Employees are your number one asset, but when injury or illness occur your costs increase while productivity and morale decrease. Getting your employees back to health and work quickly and safely is our top priority. Wellpoint Nurses, Mental Health Professionals and Physicians help control the cost of workers who suffer from Occupational and Non-occupational illness or injury through our early intervention-based Disability Management Program.
Our Disability Case Managers are highly skilled at assessing medical information and helping employees navigate the complexities of the health care system. This includes managing wait times and referrals to specialist appointments. By using only disability professionals we reduce the time spent per case and more quickly remove barriers to return to work. This stream lined approach reduces frustration for employees by limiting the number and variety of contacts they have within Wellpoint. We offer high-touch support and immediate and ongoing contact between a disabled employee and their one dedicated case manager.
Short Term Disability Adjudication and Advice to Pay
Wellpoint’s disability team consists of both onsite and telephonic case managers who are highly skilled in the effective management of claims. Wellpoint has extensive experience working with employees in safety sensitive positions, union environments and large and small organizations. Wellpoint provides a full scope of services from Disability Management to Physician Services, Evaluations and Independent Medicals and an excellent, national specialist network.
Our customers and their employees receive dedicated case managers who are highly skilled at assessing medical information and adjudicate claims in a timely manner.
Stay at Work Support
We help your employees with chronic conditions and other ongoing health issues stay at work by providing support to your employees who require accommodations or job modifications in the workplace due to a medical condition. This process allows your employees to continue to work safely and efficiently with the appropriate medically supported accommodations.
Return to Work Support
We focus on return to work as soon as a claim is opened. A Return to Work Plan outlining the employee’s capabilities and limitations is developed for review and implementation by both the employee and the company. We review available tasks and modified duties within the employee’s capabilities to expedite return to work. By setting expectations around return to work and laying out the process, we set the groundwork for Return to Work success for both the employer and the employee.
Complex and Mental Health Claims
With the prevalence of mental illness, workplace complications and conflicts, we understand that some claims need more support. This is why Wellpoint offers a robust approach to both physical and mental health claims, and claims with secondary or tertiary workplace complications. We have a high caliber interdisciplinary network across Canada that can provide all aspects of case assessment and also in some cases treatment, including cognitive behavioural therapy, mindfulness and stress coaching, and facilitated return to work meetings. In addition, we offer the services of a variety of addictions specialists and assessors.
Communication and Reporting
We have an excellent reputation for being highly responsive and easily accessible. Each Case Manager has a toll free direct telephone number so that they can be reached by either the employee or the employer. We ensure that the employer is always made aware of changes to case status, and when to expect an employee to return to modified or full duties. Our software allows each employer to view the real time status of open and closed cases and allows for detailed reporting.
Worker’s Compensation Services
Our Occupational team members are Workers’ Compensation Specialists who are highly experienced at advocating on your behalf and are focused on costs and risks reduction. We file your forms and handle appeals and tribunals in every province. We provide professional review of your WCB situation to help you develop a plan to prevent and reduce your current and future WCB/WSIB costs.
Return to Work to Reduce Time Lost
We support our clients through the return to work process with the goal of mitigating time lost. We do so by creating return to work plans for your employees and by reviewing your Physical Demands Analysis to find suitable modified duties. If you do not have Physical Demands Analysis, we can support you through our assessment division which can also preform Functional Abilities Evaluations and Ergonomic Assessments.
Wellpoint advocates on behalf of our customers and we may recommend appealing WCB decisions. We can also prepare your submission and represent you at tribunals. We employ paralegals, case managers, and occupational specialists to help reduce your costs.
Communication and Reporting
We have an excellent reputation for being highly responsive and easily accessible. Each Case Manager has a toll free direct telephone number so they can be reached by either the employee or the employer. We ensure the employer is always made aware of a changes to case status and when to expect an employee to return to modified or full duties.
Wellpoint has qualified and experienced Occupational Health Physicians available to our case managers, and to you to answer your employee health and return to work related questions and to guide you toward an appropriate solution. Wellpoint’s physicians are specially trained and certified in Occupational Medicine and are Board Certified by the College of Family Physicians of Canada, the Canadian Board of Occupational Medicine and the Royal College of Physicians and Surgeons.
Health Assessments and Evaluations
Wellpoint Health offers independent medical evaluations and medical opinions/file reviews, as well as a full suite of return to work support services. Our reports are always timely, reliable and consistent across the country. We are a major national provider of medical assessments and evaluations with over 250 full-time employees and 1,000 medical assessors across Canada.
We offer not only a quality IME but additional tools to remove return to work barriers. We have an extensive network of over 1,500 allied health professionals providing:
- Vocational Rehabilitation, including transferrable skills analysis, labour market surveys,
- Functional Abilities Evaluation,
- Ergonomic Evaluations,
- Physical/Cognitive Demands Analysis,
- Cognitive Behavioural Therapy,
- Return to Work Facilitated Meetings,
- Mindfulness and Stress Management,
- Physician Consultations, for difficult cases, and
- Doctor to Doctor Reviews.
