Case and Disability Management

CASE MANAGEMENT:
Case management is a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet a person's health, social, educational, and employment needs, using communication and resources to promote quality, cost-effective outcomes.

Case management should ideally start at the moment of an injury or onset of an illness/disease through to closing person's file after successful return- to-work is achieved. It needs to be individualized, coordinated with strong communication across stakeholders, and with a structured goal focused approach.

The case management process may include initial medical treatment and interventions, the need for understanding a worker's job demands, referrals to third parties, return-to-work determination, documentation, and adjudication (an insurance process that determines a person's eligibility for benefits based on the policy, evaluation of medical evidence, and available benefits for sick leave / short term disability / long term disability).

DISABILITY MANAGEMENT:
Disability management, often associated with employer or worker's compensation insurance and return to work programs, is a pro-active, employer-based approach to prevent and limit disability; provide early intervention for health and disability risk factors; and foster coordinated disability management administration and rehabilitative strategies to promote cost effective restoration and return to work.

There are some commonly applied disability management models including the medical model used in managed care settings; the environmental/social model; forensic model; biopsychosocial model; and others.

Disability management programs are designed with a number of characteristics such as:
- Management and Labour Support and Cooperation;
- Supportive policies for the DM program;
- Supportive benefits;
- Coordinated approaches;
- Effective return-to-work programs;
- Effective communication strategies;
- Stakeholder education;
- Performance measurement and management; and
- Injury and illness prevention;

Some important considerations in disability management are to understand issues surrounding a worker's fear of re-injury and the available return-to-work options to consider for them including:
- Graduated Return-to-Work (GRTW); and
- Temporary Job Accommodations

The steps involved in a disability management return-to-work plan are as follows:
1. Determine the person's current functional abilities.
2. Clarify the employer's functional needs and essential duties of the position.
3. Compare and rationalize the employer's functional needs versus the employee's abilities.
4. Identify the employee's immediate health and safety needs.
5. Generate and assess creative options for accommodations.
6. Assess the medical impact.
7. Assess the workplace impact.
8. Finalize an accommodation plan.
9. Provide permanent reasonable accommodation.

The legal requirements which must be followed for employment and workplace accommodations include the Canadian Charter of Human Rights and Freedoms and the Canadian Human Rights Act (duty to accommodate up to the point of undue hardship). The Supreme Court of Canada has established a criteria for the standards of bona fide occupational requirements that employers must abide by. Also relevant, is the Canada Labour Code, which addresses labour relations, occupational health/safety, and the Employment Standards Act.

- Canadian Charter of Human Rights: https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/
- Canadian Human Rights Act: https://laws-lois.justice.gc.ca/eng/acts/h-6/
- Canada Labour Code: https://laws-lois.justice.gc.ca/eng/acts/l-2/

Working with Unions:
To increase the likelihood for the success of a disability management program, it's essential to understand the role of unions, shop stewards, general contracts, mediation/arbitration, grievance process, types of disputes (for discipline or discharge), the steps from grievance to arbitration, and options for alternative dispute resolution.

REFERENCES:
College of Vocational Rehabilitation Professionals, Board of Directors. 2021-2023. Standards of Practice. College of Vocational Rehabilitation Professionals. https://cvrp.net/wp-content/uploads/129-Approved-Version-02-CVRP-SoPs.pdf

College of Vocational Rehabilitation Professionals, Board of Directors. 2019. Vocational Rehabilitation Competencies. College of Vocational Rehabilitation Professionals. https://cvrp.net/wp-content/uploads/60-Competencies.pdf