surgery.”

In 2017 I had my first surgery by a fertility specialist who claimed that he could fix my endometriosis and get me pregnant. I trusted him and I went through surgery. Within three months, my symptoms were worse than they had been before. I was in a very ugly place mentally and emotionally, and I was begging for a birth control again because I said, “I can’t continue feeling like this. I’m not myself. It hurts every day.”  It went from being painful a week to two weeks out of the month to three to four weeks out of the month. There were very few good days. I was keeping a calendar. I was keeping food diaries. It was consuming my life and it was miserable. So I begged and pleaded for birth control, and he talked me out of it because he said, “You are looking to start a family” and I said, “I understand that but this isn’t working.” So instead he put me on Clomid.

I took a course of Clomid hoping to get pregnant, but instead I ended up getting a grapefruit-sized cyst.  Luckily it did not require surgical resection, but I endured many, many days of pain until it rectified itself. After that, I foolishly put myself on a course of DHEA hoping that would improve my egg supply for getting pregnant once again; not realizing that those are the worst things you can do for endometriosis.

Breakthrough

Tawnia Jacobson [0:12.20.51]: By the fall of 2017,  I was just in a really bad place.  It was not good for my relationships. It was not good for my marriage. I knew that I needed to do something. I just didn’t know what I needed to do.

As fate would have it, one of my neighbors and I were talking one day. We had just built a house in a new development and she was a new neighbor. We were talking about infertility. She mentioned that she had endometriosis as well, and she led me down the path of Nancy’s Nook, which is an endometriosis education forum on Facebook that literally changed my life.

I went on there and I read for a couple of hours every day. I learned more than I ever learned about endometriosis in my entire life in about four hours, and it changed my life. It was Nancy’s Nook who educated me, who ultimately led me to my surgeon, who performed excision surgery, which is the gold standard for treatment right now. I had surgery last March and have felt like a new person ever since then.

Carol Harnett [0:13:34.05]: Wow, as I was listening, you probably heard me gasping because it’s incredible to listen to your experience in one fell swoop. I can’t imagine what that was like to live through.

Tawnia Jacobson [0:13.49.22]: I try to keep it as condensed possible, but it was many, many years of suffering, and many years going in the wrong direction.

I mentioned keeping food diaries.  I changed my diet so many times. I had tried gluten-free and dairy-free. It was around that time that I actually got pregnant. Part of me was like “Wow, is that what it takes?” Then I eventually went vegan; I had cut out all meat. If you read a little bit more about endometriosis, you realize that they encourage an anti-inflammatory diet. A lot of that means getting rid of red meat. My husband and I tried vegan for a while, and none of this was helping any of my symptoms. It was basically just torturing me more mentally because it was all-consuming.

Finally, The Right Surgeon, The Right Procedure

Tawnia Jacobson [0:14.32.20]: I talked about meeting the surgeon who basically changed my life. It was the excision surgery that changed my life. It was the appropriate treatment. My first surgery was ablation, which means they burn the tissue.  They don’t actually get rid of it, they just burn it, and hope to prevent it from growing back. The tissue, I guess it could be described as an iceberg. The tissue that you see is visible endometriosis, but lives much deeper than that. The part of the iceberg that you don’t see below the surface is actually the problem. You burn what you see, but you leave behind what you don’t see, and it will continue to grow. Since you’re in there basically irritating it, making it more angry, the endometriosis becomes worse. That’s why when I had my first surgery, within three to four months, I was feeling worse than I did before. We made it angry. Until I went to the correct surgeon and had the proper procedure done, my symptoms weren’t going to get any better.

Since having surgery, (a four-hour procedure), I was diagnosed with moderate endometriosis.
I did not have it on my diaphragm, Thank God, but  it was covering much of my pelvic orifice. It was growing on both ovaries and wrapped around ligaments. I had right leg pain that nobody ever paid any attention to but me. I would live from day-to-day, working out regularly, and then I would have to take one to two weeks off of my workouts at a time because my right leg was bothering me so much.

When I found the surgeon who ended up helping me, he didn’t even bat an eye.  As soon as I said “right leg pain down my back,” he was like, “Oh, yeah, your ligaments are involved.” And sure enough, when he went in there, the endometriosis was wrapped around my uterosacral ligaments. He had to dig down in there and clean that all out and I haven’t had any leg pain since surgery.

Carol Harnett [0:16:34.62]: You’re generous to share this. I know that when we look at data for why people go out of work and we look at their health data (we call it disability data), but it’s not the disability people think about. When we say disability data, we are almost always talking about illness or injuries that people have that prevent them from working — usually on a temporary basis.

Ablations and hysterectomies are procedures we’re seeing both in endometriosis and in perimenopausal women who are having difficulty with heavy bleeding. It’s interesting, too, because these procedures aren’t always successful in the perimenopausal population.  I did more background reading so I could ask you intelligent questions. I read about excision surgery and was disappointed to find that there’s a limited number of surgeons in the U.S. who have the expertise to do this surgery.

Tawnia Jacobson [0:17.29.92]: About 150, I think, worldwide.

Carol Harnett [0:17:33.91]: Yes, I think there’s about 100 in the U.S. When you think about it, I assume they’re clustered in bigger geographic areas. I think about women who this might be a good solution for — at least a strategy to manage it — those who may have to travel to see somebody who’s able to do this procedure. This is concerning because that may exclude women of certain means to be able to do that.  That always concerns me.

I actually didn’t ask you about this earlier when we started this show, or even when we’ve talked about this a little bit, but I think you referenced in one of your social media posts that there are some insurance limitations for some of the procedures. Did I remember that correctly?

Insurance Coverage and Financial Implications

Tawnia Jacobson [0:18.26.65]: Yeah, I’m going to be very careful with how I speak to this because I am not a professional in the industry. I can only speak to my personal experience, and I actually have a girlfriend who’s really going through a very frustrating situation herself with insurance regarding this.  I can say from my experience, yes, my surgeon was out of state. He was technically out-of-network, which is true for many women who are searching to find an endometriosis expert to treat them because they are very few and far between. Many of them are grouped together, like you said. We’re fortunate in New England to have in New York, Massachusetts and Maine certified surgeons who are experts in excision surgery but, unfortunately, your insurance does restrict you being able to go out of state. Lucky for me, my insurance at the time had an out-of-network option. The hospital, the lab and the anesthesia services were partly covered by my insurance. Now the surgeon himself is paid out of pocket simply because he doesn’t get reimbursed for the procedure.

