Introduction
Total and Permanent Disability (TPD) definitions generally require claims assessors to assess whether or not a claimant has a capacity for work, and if so, their likelihood of obtaining work within their education, training or experience (ETE). Certain occupational rehabilitation consultants assist people who are ill/injured to identify vocationally and medically suitable work goals and to help them obtain suitable employment. These consultants are therefore well placed to provide their expert opinion on a person’s likelihood of employment within their education, training or experience. Employability Assessments (EA) have emerged as a preferred tool to meet the Australian TPD legal and policy requirements regarding assessment of likelihood of employment.
With increasing reliance on Employability Assessments in TPD determinations, and case law increasingly commenting on information regarding assessment of likelihood of employment, the life insurance industry needs to consider factors such as:
- What professions have the expertise to conduct Employability Assessments?
- What are the industry standards for Employability Assessments?
- Is there a clear process and procedure to ensure Employability Assessments are credible and relevant?
These factors were explored further through the ALUCA TPD Working group.
TPD Working group
The ALUCA Rehabilitation Group established a TPD Working Group in 2016 to review and recommend best practise guidelines for Employability Assessments in TPD and other life insurance claims. The aim was to introduce higher standards in EA process and procedure in order to improve the quality and consistency of rehabilitation services provided on TPD claims. The TPD Working Group focussed on:
- Defining what is meant by an ‘Employability Assessment’
- The expertise of consultants undertaking Employability assessments
- Methodology used in Employability Assessments
- Content of Employability Assessment Reports
Earlier this year, members of the TPD Working Group ran a series of training sessions in Sydney, Melbourne and Brisbane specifically for the external rehabilitation providers who may be engaged to undertake Employability Assessments for our industry, to promote the guiding principles developed by the TPD Working Group. It was also an opportunity to obtain feedback from the rehabilitation consultants currently conducting these assessments, in regards to some of the challenges they experience. It is hoped that further training via webinar will be run in 2018.
An Employability Assessment is NOT a Vocational Assessment
Unfortunately, claims professionals often rely on Vocational Assessments to assist in their determinations, without understanding the differences between a Vocational Assessment and Employability Assessment. Although a Vocational Assessment will include an outline of a person’s education, training and experience, as well as a transferrable skills analysis, this is where the similarities usually end. The intent of a Vocational Assessment is more about how to support a person to get back to work, with consideration to a person’s values, aptitude, interests. The vocational options identified may also consider retraining opportunities, and the reports often do not focus on linking the vocational options to the person’s ETE.
Given this, the TPD Working Group recognised that it needed to start with defining what we meant by an Employability Assessment, and decided on the following:
“A Life Insurance Employability Assessment is an assessment of a person’s vocational capacity based on their education, training and experience and within their medical functional capabilities”
This definition recognises that vocational capacity must be matched to a person’s functional capacity. Medical functional capacity is usually derived from evidence provided by medical professionals, and includes both physical and psychological/cognitive functioning. This evidence must be provided to the rehabilitation consultant with the referral for an Employability Assessment.
Expertise of Rehabilitation Consultants conducting EAs
Not all occupational rehabilitation consultants have the training or experience to identify vocationally and medically suitable work goals and help ill/injured people obtain new employment. It was therefore necessary to identify which rehabilitation consultants had these skills which could then translate into conducting Employability Assessments.
