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Income matters to virtually all workers, and the replacement of a percentage of income by disability insurance payments can make a tremendous difference for people who face a disabling injury or illness.
But what if their disability insurance could help them remain on the job and avoid a disability leave entirely?
That’s exactly what Stay-at-Work services are designed to do.
Stay-at-Work services may be the best kept secret in employer-sponsored benefits. My impression is that most employees aren’t aware of this option – I certainly wasn’t before I started working in the disability insurance field. And when I speak to HR professionals around the country, I find that many aren’t aware of these services, and, if they are, they’re unclear what they include. Even insurance brokers, who are probably the best educated people on disability insurance benefits outside those of us who work directly in the industry, frequently tell me they’re not sure how Stay-at-Work services work.
It’s all in the name: Stay-at-Work services demystified
Stay-at-Work programs offer a suite of services designed to help employees with medical conditions stay on the job and avoid a disability leave. They usually include assessments by a disability professional, after which a Stay-at-Work plan is proposed, often including changes to the worksite or how work is done to help the employee complete the essential job functions despite any barriers and limitations associated with their medical condition.[i]
Disability insurers have a vested interest in helping prevent any disability leaves that can be avoided. Although there’s an upfront cost for providing services to people before they file a disability claim, the Return on Investment is generally positive. We estimate that our Stay-at-Work program has a gross ROI of 180%, meaning, for every dollar we spend keeping an employee at work, we save that dollar plus another 80 cents by preventing a claim.
It isn’t just the disability insurer who benefits, though: this is a win-win-win situation. Sure, the insurer saves money, but the employee remains at work, earning their full wages and enjoying all the non-financial benefits that employment entails, such as social connections, better self-esteem, a sense of meaning, and so on.
And the employer benefits by having the employee there working. They avoid indirect costs of disability leaves, such as having to find replacement workers or ask other employees to work overtime to complete the work the disabled worker would otherwise do. In fact, aside from the direct claim costs of a short-term disability leave and the worker’s continuing employer-sponsored benefits, disability leaves cost an average of 171% of the employee’s wages.[ii] Plus, workers who are helped to stay at work are likely to feel valued and supported by their employer, leading to better morale, greater engagement, and higher employee retention.
Common features of a Stay-at-Work program
Most disability insurance carriers offer Stay-at-Work services to covered members, but the details may vary.
In most cases, these services are available to any employee covered by the policy, as long as they have a diagnosed medical condition for which they are currently in treatment with an appropriate provider. The disability insurer will review the situation to determine whether Stay-at-Work services are appropriate, since not every disability leave can be prevented. Insures have an incentive to try to prevent leaves whenever there’s a reasonable chance, though, since every successful Stay-at-Work case saves money, both for the insurer and the employer.
Usually, the employee doesn’t have to file a disability claim, although they will have to agree to participate in the program and submit requested medical documentation, as well as authorizing the program to contact their HR representative and treatment provider(s).
Stay-at-Work services are free for the employee, with the costs paid either by the insurance company (using a Reasonable Accommodation Expense benefit funded by the insurance premiums) or by the employer.
For companies that are self-insured, employers are saving money by avoiding a claim, but, even if they’re not self-insured, the positive ROI of Stay-at-Work services can save them money by reducing the claim history that’s used to set their premiums.
Insurers generally require employees to go through their supervisor or HR department for a referral for Stay-at-Work services. For employees who are concerned about the privacy of their medical information, the HR department can make a confidential referral, and both they and the Stay-at-Work professional will work with the employee without disclosing medical information to the supervisor.
Once a referral has been received, reviewed, and approved by the insurer, a Stay-at-Work professional will contact the employee to complete an assessment. This may be in person or virtual, depending on the specific situation, and it will usually include a review of the employee’s medical history, job duties, work environment, barriers, limitations, and restrictions. Ergonomic assessments are extremely common, and those may result in recommendations for changes to the employee’s workspace or the purchase of ergonomic equipment.
Following an assessment, the Stay-at-Work professional will consult with the employee’s HR representative, supervisor, and/or treatment provider(s), with written authorization from the employee, to determine the best course of action. All stakeholders must agree to the Stay-at-Work plan: the employee has to agree to try the recommended changes and/or reasonable accommodations; the employer has to agree to changes to their processes and/or worksite; and the treating provider has to agree that the recommendations are appropriate to the employee’s medical condition.
Once agreement is reached, the Stay-at-Work professional will work with the employer and the employee to implement the plan. This may include collaborating with the employee’s supervisor to make changes to work procedures or the employee’s worksite, as well as ordering accommodative equipment recommended as part of the plan. Further, when equipment is needed, the Stay-at-Work professional will generally assist in ordering the specific equipment required, ensuring it is delivered and set up appropriately, and making sure the employee is appropriately trained on its use.
After the Stay-at-Work plan has been implemented, the Stay-at-Work professional remains in contact with the employee to verify the plan is effective and that no new problems come up. Even after the Stay-at-Work case is closed, the employee and their HR representative are instructed to contact the disability insurer again if needed.