This is where I’m going to be very careful with how I speak.  How I understand it is that there are basically no CPT codes for the excision surgery itself. They will lump it into the same category as ablation. My surgery was four hours long. My bowel was not involved, but many women do have bowel involvement which can sometimes involve a colorectal surgeon as well. So, if you’re in there 4 to 8 hours (sometimes 10 hours if you’re having diaphragm involvement as well) and you’re only getting reimbursed for an ablation procedure, which can be done in about an hour, you’re losing a lot of money.  That is a lot of time, energy and expense being put out there that you’re not getting reimbursed for. I believe that’s why many of these surgeons require out-of-pocket pay.

Carol Harnett [0:20:39.22]: You have to save!

Tawnia Jacobson [0:20.41.84]: Yeah exactly. My surgeon offered a payment plan. You spoke about people traveling; he gets patients from all over the world.  He had patients flying from India the week that I met him. He’s been doing this for 30 plus years so he is seeing people worldwide. It’s unfortunate because not everybody has the means to be able to do this.  When I was going through the process of finding a surgeon and scheduling surgery, I had befriended somebody through social media who lives in California. She was suffering so much and could not find a surgeon out there who was local and in-network for her insurance. She was fighting the good fight. She was appealing every time I turned around and she was just hoping and praying that she’d be able to find some loophole to be able to allow her to have excision surgery. I can proudly say today that she finally did get surgery! She had excision surgery in December, but I was at the point where I was like,  “Oh my God, I need to start saving money and fly her out here to see my surgeon,” because after I had surgery, I felt so much better. I want every person who is experiencing this pain to be able to find somebody who can help them because they deserve it.

Back to the insurance question -, my girlfriend is experiencing a very similar situation. She has had three ablation surgeries locally, at one of our local hospitals, and it’s not working for her. She needs excision and her insurance has denied her request, twice, to go see my surgeon in She’s still fighting, still trying to figure that out.

A Word About PPO Plans | More Options

Carol Harnett [0:22:19.74]: I’ll just add a quick point. I’ve been in and around insurance for the last ten plus years of my life, in addition to what I do at The Council for Disability Awareness., When you’re going through the open enrollment process, if your employer offers health insurance, (employers of a certain size are all required to offer health insurance) or have to go into the individual market yourself, it’s really important to make sure you’re in a preferred provider (PPO) plan.  At least when you go out of network, it’s pricey (you have a much more significant copay until you reach your out-of-pocket maximum), but at least it gives you options.

This advice applies not just for this situation, but for all situations, particularly if you want to go to what we would call a “center of excellence.” I would consider 100 surgeons in the country to be 100 separate centers of excellence for how to treat this condition — endometriosis — by excision.

This is not a push for you to buy more health insurance than you need.  A PPO health plan costs more money, but when you or one of your loved ones is impacted, you will be ever so thankful that you had options.

Carol Harnett [0:23:25.28]: I am looking at the clock and we have about 6 minutes and there are two questions I want to ask. You referenced a couple of times that when you were in high school you missed school and missed work.  Something that The Council for Disability Awareness focuses on is how illnesses, injuries and diseases can impact people’s ability to work.

The most recent research article I could find was published in 2017. The researchers studied the impact of endometriosis on work and life and said that on average (and the range is enormous), women lose about 5.3 hours per week to endometriosis. Whether that’s being absent or unable to do something, or not being able to do it in the way they normally could.

Can you talk a little bit more about how endometriosis impacted your ability to work for certain, but also your ability to do things in your own life?  I have met you as a very active person, so could you share with people what that is like.

Living and Working with Endometriosis

Tawnia Jacobson [0:24.51.98]: There were days missed from work, days where I had been up all night writhing in pain, or had a wicked headache and just felt terrible the next day and knew that I couldn’t function to my full capacity. That being said, fortunately for me, the worst of my symptoms developed about nine months before I had excision surgery and coincided with me  taking a new position at my job. It was a leadership role. It was administrative. I was putting so much time and energy into my new role, that it was depleting me to the point where between that and my symptoms, I couldn’t function in life outside of work.

I think the new job gave me the drive to get up every single day. Even though I was miserable mentally and physically, I had a purpose. I got up and would work four days a week, but I would then come home and be useless. I would be on the couch with a heat pack taking more ibuprofen than I had ever taken in my life.  Luckily, I had a husband who could pick up the pieces, but it wasn’t good for our relationship, and it was taking a toll on us. I just can’t help but think of women who are supporting themselves as single mothers, or women who are single and alone, and don’t have somebody to help them emotionally or physically.

I couldn’t cook, I couldn’t clean, and I didn’t do my own laundry. I was really kind of  useless outside of work. I had the ability to get there and do that, but that was kind of my purpose in life. I’ve often thought about if I hadn’t taken that new job, where would I be because I think I would have given up. I think I wouldn’t have wanted to get up anymore every single day. It’s funny how timing works out like that.  Prior to that position, I definitely missed a ton of work.

I definitely would call out. I said it used to be a week at a time,  and I would feel crummy, but then it became three weeks out of the month.  It was affecting me so much so that actually my words to my husband were: “I either have to find a surgeon who can help me or who believed my pain and my symptoms, or I have to be admitted to a mental institution, because something’s not right with me. I’m in a very dark place and I’m not myself.”  Those words really sent the message home, and he was like, “We have to do something.”

Fortunately for me, my something was Facebook and educating myself. I said it to you before and I have said it to other people, “It’s embarrassing. I’m a healthcare professional. I’ve studied science my entire life.” I didn’t know what endometriosis meant. I thought it just meant bad periods, painful bleeding, painful sex.  It was an excuse to me. Unfortunately, that’s what many people think and that’s the kind of the stigma you had mentioned. It’s a woman’s disease and women don’t normally talk about their reproductive systems. People don’t usually want to hear about women’s reproductive systems, and that’s unfortunate, because if we can tie this back to the beginning and talk about the prevalence being the same as diabetes. Diabetes isn’t always pretty either, and it affects every organ system in the body — just like endometriosis can affect almost every organ system in the body. Everyone’s symptoms might present a little bit differently, but they can involve major organ systems.

Carol Harnett [0:28:18.58]: I appreciate you sharing all that, particularly your comments about your mental health, because when I looked at this 2018 research study, they looked at lists of symptoms. The more symptoms you have, the more likely you are to be out of work for a period of time.  The number two symptom (pain being number one) was mental health, because people were feeling unaddressed and confused.

I am so grateful you’re talking about mental health because, by coincidence, we are live recording this on May 1st, which is the beginning of Mental Health Awareness Month, in addition to Disability Insurance Awareness Month, and I’ve committed to talking a lot about mental health.