The process followed by the TPD Working Group to help develop a standard of consultants conducting Employability Assessments involved:
- Reviewed the profile of external rehabilitation consultants currently performing Employability Assessments in the Life Insurance industry
- Snapshot of rehabilitation consultants providing medicolegal vocational assessments in Australia across other schemes such as workers compensation and motor accident schemes
- Considered University course content
- Reviewed court expert witness codes
It was identified that rehabilitation professionals needed to have minimum allied health tertiary qualifications as well as skills and experience supporting ill and/or injured people to obtain employment. An outline of these standards is provided below:
| Qualifications | Rehabilitation Counselling, or |
| Psychology, or | |
| Occupational Therapy | |
| Professional Membership | Full member with ASORC, or |
| Full member with RCAA, or | |
| Registration with AHPRA | |
| Demonstrated Competencies (all) | Vocational Assessment |
| Vocational counselling | |
| Transferable Skills Analysis | |
| Job Preparation Skills | |
| Job seeking and placement | |
| Knowledge of the functional requirements of occupations | |
| Analysis of the Australian Labour Market | |
| Report writing | |
| Experience | Minimum 5 years’ experience in the competencies noted above |
| Code of Conduct | Eligible to meet the Expert Witness Code of Conduct specific to the state or territory in which a potential matter may be heard.
|
Methodology and content of Employability Assessments
The TPD Working Group provided guidelines and instruction on the minimum information that should be included in Employability Assessment reports. The challenge for the group was to develop guidelines that were flexible enough to allow for variations and differences in policies and the changing nature of case law, whilst also providing greater structure and some standardisation so that EA reports have greater reliability and relevance.
Critically, information provided in reports should be reliable, objective and realistic and pertain to the real work of work.
In the training sessions conducted with occupational rehabilitation professionals earlier in the year, a frequent concern raised was the lack of clarity provided by insurers in their instructions. The letter of instructions provide by the insurer should be noted in the EA report, including the ‘date of assessment’ as defined in the policy, and the TPD definition provided by the Insurer, if provided.
As referrers, Insurers should also consider what supporting information is provided to the occupational rehabilitation consultant. One rehabilitation consultant reported receiving over 1000 pages of documentation which reportedly added very little to the quality of the EA report. The decision to provide so much information to a rehabilitation consultant may be driven by the desire to be seen as ‘fair and objective’, however, is this the case? Rehabilitation consultants require detailed information outlining education, training and experience and match this with information on functioning. Do all the medical reports Insurers have on file actually comment on functioning/work capacity? Are all the medical reports relevant considering the TPD definition and date of assessment? If there is conflicting medical information on functioning/work capacity, do you expect the rehabilitation consultant to weigh this evidence and make a conclusion on the person’s functioning/work capacity?
During the training provided to rehabilitation consultants conducting Employability Assessments, feedback was received in regards to requirements regarding labour market analysis. As Insurers, we need to be clear on the purpose of labour market analysis. Questions to consider include:
- Do you want to know whether the vocational option identified exists within the claimant’s accessible labour market?
- Do you require evidence that the experience/skills needed to obtain certain occupations match those held by the claimant?
- Do you require evidence that the physical/psychological/cognitive demands of occupations identified are within those provided by medical evidence? Some occupations have a wide range of physical demands, so an occupational job title in itself may not be sufficient to show whether an identified vocational option is medically suitable
A critical area for rehabilitation consultant is being able to provide a rationale for how an identified vocational option relates to a person’s education, training or experience. Transferable skills on their own are not sufficient to provide this link.
Below is an outline of the information identified by the TPD Working group as being minimum requirements for an EA report:
Demographics
This section should include: Claimant Name; Date of Birth; Place of Residence; Policy/Claim No; Condition; Date last worked; Date of Referral
Policy Details
This section should include the TPD definition and specify the date which the assessment was focused on (i.e. ‘As at Date’, ‘Date of Assessment’)
Purpose of Assessment
This section should outline the specific assessment/service requested by the referring party and should outline from whom the referral was received and the date received. Any specific instructions received from the Insurer should also be included in this section.
Method of Assessment
This section should specify the manner in which the assessment was undertaken (e.g. face-to-face interview, telephone-based interview, desktop assessment) and outline any specific resources used in the process of the assessment (e.g. databases used, tests administered). It should also include any limitations to the assessment.
Documents Reviewed
This section should list all documents received as part of the Referral and/or any other documents reviewed as part of the assessment. It should include: the name of the document; date it was written; and author.
