Support system

Recent campaigns to promote workplace rehabilitation are being taken on board by UK PLC. But can schemes be adapted to help prop up smaller businesses, asks Jane Bernstein

The insurance industry has largely got to grips with the concept of rehabilitation and is conscious of its practical benefits. The message is also getting through to businesses but there is still a certain amount of work required to generate wider awareness, particularly among smaller firms.

The Association of Insurance and Risk Managers recently launched a joint campaign with the Confederation of British Industry to promote the use of workplace rehabilitation through effective absence management. How effective are these types of campaigns in practice and what are the main challenges in persuading sceptical employers?

Allan Francis, UK corporate manager, casualty, at AIG Europe, is certainly enthusiastic about the recent campaign. "AIG Europe can only applaud the proposal by Airmic and the CBI to increase the awareness of the services involved in workplace rehabilitation," he says. "While it has been an ongoing battle in the insurance industry to have rehabilitation seen as an integral part of the liability programme, more and more organisations, such as Airmic and the CBI, are seeing the benefits - both in direct insurance cost and the invisible cost savings - and drawing attention of such to their members."

David Ireland, who sits on Airmic's rehabilitation committee, says there remains a degree of scepticism surrounding the costs involved. "The message we are trying to get across is that this is self-financing. It will make you money," he explains.

To mark the launch of their campaign, Airmic and the CBI have published two guides - one aimed at senior decision-makers and the other at line managers. Entitled Helping Staff Back to Work, these booklets provide user-friendly guidance on what is often seen as a complex subject. If lack of awareness is a problem, then certainly the availability of clear guides should go some way to improving matters.

Airmic says the booklets are proving popular among its members and that more have been requested among those who have recommended them to colleagues. With many suggesting that smaller businesses will be the next big challenge for the rehabilitation drive, it is a good sign that the Federation of Small Businesses confirms it has already made these booklets available through its network of regional organisers.

The campaign will need to ensure it maintains momentum, however. The next steps include a series of seminars around the country, with the first one planned for November in Wales, organised in association with the CBI and solicitor Hugh James.

Although it is hard to measure the benefits of these kinds of campaigns, most agree that as long as they can raise awareness of the issues, they are carrying out a worthwhile function. As Nancy Hempstead, UK healthcare manager at Crawford and Company, comments: "Any campaign that increases awareness of proactive management of absence and early intervention has to be beneficial."

Cost-benefit analysis

However, Ms Hempstead also believes the insurance industry could do more in this field: "There is much discussion but still some reluctance to follow through. In part, this is due to the lack of detailed cost-benefit analysis data." In addition, there remains a certain amount of misconception among businesses.

Andrew Underwood, president of the Forum of Insurance Lawyers, explains: "Foil's experience is that we see countless cases come into litigation where the rehabilitation opportunity has either been missed, or has been dodged, in the misguided belief among some claimant law firms that damages might be reduced by successful rehabilitation or that rehabilitation might be used as a 'stick' to hit the claimant with or as some kind of Trojan horse."

Those who have been working to promote rehabilitation may take heart from the fact that most insurers can now quote cases, where insureds they have worked with have implemented schemes, from which they are reaping the rewards.

AIG has conducted a study showing clear savings to employers' liability claims through rehabilitation. Mr Francis explains: "Having operated our EL book with rehabilitation for specific clients initially and now across the entire EL book, we have clear evidence that rehabilitation services have made savings to the bottom line in terms of reduced claims cost, which are passed on as part of EL premium pricing. Our analysis of 30,000 claims during an eight-year period has proven that our approach to active case management, involving both medical and vocational rehabilitation has reduced the average total paid cost of an EL claim by 20%."

Constant learning

Zurich Global Corporate is currently helping one of its clients, Electrolux, to run a rehabilitation scheme. In fact, this scheme is featured as a case study in one of the Helping Staff Back to Work booklets. Richard Nicholls, head of EL for the insurer, comments: "We are learning all the time. Through working in close partnership with customers, we have been able to fast track employees back into work with the positive help and support they need."

He adds that: "Zurich Global Corporate seeks to engage with all customers who adopt a serious professional approach to risk management, to see if our rehabilitation product is suitable for them. Customers have been very receptive."

Hugh Robertson, head of health and safety at the Trades Union Congress, takes a more cautious view: "We know intellectually it's going to work. However, in practical terms, the rehabilitation agenda for occupational health is at a relatively early stage and there are few employers who have actually reached the point where there can be proper empirical evidence."

Of course, it is not just employers who need to take rehabilitation on board - it is equally important for them to achieve buy-in from their employees. Mr Ireland, who has direct experience of implementing a scheme within Vinci, where he is group insurance director, says it is about letting employees know that it is part of an overall package. "For example, we have regular health screening, a good training package - it has to be part of a whole culture."