We have 60 seconds left to our time together, so I’m going to ask for a 30 second headline. Looking back on what you know now, what’s the number one piece of advice you would give to people?

Tawnia’s Best Advice | Educate Yourself

Tawnia Jacobson [0:29.15.14]: Educate yourself. Don’t trust that the doctors know exactly what they’re talking about. I don’t say that negatively, because I work with physicians every single day, but they’re not all experts in what you’re experiencing. Be your own advocate; do your own research, and find the specialist in the area that you need.

For me, it was endometriosis; Nancy’s Nook saved my life. I wish I would have found that resource earlier. If people are struggling, go look at the documentary on endowhat.com. It is life-changing.  

Carol Harnett [0:29:48.41]: Thank you so much, Tawnia, for being our guest. In my opinion, this  is the best show we’ve ever done.

For everyone who has been listening, we hope this show has helped you.

I want to say thank you to all of our listeners. Have a great day, and there’ll be a transcript that accompanies this show so it is easier for  you to get all of the information that we referenced. We will make sure there’s links for all of it.

Thank you again, Tawnia.  

Tawnia Jacobson [0:30.11.97]: Thank you for having me –  such a great topic.




Trends in Disability Insurance Claims Management

Originally posted by Ian Bridgman at The Claim Lab April 30, 2019

Last month we started a series of newsletters (February) to introduce the concept of data enrichment of claims information and we discussed how this will help us to understand what’s really preventing return to work for complex claims.

Maybe for those short term disability plans of 3 to 6 months, the duration is driven by diagnosis. In the healthcare industry, recovery is measured over a 6 month period. So by its very nature a claim that has gone on longer than 6 months has complications…

We have been told for many years in the claims world that we should not over medicalize claims, yet when claim managers get stuck, they order an IME!

We know that the likelihood is that there is something else going on: work issues, poor motivation, anxiety, depression, domestic issues, medication dependence, etc. on top of the primary diagnosis.

These are the psychosocial factors, that after the first few months of a claim, should really be driving our claim management process.

An experienced claim manager could, probably after 7 mins on the phone, start to dig into some of these issues, BUT we don’t have many experienced claim managers any more, and if we do, their case loads are too high, and new claim managers are lacking the required skills.

Just imagine for a moment, that we had developed a way of understanding these psychosocial influencers without the need for an experienced claim manager!

Click here to read the full post at The Claim Lab


The Claim Lab is an organization that has been conceived to help Disability and Worker’s Compensation Insurance companies improve claims outcomes using innovative techniques.  Learn more at www.claimlab.org.




Celebrating the Modern Dad: Transitions and Wellbeing for Today’s Family



The presence of a loving father greatly increases a child’s chances of success, confidence, resilience, physical and mental well-being.

Family Dynamics of the Past

Not too long ago, society deemed dads incapable of caring for their children.  At least that’s what the television ads would portray. Picture this: a bumbling dad burning dinner and twisting the baby’s diaper in a knot, only to be saved by dear old mom.  At the time, fathers were simply the breadwinners, and had no business in the kitchen or caring for the children.

But that was then.  

The historically significant shifts in technology, alongside the evolution of gender roles, over the past 70 years, both at home and in the workplace, have changed that.  Now, dads are just as likely as moms to say that parenting is important to their identity.  According to Pew Research, it is now less common for dads to be the sole breadwinner of the family.  In 1970, 47 percent of families were supported by the working dad alone. Today, that number has dropped to 27 percent.  Most two-parent families with kids have both parents working in some capacity.  Along the way, society has done away with stereotypes about what fathers do. 

If there is a strong evidence to prove the importance that fathers be around and be involved, then they now have a stronger argument to be home.” 
– Paul Raeburn.

The Modern Dad: Fathers as Caregivers

The modern-day father comes in various forms. Today’s father is no longer always the traditional married breadwinner and disciplinarian in the family. He can be single or married; externally employed or stay-at-home; gay or straight; an adoptive or step-parent; and a more than capable caregiver. More fathers are actually making the conscious choice to stay home to raise their children.  According to Pew Center, in 2016, 24% of stay-at-home dads reported that this was the main reason they were at home, up from just 4% in 1989.

As more and more dad’s take on the caregiver role, new studies are being conducted on the science of fatherhood that investigates the role of fathers in their children’s and families’ lives.  According to author, Paul Raeburn,  “Fathers who play with their kids have children who have fewer behavioral problems in their school years, adjust better to their transition to school from toddlerhood, and have less likelihood to be involved in delinquency or criminal behaviors as teenagers and even more as adults. This has a lifelong effect on children and it’s really only in the last few years that this has begun to be recognized.”  

The NEW American Family and the Need for Comparable Paid Family Leave Laws, Disability Insurance

As dad’s role in the family dynamic becomes more equalized with that of what the stay at home mom’s role used to be, the need for paid leave programs for all workers has come into the public and political conversation. Today, only a few states have laws requiring paid leave for various circumstances. And while many companies have their own, more generous policies, the benefit is not as widespread as you might imagine: The National Partnership for Women and Families, a non-profit, non-partisan advocacy group, estimates that only 17 percent of workers in the United States have access to paid family leave through their employers.

To help working mothers, paid parental leave – for moms and dads — may be the next frontier. Employers and governments are now talking a lot more about giving fathers a break so they can be the dads they want to be – and so the daily work-parenting load will be more equally distributed. In fact, the Trump administration has reportedly drafted a budget that would require states to offer six weeks of paid parental leave. So far, there are no signs of any progress on the plan, mostly because there are no specifics about how to implement it yet, but the fact that such a priority is even on the budget at a time of massive spending cuts is good news. 

Whether or not your state or company offers ample paid leave, disability insurance (or, as we like to call it, “income insurance”) is another benefit more employers are considering as additions to their benefits packages, and one more families should consider during their company’s open enrollment. Although fewer than 40 percent have access to personal medical leave through short-term disability insurance that is provided by their employer, most workplaces offer you the option of purchasing more. It’s a decision that can save a family’s finances should the unexpected happen.

Proactive Steps Dad Can Take for Longterm Health and Wellbeing

Outside of benefits and income protection, and as primary caregivers, it is important for men, like their female counterparts, to take a proactive approach to healthcare, something most men historically do not do. According to a recent article by the Wall Street Journal, men are notoriously bad patients. Compared with women, they avoid going to the doctor, skip more recommended screenings and practice riskier behavior. They also die about five years sooner, live with more years of bad health and have higher suicide rates. Now, with the growing recognition that treating preventable causes of death and disability could close the medical gender gap, the health-care industry is mounting a new push to get men the care they need.  

