Off the fence

Although as a concept rehabilitation is 15 years old, obstacles to uptake remain. Geoff Sayers argues it is time for all parties to stop sitting on the fence and take influential action

Actions speak louder than words and nowhere is this statement more appropriate than when looking at the use of rehabilitation by insurers. A marked progression has been achieved in rehabilitation since the concept was first seriously mooted within the insurance industry approximately 15 years ago. Awards, seminars and a plethora of other events promote its benefits; however, scratch beneath the surface and many insurers continue to use rehabilitation only for the most serious injuries.

Insurers obviously want to achieve the best possible outcome for people who may have been critically injured but these cases remain in the minority. For example, of approximately 1500 live employers' liability claims at St Paul Travelers, only around 5% would be categorised as cases involving severe disabilities, such as paraplegics or tetraplegics. The majority of cases involve soft-tissue injuries where the affected individuals should recover and be able to return to work.

The problem the insurance industry has is that there is plenty of talk and analysis but no clear guidelines on when rehabilitation should be used and at what time.

Rehabilitation should be used as standard for all EL claims where an injured party would benefit from prompt treatment. In particular, the use of rehabilitation needs to be stepped up massively for lower level injuries that could result in claims of under £5000. If this were to take place, it would mean a substantial increase in the amount of rehabilitation provided. This is a growing industry that will only become larger, meaning its regulation should be supported so that care of a consistently high quality is ensured.

Notification improvements

Bringing rehabilitation to the masses will also require a more organised approach to claims notification. Too often, the first an insurer hears about someone being injured is when they receive a letter from a claimant lawyer - an event that is likely to be months down the line. Insurers should instead be informed of a possible compensation claim five days after the injury occurred - the period after which statutory sick pay can be claimed.

This would require better processes to be implemented so that employers can contact insurers and provide full details. Crucially, there needs to be competent assessment. Employers may be able to provide this themselves but, if not, then an independent occupational health professional should be used.

Beyond physical symptoms, an individual's psychological welfare should also be assessed as should the vocational situation. For example, are they likely to be able to return to work? If so, when, and if not, are there any alternatives?

Many employers are likely to buy in to early notification if insurers are able to clearly explain the advantages; they do not want their employees off work unnecessarily or to be drawn into litigation.

Currently, as soon as an employee is injured, there is a tendency for all parties involved to enter into a 'blame game'. Instead, insurers should encourage both sides to hold off while the interests of the injured employee are put centre stage. This will not delay matters. At the moment, an average EL claim takes 1000 days to settle - hardly a record to be proud of.

Workplace injuries

In the case of workplace injuries, it should be agreed that individuals can benefit from rehabilitation on a non-fault basis through insurers ensuring treatment is provided - liability can be decided at a later stage. Apart from the obvious benefits to individuals, immediate access to rehabilitation offers insurers a controlled and effective way of managing claims. It may also help take the sting out of litigation; if an injured employee knows their employer is helping to organise appropriate treatment they are less likely to feel any animosity towards them.

In addition, the treatment offered should be independent and not viewed as some sort of obligatory insurer arrangement.

So, what are the pitfalls of taking this approach? It is always possible for some non-genuine claims to slip through the net. For example, someone might have a pre-existing injury or it could be their fault an accident occurs. However, insurers should be prepared to absorb the cost because, in most cases, claims are genuine.

The biggest argument for increasing the amount of rehabilitation is the current lack of incentives for employers - with the government called on to take action that would rectify this. Earlier this year, the Association of British Insurers proposed new tax incentives be introduced. The proposals included a new tax credit to reward employers that provide rehabilitation programmes in addition to making sure that those who comply should not have it deemed a tax benefit for employees; instead, it should qualify for tax relief for employers.

A total of 28 million working days every year are being lost due to work-related illness - a fact that costs the economy up to £13bn a year. The government has said it wants to reduce the number of people on incapacity benefits and get more individuals back into employment.

So the government's aims are in parallel to those of the insurance industry but rehabilitation must be made to appear worthwhile. Taxing access to rehabilitation makes no sense and it is not surprising that only 12% of employers currently provide any form of programme for their employees.

Saving costs

Complaints from the claimant lawyer community that insurers are calling for rehabilitation merely as a means of cost saving are not going to go away but if the rehabilitation offered is guaranteed as independent and suitable then a lawyer should not be able to stand in the way. Some unions have already stated that they are on the side of rehabilitation provision.

Furthermore, there is widespread evidence to show that rehabilitation works. In Sweden, for example, the number of people paid through its public sickness insurance system has halved since the increased focus on the use of rehabilitation services from 1990.

In early 2007, St Paul Travelers is set to introduce a proposition that has rehabilitation at its core. It may not be suited to every business - there may be some additional premium if rehabilitation is built in - but the arguments in favour of having fast access to quality treatment are overwhelming. It is time for all stakeholders to get off the fence and show that this is the only logical way forward.

- Geoff Sayers is general manager of claims for St Paul Travelers Insurance UK.

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