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Ensuring support for plan members during COVID-19: Adjusting disability adjudication processes

Jun 30, 2020

Categories: Employee Benefits, News

When physicians and other practitioners were focusing on COVID-19, 3sHealth temporarily adjusted its processes to make sure that plan members could receive uninterrupted access to their benefits.

Normally, health-care employees who apply for disability benefits need to get medical documentation to support their claim. In response to the challenging circumstances that the pandemic created, the Employee Benefit Plans Board of Trustees approved temporary changes to disability adjudication practices. These changes ensured that 3sHealth could continue to process and pay disability benefits to our plan members.

“Times are really stressful, and we did not want our plan members worrying about not receiving payments or about gathering documentation,” says Alana Shearer-Kleefeld, Director of Employee Benefits. “3sHealth highly values the relationship it has with physicians and practitioners who complete medical assessments for plan members. COVID-19 created a unique situation where we needed to temporarily adjust our adjudication processes because of physical distancing requirements coupled with the health system’s focus on the pandemic.”

Through April and May, 3sHealth did not require applicants to submit an “Attending Physician’s Initial Statement Form” to support a new application for disability income plan benefits. Instead, after a plan member submitted their application, a 3sHealth Claims Adjudicator would collect medical information directly from the plan member by telephone. Adjudicators also phoned plan members currently on disability for a medical update.

For both new and continuing claims, adjudicators made decisions collaboratively with the mental health advisors, rehabilitation advisors, and medical consultants on 3sHealth’s staff. These positions came to 3sHealth as a result of Employee Benefits’ ongoing “Path to Health” disability claims management redesign project.

“Without our ‘Path to Health’ work, we would not have been able to respond so quickly during these extraordinary times. It’s the reason that we’ve put so much work into the redesign. That is what ‘Path to Health’ is all about: taking care of the caregivers.”

As more medical services become available during the “Re-Open Saskatchewan Plan,” 3sHealth Employee Benefits is once again making requests for medical information to support disability income applications. Since it will take time for people to get back in to see their physician and treatment providers, 3sHealth commits to moving forward in a reasonable way to ensure that plan members are not adversely impacted as they resume their medical supervision and treatment.

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