The first step is prevention. As we know heart disease the number one cause of illness and death for the American man.  Families can help the dads in their lives think about their own health and lifestyle choices and ensure they are taking the right steps to look after themselves.  The Centers for Disease Control, offers families a simple guide to help the men in their life get and stay on track with their health.  Here are some tips: 

  1. Gather for the Family Meal.
    While you are at it, have dad eat his fruits and vegetables every day.

  2. Get active!
    This Father’s Day, find fun ways to exercise together. Regular physical activity has many benefits. It can help dad control his weight, reduce his risk of heart disease and some cancers, and can improve overall mental health and mood.
  3. Don’t Forget to Breathe.
    Help the men in your life recognize and reduce stress.
  4. Schedule the Check Up.
    Men can prepare for doctor’s visits. Certain diseases and conditions may not have symptoms, so checkups help identify issues early or before they can become a problem.
  5. Know the Signs of a Heart Attack:
    • Pain or discomfort in the jaw, neck, or back
    • Feeling weak, light-headed, or faint
    • Chest pain or discomfort
    • Pain or discomfort in arms or shoulder
    • Shortness of breath
  1. Know the Signs of Depression: They include persistent sadness, grumpiness, feelings of hopelessness, tiredness and decreased energy, and thoughts of suicide.

A father’s influence has changed over the years. For example, today there are more stay-at-home dads by choice and those that are able to take paid leave for a new baby.  This has created a cultural shift placing a father at the core of caregiving. As a result, it is having long term positive effects. As the number of dads who are in the caregiver role increases, it is ever more important they take advantage of employer paid leave benefits, and at the same time, take proactive steps to maintain optimal health… not just for their own good, but the good of their families (and society in general).  

Happy Father’s Day!




Seven Ways Employers Can Create Flexible Work Options

Competition for Talent Informs Trend in Flexibility as Benefit Option

HR departments know all too well the fierce competition for top talent being waged today. And as you develop appealing compensation offers and benefits packages, there is one peak benefit that employees are clamoring for—and that’s flexibility. If you are still clinging to a fixed work schedule, you may soon be left behind; in fact one survey finds this is the top work benefit employers are expecting to add in 2019, and many workers won’t hesitate to move to another company with a more attractive benefit offering.

However, even if you want to add flexibility, there is the issue that not every workplace seems cut out for it. After all, you still have clients to deal with, and work that must be completed. The good news is that it’s possible to offer flexibility without throwing schedules out the window. Here are seven ways that you could consider adding a modicum of flexibility to almost any workplace.

  1. Determine the Hours that People MUST Be There, and Work Around That
    Maybe you are in the Eastern time zone and primarily deal with West coast clients that could necessitate a longer day. Consider letting your staff come in a bit later on at least some mornings.  Another option would be to rotate the team member who stays late to cover the West coast hours. The goal? To be available to successfully manage client issues without requiring the entire team to work all the hours.
  2. Identify Work That Can Be Done from Home
    Even in a call center where employees are literally working the phones, see if there is some element of their work that they could do on their own time or at the location of choice, such as typing up reports or doing other paperwork. Employees who feel that you are keeping these types of opportunities in mind will be grateful when they are presented, even if they understand that the majority of their work must be completed on site.
  3. Let Employees Take Care of Personal Needs
    Don’t make employees feel they have to hide the fact that they’re making a doctor’s appointment or shopping for a birthday present online during a lull. Just remember chances are they are answering work-related emails on their own time, too. The lines of work and leisure time continue to blend, and your team needs to know that you understand and respect that reality.
  4. Allow Employees to Trade Shifts With Each Other
    If you work in an industry like retail or food service where employees work varying schedules, don’t make it onerous for them to trade shifts. Find an app that lets them do it themselves or create another system that allows them to trade or give away shifts. While you’re at it, talk to your employees about how they feel about the shifts they have. If you always give a Friday night shift to the same person, make sure that they are ok with it or set up a rotation. While seniority should count for something, you still want to make sure that all your employees believe the system is fair.
  5. Ask Employees What They Need
    Often employees will be reluctant to speak up because they don’t want to seem as though they are complaining. Yet there might be some aspect of their hours that are challenging and could easily be changed. For example, a team meeting first thing in the morning can be hard for a parent. If it’s all the same to you, you could move the meeting to 10 a.m., or let them dial in from home. If it would accomplish the same goal, you could also cancel the meeting altogether and have people share their updates via email or a project management software.

    You might also find that a devoted employee would work an extra hour or two after he has put his kids to bed if it allows him to leave early to see a soccer game or oversee homework time. Someone else who is a caregiver might happily cover early shifts that no one else wants in exchange for one afternoon a week off. The key is to ask your team what they need or want; let them know that you can’t always accommodate them, but you’re willing to try.

  6. Set Up Processes to Track Remote Work
    Even if your staff is trustworthy, it can be a big leap to just let employees work from home on the honor system. It’s perfectly reasonable to set up expectations that a telecommuter has to be available at a certain time, or that employees must log into the work system so that you can track their hours. Keeping the controls a little tighter when you start offers the chance to eventually loosen them if things go well. Remember, it feels much more punitive to go the other way so err on the side of caution as you explore these new freedoms.

  7. Focus on Output Rather Than “Face Time”
    The key to making it all work: Does it really matter where your team is doing their work as long as they are doing it? In some types of organizations, of course it does. But in others, the focus could shift from when and where the goals were accomplished to just the fact that they were.

 


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For Employers, Vendors are Key to Strategic Absence Management

By Marjory Robertson, AVP & Senior Counsel and Abigail O’Connell, Senior Counsel, Sun Life Financial

When employees need to step away from work — whether to welcome a new child, care for a family member, or another life event — protecting their jobs and benefits, understanding their rights, knowing whether their employers will pay part or all of their absences, and meeting paperwork deadlines and other obligations is often overwhelming. If they work for an employer without a consolidated absence approach, they also will be required to contact separate entities for different benefits and entitlements. Workers may be calling their HR team to file their Family & Medical Leave Act requests, and contacting their insurance carriers to file claims for short-term disability benefits.  There is a lot to manage when it comes to employee leave, and it can be a heavy burden on employers.

Employee Absences Can Be Overwhelming for Employers

Legal requirements regarding leaves of absence (paid and unpaid) and workplace accommodations are changing at breathtaking speed. Employers’ human resources staff do not have the time, personnel, or expertise to ensure they are complying with the various requirements of the FMLA, the Americans with Disabilities Act, and the increasing variety of federal, state, and local paid and unpaid leave laws.