What kinds of conditions can Stay-at-Work services help?
I’m often asked when an employee or the employer should consider Stay-at-Work services, and which diagnoses are most amenable to them.
The majority of Stay-at-Work referrals we receive are for musculoskeletal conditions, especially back problems, arthritis, and so on.[iii] Those have accounted for 75% of the referrals over the life of our Stay-at-Work program, and 90% of those employees have successfully remained at work, avoiding a disability leave. The next most common category of conditions referred is diseases of the nervous system, representing 8.6% of referrals, followed by diseases of the ear and mastoid process (2.9%); the former group of workers have had a 96% success rate, while the latter have successfully stayed at work 99% of the time.
One category of medical conditions that is underrepresented in Stay-at-Work referrals are behavioral health conditions: employees diagnosed with mental health and/or substance use conditions. Just 1.9% of Stay-at-Work referrals are for mental health conditions, and a mere 0.02% are for substance use (alcohol and/or drug) disorders. In contrast, recent data suggest that as many as one-third of all American adults may be struggling with a diagnosable behavioral health condition.[iv]
That discrepancy may reflect the reality that employees typically hide their behavioral health conditions from their employers, but I believe it’s also likely most people – both employees and their supervisors and HR representatives – don’t think of Stay-at-Work services for behavioral health diagnoses. That’s too bad, though, since 97% of employees referred to Stay-at-Work services for behavioral health conditions have agreed to participate, with 83% those who participated successfully remained on the job.
Across all conditions and all industries, 86% of workers referred to our Stay-at-Work program have successfully remained on the job.[v] Of course, our Stay-at-Work team completes an assessment to determine whether the employee is likely to benefit, so we’re not offering the services to people who are unlikely to benefit, but the success rate is still astonishing to me. And I’m always amazed to see how successful we have been with conditions I’d have never thought were appropriate for them, like cancer (making up just 0.9% of our referrals, but with an 87% success rate) or Diabetes (0.6% of referrals, but an 87% success rate).
Or, as in the case below, Multiple Sclerosis, which makes up 0.6% of our referrals but has a 95% success rate.
Possibly more important, Stay-at-Work successes are long-lasting: only 6.7% of employees who complete a successful Stay-at-Work program with us file a disability claim for a similar condition within 24 months of completing their case.
A Stay-at-Work Success Story
No matter how much information is shared about Stay-at-Work services, it still tends to be difficult to understand how they work in reality. The following case study is offered to make that easier. The employee’s identifying information has been changed to protect their privacy, but the diagnostic information, accommodations, costs, savings, and employee quotes are all from a real case.
The employee was a 30-year-old middle school English teacher who was diagnosed with MS when she was 18. Her primary symptoms included physical and mental fatigue, along with impaired fine-motor coordination, which have recently increased. She also reported mobility issues which are helped by the use of elbow crutches. She reported feeling fatigued by standing to teach and has difficulty writing on the board because of her fine-motor issues.
She had two free periods per day, one for her lunch and the other for correcting papers but had to pack up her materials and go to another room to do her work since her room was used by another teacher during that time. She also reported that she had to walk to another room on a different floor to pick up her printing, as there was no printer in her classroom; on days when mobility was a more significant issue, she used the elevator to get to the second floor, which took more time than going up the stairs and reduced her productive time.
Finally, the onsite assessment identified the employee’s chair as problematic, both because it was not ergonomically correct for her and because the castors tended to slip while she was getting into and out of it. She noted that she has fallen while walking to her car, and she said she is fearful of falling if her chair slips out from under her.
The Stay-at-Work professional discussed the situation with the employee’s HR Representative (with the employee’s written authorization) and recommended a Stay-at-Work plan to include:
- Installing a smartboard at the front of the classroom to allow her to use a keyboard to write on the board rather than having to stand in front of the class and use chalk.
- Replacing three of the chalkboards in her classroom with whiteboards since she found it easier to write with dry erase markers than chalk.
- Purchasing custom-built tall chair with arm- and footrests, but no wheels, to allow her to sit while in front of the class.
- Providing a new desk chair with special rollers (rather than casters) to reduce slipping, as well as armrests and a contoured seat pan, also custom built to accommodate the employee’s small stature.
- Giving her ergonomic writing utensils.
- Installing a printer in her classroom.
The professional also recommended:
- Additional non-student work time to allow for recovery between classes and for more time for class preparation.
- Allowing her to stay in her classroom during non-student time, rather than requiring her to go to another room.
The school approved the new equipment but, as the school’s IT professional was reviewing the proposal, it was noted that the employee’s desktop and laptop computers were not compatible with the smartboard. The IT professional also noted that the employee had complained in the past about having difficulty with the laptop keyboard because of her fine-motor issues.
After additional consultation with the employee’s HR representative and the IT support professional, the following changes were made:
- The disability insurance company purchased a smartboard, whiteboards, two ergonomic chairs, ergonomic writing utensils, a laptop, and a tablet computer.