Independent Medical Evaluations
Independent Medical Evaluations, Fitness for Work Medical Assessments, Case File Reviews and Medical Opinions are managed by our network of medical evaluators. Our network consists of seasoned specialists who work closely with our medical directors. WellPoint is committed to medical and occupational expertise. We provide the following services across Canada:
- Independent Medical Evaluations
- Fitness for Work Medical Assessments
- Complex Case File Reviews/Medical Opinions
Our medical directors are occupational health physicians, and Board Certified by the College of Family Physicians of Canada, the Canadian Board of Occupational Medicine and the Royal College of Physicians and Surgeons. This focus on certified occupational physicians ensures the evaluators receive the guidance needed to understand the workplace context, risks, impacts and possible solutions. This means our evaluations always relate specifically to the short- and long-term disability claim, ensuring case managers and key professionals get what they need to move the claim forward.
- We provide accurate and timely diagnoses and prognoses that clearly indicate the optimum management for the employee and any restrictions/capabilities that may be barriers to return to work.
- Our goal is to provide an unbiased and highly professional evaluation so that the employee and employer can have a good understanding of what the stay at work/return to work potential is or might be.
- Our assessors are experienced professionals, with a minimum of five years medical experience.
Case Management Disability Solutions
Wellpoint offers a wide range of supports through our vocational rehabilitation case management of long term claims. Knowing that sometimes long term disability (LTD) cases need extra vocational and rehabilitation support, we partner with the carrier to provide extended resources and care.
Those services include:
- Vocational Assessments,
- Psycho-vocational Assessments,
- Vocational Transition and Job Re-entry Services,
- Neuro-psych Vocational Assessments,
- Psycho-educational Assessments,
- Labour Market Studies (LMS),
- Transferable Skills Analysis (TSA),
- Ergonomic Evaluations,
- Physical and Cognitive Job Demands Analysis (JDA),
- Return to Work Co-ordination,
- Facilitated Return to Work Meetings,
- Job Search Training Programs,
- Cognitive Behavioural Therapy,
- Hospital Discharge Planning,
- Life Care Planning, and
- Catastrophic Case Management.
Field Case Management
Wellpoint maintains a program that specialises in providing clinical assessment case management and vocational expertise to insurance carriers for LTD cases. Our specially trained staff understand the nuances of LTD and have extensive experience in the disability industry.
Our national medical and vocational services are delivered onsite. We establish goal-directed plans based on personal consultations with the employee, medical provider and the employer.
Our Labour Market Studies and Transferable Skills Analysis are state-of-the- art and use multiple data points to pinpoint the wage earning capacity of the employee.
For disabled employees unable to return to their original employer Vocational Case Management Services provide one-on-one meetings with the employee to provide thoroughly documented vocational land job search assistance.
We help employees attain sufficient physical capabilities and work skills to compete successfully in their local labour market.
Transferable Skills Analysis (TSA)
Wellpoint uses vocational professionals who specialize in providing relevant and appropriate Transferable Skills Analysis (TSA) reports. Information pertaining to the educational, employment, physical capacity, social, and/or psychological status of the individual is significant to the process of determining vocational potential. By quantifying these experiences and competencies in the same terms as used in the National Occupational Classification, conclusions can be drawn with respect to the level of match between the abilities of an individual and the demands of various occupations.
Labour Market Survey (LMS)
Determines employment opportunities associated with particular job goals within defined geographic areas. The survey serves three purposes: first to document the feasibility of the vocational goal(s); second, to document the existence and hiring trends of available jobs; third, to clarify the re-employment potential of the claimant. Typically, 10 to 15 suitable job leads are identified.
Loss of Earning Capacity Determination
Loss of earnings, loss of permanent interdependency relationships, loss of homemaking capacity, loss of shared family income and perhaps losses of shared family homemaking are explored. At issue is the loss of the value of any work the client would have done, but for the accident will now be unable to do. Physical and cognitive limitations are examined as they impact on present and future earnings capacity. Wage and salary ranges are provided. A Labour Market Survey (LMS) is available in conjunction with this service.
Future Care Cost Analysis (Life Care Plan)
Provides a comprehensive summary of: therapeutic modalities, evaluations, education, attendant care services, medical follow-up, equipment needs, supplies, pharmaceuticals, home modifications, vocational needs and the associated costs for injured individuals over a specified period of time.
Return to Work Coordination
Return to work coordination can include assisting the client with negotiating timely and safe re-entry into the workforce, whether with the same employer or a new employer or occupation. Services include one-on-one job placement assistance to enable individuals to secure and maintain employment. Creative job placement may begin with researching volunteer placements and expand to referring to our pool of accommodating employers.
The key activity is finding and securing employment. Cold calling and fieldwork are used extensively to find suitable employers. Job trials and unpaid work experience may be developed to offer work conditioning and skills enhancement. Job interview rehearsal is included as is electronic job search. Regular reports are available.
Vocational counselling is available from a trained vocational rehabilitation specialist who promotes sound vocational decision-making. The objective is to bridge the gap between loss and capacity by establishing realistic return to work objectives, goals and plans. Qualified vocational rehabilitation specialists who have expertise in social work can set out these plans.
Vocational assessment is a process of gathering data and determining a person’s potential for work activity. This includes a comprehensive evaluation of a claimant’s biographical and social history, education and work history, medical and other pertinent records, psychological/neuropsychological records and vocational test results. This review helps determine vocational potential. Testing is available from trained psychologists and vocational evaluators who can additionally measure achievement, vocational aptitude, and interest and work personality. Persistence, pace and voluntary effort are reviewed. Return to work prospects are set out using National Occupational Classification criteria.