Further, the consequences of noncompliance for employers are very serious, ranging from government investigations by the Equal Employment Opportunity Commission or the Department of Labor to individual lawsuits by employees.

More employers are choosing to outsource their leave management to their disability provider. In fact, according to a 2017 leave management survey by the Disability Management Employers Coalition, 88 percent of employers who outsource their leave management do so with their disability insurers. They have expert legal and compliance personnel and systems who help employers ensure compliance with this myriad of changing leave and accommodation laws. Moreover, insurance companies want to partner with employers to evaluate and handle complex leave and accommodation issues and challenges. Their knowledge, skills, systems, and staff help employees receive the benefits they need quickly, and prevent FMLA and ADA abuse, including the challenging management of intermittent FMLA leave.

Vendors Can Ease the Burden of Employee Absence

To streamline the employee and employer experience, many companies select one vendor to administer paid and unpaid leave, absence, and disability benefits. A consolidated approach enables both employees and HR managers to contact one entity for information about their rights and obligations concerning multiple benefits and entitlements, like short-term disability, FMLA, and ADA/ADAAA accommodations.

In many situations, both the FMLA and the employer’s STD policy may cover an employee’s absence, enabling the disability carrier to make determinations based on a single employee claim form. Employers and managers receive consolidated reporting showing the status, dates, and timelines for employee absence to support workforce planning.

Vendor Expertise Can Help Target Plans to Boost Engagement

With one vendor, employers can incorporate and administer company paid (and unpaid) leave plans and programs alongside absence management programs and disability insurance. For example, the vendor may highlight an aspect of the employer’s employee assistance program based upon the employee’s particular absence reason, or remind the employee of a duty to report to his or her supervisor based on the employer’s usual and customary call-out requirements. More and more employers are offering paid paternal and/or family leaves. Insurers can administer these leaves along with the unpaid statutory leaves and also ensure that employer-sponsored paid leaves are coordinated with the increasing number of state paid family and medical leave laws.

Program Efficiency, a Great Benefit of Outsourcing

Through their disability insurance provider, the employer may gain efficiency by setting up a single-file feed and vendor agreement. The employer’s staff may also become more efficient by outsourcing absence administration. Additionally, using an outside administrator limits risk of exposure to employee personal health information; employees will appreciate not having to provide sensitive medical information to their manager or HR. The provider can become a trusted partner to provide collaborative and consultative guidance on a range of complex compliance and administrative issues.

Some Highlights:

  • Disability insurance carriers have decades of experience in managing absences, accommodations, and claims related to an employee’s own medical conditions, and for other leave reasons authorized by law or by an employer-sponsored leave plan.
  • Insurance carriers hire expert claims, vocational, and legal staff who can properly evaluate eligibility for leave and benefits, and administer the claims and accommodations in a seamless and integrated manner that best serves employers and employees alike.
  • Disability carriers offer client-friendly services, including timely processing of claims for leave and/or disability, integrated management of leave and disability claims, detailed reporting on leave and disability incidence rate, and timely and helpful communications with both the employer and affected employees.
  • Insurers have made – and will continue to make – substantial investments in legally-compliant claims and leave technology to meet evolving needs. They also maintain strict data privacy and cyber security standards.

Engage your disability provider for help with your absence and leave management policies. From providing support tools to navigating the nuances of leave protocols and maintaining compliance, your insurer can support you and your employees throughout their leave duration.

For more on paid leave and your paid leave strategy, tune into the CDA podcast, with Carol Harnett, Abigail O’Connell and Marjory Robertson.




The Value of Disability Insurance as Income Security


By Gene Lanzoni, Marketing, Thought Leadership, Customer Insights 
The Guardian Life Insurance Company of America


The ability to earn an income is essential to modern living, yet more Americans often prioritize protecting their home, car, health, and teeth over helping protect their income with insurance. When a life event that causes a disability occurs, even in the short-term, it can disrupt an employee’s financial security, especially if they are unprepared for a work absence.  In fact, according to the American Council on Life Insurers, over 50 million Americans are without disability insurance.  Here’s why it matters:

Even a short unemployed break can cause financial instability. Given that more than half of working Americans live paycheck-to-paycheck, most cannot go without one for a single pay period, let alone three or more months. Let’s put this in perspective – working adults have about $5,000 in emergency savings, which disappears quickly considering the U.S. median monthly cost for housing, food, and transportation is roughly $3,000.[1] Those who’ve had a disability leave report emergency savings of just $2,500.[2]

We recently released our latest set of findings from Guardian’s 6th Annual Workplace Benefits Study for a financial wellness report titled Income Protection: The Role of Disability Insurance in Financial Wellness,” which finds only 54% of working Americans have disability insurance. The report validates that there are still a lot of misconceptions around the value of disability insurance. For example, many adults believe the product is for people who suffer from disabilities that are catastrophic or that it’s for disabilities which happen at work and covered by workers compensation. This is where education plays a critical role in helping employees understand that disability insurance serves as income replacement should you be out of work for an extended period of time.

While a competitive salary is important, especially in today’s low unemployment job market,  candidates will also be pushing for the best options in benefits. For employers, including disability insurance as part of your overall employee benefits offering can demonstrate that you care about your workforce’s financial security and wellness. Disability insurance has benefits everyone, regardless of age, gender or profession, should consider:

  • Income Protection
    While living paycheck-to-paycheck, workers don’t save for emergencies, such as an unexpected, unpaid leave of absence or disability. Emergency savings go fast when they have to cover pay regular monthly expenses on top of medical bills. Guardians’ study found 49% of those surveyed that did not have disability insurance withdrew from savings, investments or retirement plans to pay for their injury. Disability insurance provides an extra layer of income protection, which can make it easier to take care of financial responsibilities and not have to leverage other financial sources

  • Understanding Disability Insurance

    Guardian found only one in 25 consumers exhibit a high level of disability insurance knowledge. Today’s disability insurance programs now offer a variety of features to help employees navigate and understand their benefits. Some of those features include online enrollment payroll deduction and no medical exam to enroll. Even if certain employers can’t offer employer-sponsored disability insurance, they can provide access via an employee-funded disability insurance product. That shows flexibility and commitment to employees’ long-term financial health and well-being.
     

  • Improved Worker Satisfaction

    Guardian’s study indicates offering disability insurance can enhance overall work satisfaction (71% vs. 54%), as employees feel their company truly cares about them. Companies that offer return-to-work programs see an extra boost in satisfaction, as 70% feel their employer cares for them after completing a program.