- The disability insurer also paid to have her desktop computer upgraded to be compatible with the smartboard.
- The school moved the employee to a different room, closer to her reserved (disabled) parking space, and allowed her to remain in her room throughout the day, eliminating the need to pack up her materials and go to a different room to work.
- The school also provided a printer for her classroom, so she wouldn’t need to go to a different room on a different floor to pick up her printing.
The total cost of the Stay-at-Work case for the disability insurance company was $13,862, including $13,082 for equipment and $780 for the Stay-at-Work professional. (Additional costs paid by the school district included the new printer and installation of the equipment provided by the insurer.)
The estimated savings were $3,319 in direct claim cost savings, and approximately $8,994 in indirect costs, along with avoiding an estimated 58 (calendar) disability days.[vi]
Following receipt of the equipment, the employee wrote to the Stay-at-Work professional, “Everything has been ordered and installed and it’s AMAZING!! The technology is sure making a difference,” followed by a smiling emoji.
In reviewing this case, the Stay-at-Work professional said she believed the savings were substantially more than estimated, telling me that she believed that the employee was almost certain to go out on disability leave without the assistance provided. Further, the professional stated that she thought it was likely that the employee would have transitioned to long-term disability and may not have returned to work at all, especially if her condition continued to deteriorate or if she had developed other issues while she was out on leave (such as depression or anxiety).
She said, “Not only did we keep her at work right now, but we bought her time so she can continue working as new treatments and new accommodations are developed for MS.” This is especially important in light of recent developments in the understanding and treatment of this incurable condition.[vii]
If you’re struggling with a medical condition and thinking about submitting a claim for a disability leave, consider Stay-at-Work services. There’s no guarantee that your insurer will determine you’re appropriate for them but, if you are, you could very well avoid a leave and maintain your income. And, if so, everyone wins.
This piece is not intended as medical or legal advice. Always speak with your medical provider before initiating a diet or exercise regimen or if you have medical questions. If you have legal questions, consult with an attorney.
This article represents my own opinions as a non-physician and does not reflect the opinions or positions of my employer.
[i] Limitations are activities the employee doesn’t do as well as they would if they didn’t have the medical condition; some common examples of a limitations include limitations on how much weight the person can lift, how long they can stand, and how quickly they can complete their essential job duties. Restrictions are things the employee either cannot or should not do because of their condition. For example, an employee of certain medications may be restricted from using heavy machinery, or an employee with a seizure disorder may be restricted from driving.
[ii] Jolivet, D. and Bonner, C. (In press) The Hidden Costs of Employee Absences: A Call for Strategic Tracking and Management.
[iii] Statistics on Stay-at-Work and Return-to-Work services reflect combined insured and self-insured results between January 1, 2008, and December 31, 2023, based on internal data developed by The Standard Insurance Company. Calculations in this piece were done by the author and reflect my perspective on the most effective ways to measure outcomes for those services.
Stay-at-Work disability day and claim cost savings are calculated based on the relevant STD benchmark average duration and liability per closed claim from the Integrated Benefits Institute (IBI) for the associated case closure year between 2014 and 2022, along with the employee industry and ICD-10 diagnosis category. Claim durations prior to 2014 are calculated as the average duration from benchmark averages between 2014 and 2019, with the associated costs adjusted based on annual wage inflation; claim durations after 2019 are calculated as the average duration from benchmark averages between 2021 and 2022, with cost costs adjusted for annual wage inflation. It is estimated that 75% of successful SAW cases would have resulted in a claim without intervention, so savings are calculated as 75% of the associated benchmark averages.
[iv] Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24‑07‑021, NSDUH Series H‑59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023‑nsduh-annual-national-report, accessed September 24, 2024.
[v] To be clear, an “unsuccessful” Stay-at-Work case doesn’t mean the employee necessarily went out on disability leave. In a sample of 199 cases, the most common reason the case was determined to be unsuccessful was the employee failed to submit the medical documentation required for the program (45 cases, 23%). The top ten reasons for being considered unsuccessful were:
| Reason for Outreach | Count | Percentage |
| Medical information not submitted | 45 | 23% |
| Did not respond to outreach | 33 | 17% |
| Declined services | 29 | 15% |
| Stopped responding after initial contact | 28 | 14% |
| Declined – Employer provided accommodation | 14 | 7% |
| Employee resigned | 10 | 5% |
| Changed positions and assistance no longer needed | 5 | 3% |
| Request withdrawn | 5 | 3% |
| Declined – Employee will purchase own equipment | 4 | 2% |
| Inappropriate referral (such as employee had no medical diagnosis) | 4 | 2% |
[vi] This case essentially broke even for the school, with the gross ROI for direct and indirect costs estimated at 117%, but it is unusual for the amount of money spent on assisting the employee. The average cost for Stay-at-Work services is $2,168 per referral, and only 0.2% of Stay-at-Work cases cost more than $13,000.
[vii] See, for example, MS Society, Latest research news, https://www.mssociety.org.uk/research/latest-research/latest-research-news-and-blogs, accessed on September 26, 2024.
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