Providing for income in the event of disability remains a prickly issue in the worsening socio-economic climate in South Africa. There seems to be no satisfactory solution to the growing number of (sometimes fraudulent) disability claims, and resulting escalations in premiums and costs to the employer. Nor does there seem to be any incentive for the employee to return to work.

The strict requirements of the Labour Relations Act do not make life any easier for employers: the Act requires them to, inter alia, offer continued employment rather than dismissal to those with injuries or illness.
 
Providing for all risk events is a costly exercise, unless effectively managed. One aspect of this management is proper disability assessment. Another is creating products that are inexpensive because of expertise in risk underwriting.

Sanlam has excelled in both these aspects. As one of the largest underwriters of disability benefits in South Africa, we have gained invaluable experience in the assessment of disability management. Moreover, our disability products do more than just take care of the financial needs of disabled employees. Our proactive healthcare intervention capability reduces claims and lost hours, and thus enhances productivity. The range is:

IncomeCare – disability benefits, rehabilitation and cost control
Group Income Insurance – affordable cover against loss of income
Accelerated payment of Group Life Insurance – a lump sum payment
Waiver of Contribution Benefit – maintaining a member's insurance when disabled
Group Risk Services – disability claims management and rehabilitation

IncomeCare

IncomeCare provides disability management that complies with the strict stipulations of the Labour Relations Act, but still contains costs by reducing the likelihood and the severity of disability claims.

Yet employers frequently find the biggest benefit in IncomeCare's proactive health management and rehabilitation programme. This is designed for employees who are absent from work for more than fourteen days, because of injury or illness.

IncomeCare provides qualifying disabled staff with a healthcare and rehabilitation programme so that they may return to work. IncomeCare not only provides a benefit in the case of total disability, but also in the case of partial disability.

This proactive healthcare intervention reduces claims and lost hours, thus enhancing productivity, while a lower rate of claims helps to contain premiums and costs.

Furthermore, it helps partially disabled staff members to continue in employment, ensuring continued income.

Group Income Insurance (PHI)

The product provides cover against loss of income if a member is unable to work due to disability. Sanlam pays the member an income until he/she recovers or reaches retirement age.

The assured income of every member is determined by the rules of the scheme in proportion to his/her income before disability.

As soon as a member becomes eligible for a benefit payout due to disability, his/her premiums towards income assurance (PHI) are discontinued, but these are resumed as soon as the member recovers.

Accelerated payment of Group Life Assurance

If a member's disability has lasted for the full waiting period of six months, Sanlam pays a lump sum. There is no waiting period where the benefit is payable by instalments.

Waiver of Contribution Benefit

This benefit provides for the maintenance of life insurance when a member becomes disabled. It thus makes provision for the fact that the group, presently consisting of active lives, will eventually also include the non-active lives.

Group Risk Services

Sanlam's group risk assessment team is a specialist group handling the assessment of rehabilitation potential, as well as the assessment of disability claims on behalf of our clients.

Their tasks further extend to disability and claims management, rehabilitation, claims assessment and management of admitted claims by a panel of medical doctors, occupational therapists and full-time claim assessors assisted by legal consultants. In addition, we supply full HIV/Aids counselling and supply employers with management data to help project prevalence trends within their workforce.

• Disability & Claims Management

A consistent, managed approach is essential to managing disability claims. A proactive approach to countering absenteeism will go even further. But this requires the necessary infrastructure to ascertain whether claims are valid in terms of the contract.

Drawing on years of experience in the field and by benchmarking our service against best practices in the world, Sanlam has built up such an infrastructure, which includes:

• proactive absenteeism monitoring and rehabilitation;
• highly qualified experts as consultants to assess claims;
• securing networks of specialists in various fields to ensure fair and objective medical assessment, and
• ensuring periodic revision of the level of impairment and disablement.

This tried and tested system helps our clients to ensure maximum productivity and a measure of controlling costs. It also places Sanlam in an ideal position to offer fund trustees a fee-based service in assessing ill-health retirements.

• Rehabilitation Process

Sanlam's rehabilitation centre is well established, drawing on a network of physiotherapists, occupational therapists and psychologists to facilitate the process, which helps our clients to:

• monitor absenteeism through sick-leave reporting;
• assess the rehabilitation potential through a primary selection process including
• cost-benefit analysis, and to
• monitor the progress of the rehabilitation programme.

• Claims Assessment Process
  

Sanlam has established a disability claims assessment process with the help of a full expert panel including Sanlam's medical panel, claim assessors, legal consultants and occupational therapists.

As part of their client communication, teams visit clients to proactively explain Sanlam's methods of assessing claims, which, for objective assessment, draws heavily on a network of:

• psychiatrists for the assessment of, for example, depression and anxiety claims;
• orthopaedic surgeons/neurosurgeons for the assessment of back and neck problems in particular, and
• specialist physicians for the assessment of, for example, heart and lung problems.      
  

This team would obtain second opinions by other specialists where necessary, and also arrange independent opinions by reinsurers. For on-site assessments, the team arranges visits by occupational therapists to the employer, workplace and claimant, as well as observation by private assessors.

• Management of Admitted Claims
  

Admitted monthly income claims are actively managed at least once a year, depending inter alia on the nature of the impairment/disablement. Sanlam follows the same philosophy and processes as in the case of new claims. Approximately 10% of claimants admitted subsequently recover and return to work.

Contact details:

Anton Stander
Sanlam Group Risk
Tel: (021) 947 2324
Fax: (021) 947 5794
Email: anton.stander@sanlam.co.za