  • Integrated Absence Management

    Absences can be hard on both an employee and an employer. Integrating an absence management program with disability insurance can help employers navigate the ever-changing paid leave laws that vary by state. Consultants and benefits carriers can work together to deliver a holistic, integrated plan that will keep employers covered and deliver a seamless employee experience.  With all these benefits available, employers and employees should re-evaluate the way they think about disability insurance plans. Signing up for disability insurance is really a way for individuals to help protect their incomes.

Disability insurance offers protection and satisfaction to both employers and employees, making it one of the most valuable products in a benefits portfolio. Nobody can predict the future, but it’s always wise to prepare for the unexpected. For more details on the financial wellness paper,click here.


The Guardian Life Insurance Company of America, New York, NY. Unless otherwise noted, the source of all information is Guardian’s 6th Annual Workplace Benefits Study, report titled: “Income Protection: The Role of Disability Insurance in Financial Wellness (2019).

2019-79673 (5/21)

[1] 20 Something Finance, (2019) “The Shocking Percentage of Americans that Live Paycheck-to-Paycheck.”

[2] Guardian’s 6th Annual Workplace Benefits Study, Financial Wellness Series, Part 2,“Income Protection: The Role of Disability Insurance in Financial Wellness,” (2019) p. 10.




Podcast: What Every Employer Should Know About Social Security Disability Insurance



Introduction

Carol Harnett: [00:00:00] Hello, this is Carol Harnett. I’m the president of The Council for Disability Awareness. Welcome to our podcast, which is called The Financial Health and Income Network. Today we are going to talk specifically to employers about how Social Security Disability Insurance works and how it can help protect employees who can no longer work due to an illness or an injury.

What is important for employers to know in a grounding basis, around disability insurance products is that in the group insurance market, there is a product that most employers are probably familiar with called long term disability insurance. About one third of employees — according to the Bureau of Labor Statistics — in the United States have what’s called an LTD policy — a long term disability insurance policy — that’s either fully paid by the employer, or partially paid by the employer.

In addition to that, about half of Americans have some form of disability coverage, most of which makes up the difference. It is either a group policy that the employee pays all of the premium for instead of getting assistance from their employer, or they may be doing something called an individual disability insurance policy that they secure working directly with an agent or an advisor and an individual disability carrier.

Today we are going to focus on this very specific type of coverage that is provided by the federal government but has a very well-defined process, including a very well-defined approval process, application process, and review process. This is Social Security Disability Insurance.


You can hear the full podcast or if you’d rather read than listen, we captured the transcript from the conversation below.


Introducing Ted Norwood from IBI, Inc.

I’m really pleased to have a subject matter expert with us on the show today. My guest is Ted Norwood. He’s the general counsel and director of representation at Integrated Benefits, Inc. We are very pleased that IBI, which is their acronym, is a member of The Council for Disability Awareness and supports us. So we thank them for that. Welcome Ted. We’re so pleased to have you here with us today.

Ted Norwood: [00:02:21] Thanks Carol. It is a pleasure to be here. I’m really excited to let people know about how all this works because it is a frequently misunderstood system.

Carol Harnett: [00:02:36] If you don’t mind, I’m going to kick you off in the most basic of all things, which is: we assume that everybody understands what SSDI is, and with them we use the acronym all the time, and A, nobody even understands what the acronym means and B, really doesn’t understand what the coverage is. Can you go right to the basics and ground our employer listeners in that?

What is SSDI?

Ted Norwood: [00:03:08] Sure. SSDI– commonly just referred to as Social Security Disability– is a disability program through the federal government’s social security system that you pay into from your paycheck through your taxes.

It covers anyone that pays in. It doesn’t cover lots of federal employees, people that don’t pay those taxes. For instance, lots of teachers aren’t covered– they’re covered by different things. Railroad workers are covered by a separate policy, but they must pay in, and that differentiates it from the other social security disability program that people often combine with it or get confused by, which is SSI, or supplemental security income. This is a disability program for people that don’t have the work history or haven’t paid in. It’s a much smaller benefit.

SSDI is a better benefit; it’s a pretty strong benefit with an average payout of $1,600 a month. After being disabled for twenty-nine months, you become Medicare-eligible, and it will last until Social Security finds that you are no longer disabled or until you hit full retirement age. And they do reviews every two to five years of your case to see if you’re still disabled.

Although social security policy can bore some people– the big takeaway is that Social Security Disability is designed to work with long term disability to provide the best policies. A combination is the most important thing.

Carol Harnett: [00:05:08] That’s really well said and it’s a great basic summary. One thing I’d like to ask is– and I think some of our listeners are not familiar with — is I’ve often heard that you have to pay quote-unquote a certain amount of quarters into Social Security before you would become eligible for SSDI. What does that mean when people say that?

What is Elligibility for SSDI?

Ted Norwood: [00:05:35] It means you have to work a certain amount. You know, if you just go out and get a job and then claim disability right away, you haven’t really paid in enough to qualify. The rule is about 40 quarters, which is about 10 years of work. If you’re younger than that, there are formulas for adjusting that. When people are applying for Social Security disability, they usually have a significant amount of work history, and if they don’t have the work history, then they have to apply for the SSI. So most of your applicants are people that have a strong work record, but they’re not able to do the job that they’ve been doing anymore.

Carol Harnett: [00:06:32] Those are good points. When you say a strong work record, is that a nice way of saying that these are people who are older, who have worked for a period of time? If so, do you happen to know what the average age might be for a typical applicant?

Applicant Profile

Ted Norwood: [00:06:51] Uh-oh, I think I’m busted here because I don’t know what the average age of the typical applicant would be, but I would say it would skew older. Young people are covered. If you’re working at a salary job, odds are you’re probably covered if you’re going through, or if you have a steady job, or even steady seasonal work, but the average applicant is older. That’s probably mostly a factor of the wear and tear that goes on to your body after years of working. You know in your 20s and 30s you’re going to be stronger and more flexible, with better recovery and stuff, and less likely to have those over time injuries. So I would say that average applicant is probably around 50 if I had to guess.

Carol Harnett: [00:07:52] Okay, that seems fair. When I think about what I know about long term disability claims, we do know when people are younger that is often when we’ll see more accident related reasons for being out of work, while illness is usually the major reason why people are out on long term disability. Accidents will play a larger role the younger you are and then the older you are obviously illness tends to play the biggest role.