Small packages

One of the main issues now is to get the smaller businesses on board. David Bishop, spokesman for the FSB, comments: "We're pleased small to medium-sized enterprises are on the agenda but there is still far more work to do generally to ensure rehabilitation is meaningful to small business."

He explains that there are genuine practical problems that small companies face. Andy Whittington, corporate manager at AIG Medical and Rehabilitation, points to redeployment as one of these problems: "My experience is that SMEs don't have the range of redeployment options that perhaps the larger business would have. Where somebody has been badly injured and can't return to their pre-accident role, the larger company will have other options, but smaller companies are more limited."

Phil Grace, casualty risk manager with Norwich Union, observes: "The Health and Safety Executive has been promoting the benefits of rehabilitation and return-to-work programmes for some time now. However, the case studies published to date have almost exclusively been based on the experience of larger firms and employers. They have the knowledge and motivation to investigate rehab services plus the muscle and leverage to get programmes off the ground. SMEs will find it harder."

For the SME sector, it will no doubt be important to emphasise that cost does not necessarily have to be a major issue, and that there are some straightforward and cost-effective ways to introduce rehabilitation measures through absence management (see box, p31).

Ann Dougan, Cigna Healthcare's marketing director, says much of it comes down to simple communication: "An employer is going to have more success in rehabilitating an employee if they're talking to them very early on - asking a few key questions about what their situation is and what kind of help they might need."

Ms Dougan takes the example of any employee expressing anxiety about getting themselves to work, or about attending afternoon physiotherapy treatments: "So you identify these types of concerns and you say 'we'll transport you to work and you only to have to work in the mornings'."

Market entrants

There are also some products entering the market that are relatively economical. Among the most recent is a software solution from the Protego Group, in association with Prevent, called Arc - which stands for absence, return, care. This basically sits on the desk of line managers, prompting them to ask questions in a sympathetic manner, following HSE best practice.

Jason Freeman, director at the Protego Group, comments: "Many businesses have the perception that this is an expensive route to go down but it isn't. If they weigh up the cost of implementing a scheme and compare it to the cost of absenteeism, they will soon realise that it could potentially save them thousands of pounds."

There remains a genuine need for the insurance industry to continue campaigning to raise awareness, and initiatives like that of Airmic and the CBI have not set themselves an easy task. At the time of the launch, outgoing chairman of Airmic Andrew Cornish observed: "There are some excellent examples of UK employers enabling their employees to return to work. The challenge now is to spread the word to the many firms that still have a long way to go."


What simple, inexpensive actions can make a real difference?

Renee Gibbs, health services director at HCML, recommends a five-step guide:

1. keep in touch with the injured employee regularly while they are off work;

2. say sorry for their suffering or injury - especially if it is a work-related injury;

3. make accommodations to get them back to work, even if it is very part time, to keep them active and included in the work environment;

4. provide a percentage of their wage while they are off work. It can also be helpful to offer to pay for reasonable medical costs to expedite their recovery;

5. liaise with their GP, to advise them that you are willing to help and want to work with them and offer to take the individual back on 'light' duties and reduced hours, for example.


Case management is a strongly emerging profession in the UK. Essentially, case managers pull all the strings of rehabilitation together - liaising with the injured party, employers, insurance companies and HR departments - essentially acting as a co-ordinator. However, case managers are completely independent of any issues of liability and are solely there to help the injured party on their way to recovery. Employers and insurance companies are advised that case managers do not get involved in any litigation or any claims process. Looking after the patient and the employer's business is their priority.

The case manager's initial role is to react to a medical assessment and prognosis of the injury. As qualified medical professionals, usually nurses with extensive experience, they are in a good position to interpret medical information and translate it for employers. The key benefit of case managers is that they are able to recognise which treatment is needed by the injured party and are able to get the relevant treatment to them at the right time, either through the NHS or other service providers.

Sometimes the NHS may not be able to get the right treatment to the patient quickly enough - waiting lists can be prohibitively long in some areas of the UK and may not be available at all. Therefore, it is essential to have a wide network of service providers - osteopaths, diagnostic tools, physiotherapists and counsellors - who are able to administer treatment anywhere in the UK, at a faster speed to aid recovery. Once a case manager has established what treatment a patient needs, they can liaise with the patient's doctor, specialists and hospitals to ensure the treatment actually happens and ensure the patient is fully aware and understands how they will be treated.

The key to rehabilitation is early intervention of treatment and this is where the concept of case management really illustrates the benefits - the earlier that treatment can be administered, the greater the chance of a full recovery.

Source: AIG Medical and Rehabilitation.

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