Executive Summary
This section should provide a brief synopsis of the findings of the Employability Assessment and any identified vocational options.
History of Condition / Treatment
This section should include an objective summary of the medical documents reviewed with all opinions clearly referenced. Information relating to past, current and potential/future treatment should be noted where referenced in the documents.
Functioning and Work Capacity
This section should list all opinions provided in the documentation in relation to function and work capacity. The author should then formulate an overall statement of work capacity to be specifically applied to this assessment.
Education and Training
This section should detail all education and training undertaken from high school onwards. It should as specific as possible such as: formal/informal/on the job training; name of qualification; dates of commencement/completion; institution; mode of study/training (e.g. face-to-face, online, full time, part time) and level attained (if applicable). This section should also include any registrations; licences; tickets; cards and their currency.
Experience
This section should include all forms of employment including paid, unpaid, casual, voluntary, and work experience from high school onwards. Providing this in reverse chronological order allows for more recent work to be identified first. Each role should include: job title; duties; dates of employment; name of company; location etc. It should note any changes in job title that may occurred during tenure with the one employer and also any specialist or project positions held.
If there is insufficient information regarding duties/responsibilities, clarification may be used from reliable sources (e.g. ANSZCO, ACC). These resources and assumptions should be referenced.
Avocational Activities
This section should include a list of the avocational activities such as: hobbies; community interests; club interests/associations etc.
Transferable Skills Analysis
This section is an analysis of education, training and experience to identify residual skills. These should be grouped into skill-specific categories for example: communication, computer skills, industry specific etc.
Vocational Options
This section should include analysis and rationale for the suitable vocational options identified based on education, training or experience, and consistent with functional/work capacity. Include the following: occupational title, description, and functional demands. Where vocational options were considered but deemed unsuitable, provide a short rationale.
Labour Market Analysis
The inclusion and purpose of a labour market analysis is highly dependent on policy definitions. Therefore, the instructions from the insurer are critical to this section. Data provided in this section should be realistic, reliable and referenced.
Conclusion
This section should re-iterate the vocational options identified, and that this was based on ETE and functional capacity. This should mirror the executive summary.
Appendix
This section should include your professional profile including your CV, demonstrated competencies and that you agree to be bound by the code of conduct.
Conclusion
It is NOT the role of the rehabilitation consultant to assess whether or not a claimant meets a TPD definition. This is the role of the Insurer. An Employability Assessment is one tool to help the Insurer make an objective decision. The Insurer- whether it is through their internal rehabilitation staff or claims staff- also needs to be able to critically evaluate and analyse Employability Assessments reports to ensure they meet the standards required.
The minimal guidelines developed by the TPD Working Group provides a framework that Insurers may use to educate their claims staff as well as external rehabilitation consultants on the importance of objective and robust Employability Assessments. It is acknowledged that changes to policy definitions and case law are also likely to affect the content of Employability Assessments, and that ongoing refinement of these guidelines will be required.
The author would like to acknowledge and thank the members of the TPD Working Group:
- Lena Kesoglou- OnePath Life (Working Group Lead)
- Karen Robertson- AIA
- Linda Winterbottom- RGA
- Alicia Gibbs- OnePath
- Nick Mingo- Swiss Re
- Sumit Verma- AMP
- Joanna Gregoriou- BT
- Margaret Black- University of Sydney
- Elizabeth Haddow-Allen- CommInsure
Lena Kesoglou is the Rehabilitation Manager at OnePath/ANZ. She is also the current Chair of the ALUCA Rehabilitation group and in 2016, she headed up the ALUCA Rehabilitation working group to develop minimum standards for Employability Assessments on TPD claims. She has worked in a rehabilitation role within Life Insurance for 10 years, and prior to this has worked in training, quality assurance and management roles with rehabilitation providers in the workers compensation scheme. She is passionate about promoting and incorporating rehabilitation services as an integral part of the life insurance claims process, and making a positive difference to the lives of our customers.
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