Now you just made a point that I think is really important for employers to understand, which is a big differentiator between long term disability insurance and SSDI, and that is this idea of what type of work are you disabled from? Are you disabled from your ability to do your own occupation, or your own job, or are you disabled from being able to do any kind of work? And can you shed some light for listeners on the requirements around your inability to work when you apply for SSDI?

Clarify the Inability to Work

Ted Norwood: [00:09:05] Absolutely. This is a critical difference between the private disability and this public disability. When people think that they’re disabled, and they can’t work as an engineer anymore, or they can’t work in their factory anymore, or as a teacher, they think: well, “I’m disabled.” If you have a private policy, then that’ll mean you will be disabled, probably for a couple of years at least.

Social Security is different. Social Security I call a “catastrophic” disability policy– that’s an unofficial term– but it only covers you if you’re disabled from any work. The language of the Act says from being able to perform jobs that exist in significant numbers. Once upon a time they liberally interpreted that and they’d cut you some slack, but over the last 15 or more years, they’ve really cracked down, and when they say significant numbers, I mean almost any job.

So, if you are, let’s say you’re 49 and and you had a really good job at a Ford plant, and you have some back problems. Maybe you had some cancer, something going on, something severe, you no longer can do that job. But if Social Security thinks that you can be a ticket taker at the movie theater on a full-time basis– which I don’t even know what movie theaters employ those people– they’re going to deny your case.  They use a lot of outdated information, which isn’t necessarily their fault, but it’s difficult and they’re very tough.

An important thing to understand is that if you’re relying on Social Security, you have to be really, really limited.  If you can’t do hard physical work, but you could do a sit-down job, there’s a really good chance you won’t get your Social Security. The terrible thing about that is that if you’re used to doing hard work, and then you want to transition to a sit-down job, it might be really hard, especially if you’re older, to transition to that. So you end up in this gap where Social Security says, “you’re not disabled, you’re capable of performing some jobs. You’re just unemployed.”  Meanwhile, unemployment says yeah, you’re unemployed; but you know, our insurance only lasts for so long, and it’s really tough for people to find the resources to be able to make those transitions and get those jobs.

Job Function Differentiation

Carol Harnett: [00:12:00] That’s a really fair point. In long term disability insurance– provided, both by an employer and bought individually by the consumer, does somebody quote-unquote meet the definition of disability? We don’t expect someone who’s done a job like a physician, for example, or a senior executive in a company, to do a job that goes outside of their knowledge, skills, and abilities. We don’t expect them to be that ticket taker at a movie theater. It’s a much closer alliance to work, that either is exactly like what they used to do, or similar to what they used to do, using transferable skills.

Sometimes, a surgeon may no longer be able to do surgery because she has a hand tremor, but she could do medical reviews for an insurance company. She could also see patients and screen them for whether they’re a candidate for surgery. That is big difference between a private disability insurance policy and a public one like SSDI, is that correct?

Accommodations for Work: Private vs. SSDI

Ted Norwood: [00:13:28] Yes, and I would add that lots of private policies that I’ve seen factor in income. For instance, you are a successful surgeon who develops a hand tremor. Although you might make several hundred thousand dollars a year, you will go to an insurance review physician position, and you are probably not going to come close to that salary.

The policies on the private side will lots of times accommodate that. They might say: “Hey, this is an offset– because you’re capable of doing this or we expect you to try to find this,” but they make up the difference. Social Security says that if you have a really solid job making $60,000 a year, but they think that you might still be able to do this job, which is minimum wage,  they expect you to go do it.

Carol Harnett: [00:14:34] Yes, I think that’s that is probably not on their radar.

Ted Norwood: [00:14:42] No. When I’ve talked to employers and when I talk to claimants and people in general, they really don’t know anything about it, I always tell them that that’s fine. Hopefully you don’t have to really ever know about the details of Social Security Disability. You find if you have to go through it, that’s really unfortunate, but once you become an employer, and you’re making decisions about whether or not to offer policies to your employees, it’s then it becomes important to understand what they’re really facing. If you think that someone will, they can just get on Social Security, you know, if they can’t work here– that’s not as easy as it may sound. Unfortunately. I wish it were.

Carol Harnett: [00:15:36] You mentioned an average benefit, but because we’re talking about the monetary side of Social Security now, can you help listeners understand the range of payments? And can you also clarify, is there a cap or a maximum that somebody might receive on Social Security Disability?

Payments

Ted Norwood: [00:16:02] Well sure. Once you go on Social Security Disability, your payment depends on your work history and your payment history. When I say your work history, that means what you’ve paid in. You don’t pay into Social Security if you make over a certain salary or income per year; you only pay up to a cap. The max benefit, what does it end up being? I think I want to say it’s about three thousand dollars, and it can go up if you have dependents because it gives you extra benefits if you have minor dependents during the same time you’re out. But you know, you can’t replace a large salary just on Social Security disability.

Carol Harnett: [00:17:00] And if there were a minimum payment?

Ted Norwood: [00:17:05] Well, the minimum payment would be about eight hundred dollars. The SSI benefit, which varies– and that’s for people that don’t have any SSDI coverage at all– usually is somewhere between five and eight hundred depending on all the factors that go into that. So SSDI is always going to be better than that.

And I say “always.” You know, whenever as a lawyer I say “always” that really just means “almost always.” Sure enough, some lawyer’s listening saying “no, that’s not true; here is the example where it’s different.” And yes, but speaking generally, for someone to take away,I would say, $800, but that’s very low.

Carol Harnett: [00:17:56] It’s not a lot of money; this is a monthly payment, just to clarify for our listeners.

Ted Norwood: [00:18:03] Yes. It’s a monthly payment.

Attorney Required

One of the things I should mention — talking about lawyers– another difference between private insurance and Social Security is you almost need to have a lawyer to get on Social Security [Disability]. If you have a terminal illness, you probably don’t, but you’re taking a risk doing it yourself. To use the Social Security’s Disability program, it’s strongly encouraged that you use an attorney– even by Social Security.

Private insurance, you don’t need an attorney to get on. Sometimes there are disputes between insurers and claimants, and you might need a specific type of attorney when that comes up. But for the most part, you don’t get an attorney to activate your private disability policy; that’s a big advantage, too.

Carol Harnett: [00:19:04] Yes. You’re leading right into the next question, which is: What is the process? How do you apply and when do you apply for Social Security disability? How does the process work and how quickly might you receive a decision?

The Application Process

Ted Norwood: [00:19:22] Social Security only covers disabilities that arise from a medically identified problem that will last for 12 months or more.

If you break both your legs, but you’re probably going to be better in six to eight months, then you won’t qualify. If there are complications with that and it ends up taking 12 months before you can go back to work, then you could qualify. However, Social Security’s going to look at that very suspiciously.

Once you are out, or once you know you’re probably going to be out for a year and facing a kind of a grim diagnosis — there’s a lot of really grim stuff we deal with in disability, obviously– then you should apply. Once you’re sure you’re not going to be able to do this for a long time, then you want to apply.

You can file online. Everyone should be online creating their My SSA Account, even if they’re not about to apply.  It’s good that Social Security’s trying to expand their online presence and getting that set up helps them out.  You can go online and apply. You can also go up to your district office; the same place where you get your Social Security card, and file an application. Social Security will take it, make sure you have coverage for SSDI. Then, they send it out to the state agency, which is a federally-funded state agency.

Evaluation

They will evaluate you. The first step takes somewhere between two and six months, and this depends on how quickly they get your doctor’s records, how backed up they are, how difficult your case is, and if they have to send you to an exam.

After the initial evaluation, there’s about a 35% chance of being awarded– which means a 65% chance of being denied. The next step is to then file a reconsideration, which is just a review by that same state agency. There are certain regions in the country currently where you don’t have to file for reconsideration, but Social Security just changed that and they’re moving to everyone going back to reconsideration.


Annual Chart for SSDI’s Overall Award/Denials at Each Level


Reconsideration

Reconsideration. It’s the exact same process again, but they have someone else at the agency look at it. Obviously since it’s the same agency, they’re not going to have the same award rate of their own denial, so it’s about a 15% chance they’ll pay that case. So an 85% chance you’re going to be denied.

Now you are 6 to 12 months into your application and you still don’t have benefits. Now you request a hearing with an administrative law judge. Your case gets back to the federal Social Security program. They’ll assign your case to a hearing office, which is different than your district office, and there’s a long wait for that. It’s somewhere between 12 and 20 months. Depending on where you are, there are a few offices that are under 12 months, and there are some offices that are getting close to 30 months of waiting time.

Building a Case

Now you wait and you build your case. Hopefully you keep going to the doctor. You don’t get any benefits, or any insurance, and you wait until you get in front of a judge. You explain your case to the judge, and you’ll give him all of you medical records that you can get a hold of, and he’ll make a decision. Hopefully you have a good attorney.

At that point you have about a 45 percent chance to be awarded. If you’re denied by an ALJ you do have an appeal within Social Security to their Appeals Council. It’s another year usually and they don’t send many cases back because they’re really trying to not add to that backlog they already have and they basically dare you to take your case to Federal Court.

Appeals in Federal Court

If you talk to your attorney and they want to take your case to Federal Court, you can do that. The courts love this because courts are ALWAYS looking to have lots of cases– that’s a lawyer joke!  Social Security floods the courts with these cases. At that point, your case is no longer actually in the agency, it’s in federal court, and you’re actually suing Social Security and saying, “hey, you guys didn’t follow your own rules, and you wrongfully denied my disability.”


Click to get average wait time for a hearing in your area.


The odss are 50/50 in the federal courts, but it’s important to remember that most attorneys will only take very strong cases to federal court. It’s a really long, difficult process and you can’t just take your chances up there. You’ve got to have a really good case now. I will say this: most attorneys only take really good cases to begin with.

One thing that’s important is there’s a myth of disability fraud, It doesn’t really exist, because you have to work so long to get coverage to even qualify. If you haven’t worked enough, your scam isn’t going to work, because you just can’t get benefits. You get awarded, only after a long, difficult process. That is, if you work long enough to qualify. You go two years without income, and then all you get is $1,800 a month, which is certainly less than you were making before. So it’s a really, really bad scam. But people continue to think there’s a lot of fraud, when most of the rot is actually on the inside.

Carol Harnett: [00:26:00] I would ask a clarifying question: you’ve mentioned having an attorney help you with your case. Is there a charge for people when they have an attorney help?

Associated Attorney Fees

Ted Norwood: [00:26:11] Social Security has really set some strict rules on on fees, and your fee always has to be approved by Social Security. You cannot charge a fee up front. All fees are– if the claimant is paying it– your fee has to be contingent, and the max you can get is 25 percent. If you use Social Security’s fee agreement, the cap is $6,000. An attorney can charge their fees and expenses to a claimant. Most do, but some don’t though, and some attorneys will ask for money up front to hold to cover expenses and stuff, but most don’t. It’s pretty much free for you to get the attorney to do their work, but they’ll only take your case if they think they can win. If they don’t think you have a case then it’s not a sound business decision for them.

Carol Harnett: [00:27:08] Great. Well, I can’t believe how fast this time is going. We have a little less than three minutes.

Ted Norwood: [00:27:14] I saw that.

Carol Harnett: [00:27:16] I had to look at my list of questions and I think the best one to choose at this point is: in your experience what final closing words of advice would you give to employers when you think about disability in general and Social Security disability insurance on top of that?

Final Word to Employers

Ted Norwood: [00:27:35] Group private disability insurance is a pretty affordable benefit, and it is a lifesaver for your employees if they go out of work. Fighting with Social Security is so hard. Everyone we represent that has LTD says, “that $10 a month was the best decision I ever made.” They get their benefits quicker. They still have to go through the Social Security process, because there’s an offset to that LTD, but they have money, they’re getting something. They’re not scrambling.

Social Security– if you have to wait for Social Security, it doesn’t just decimate your spirit and your income; it decimates your insurance coverage; your ability to pay for the doctors, who eventually stop seeing you. It ruins marriages and relationships and strains your family because people lose their houses. And it is long and difficult and tragic. It’s so affordable and such a good benefit to give to your employees. When they go out sick, or they get cancer, they wear down– and they’re better-taken care of. I believe in it,  and it was not even on my radar when I came out of law school; I hope employers at least look into it.

Carol Harnett: [00:29:08] Well said. I’ve known a gentleman by the name of Dick Mucci who currently runs the group insurance operation at Lincoln Financial. He has worked in and around individual disability and group disability, the private industry, his whole career. He has always said he couldn’t imagine why employers wouldn’t provide long-term disability coverage. It’s difficult for an employer to lay someone off after three or six months and leave them without some form of an income to help them get through long term disability.

So with that, Ted, I’m going to say, thank you so much for the information you shared. It’s been a privilege to have you on this show.

Ted Norwood: [00:29:54] Thanks for having me; I appreciate it. Good luck, everyone.

Carol Harnett: [00:29:57] Thank you, everyone. Bye-bye.


Click below for more articles from Ted Norwood about Social Security Disability Insurance.