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Episodic Disabilities and Insurance: What Supports Should Employers Ask for from Insurers?

Private Health Insurance is an Important Support to Employees Living and Working with Episodic Disabilities

Private health insurance is a critical benefit for employees living with episodic disabilities. How you structure your health insurance can make a big difference as to whether it will provide adequate support to your employees living with episodic disabilities. This fact sheet offers some tips on getting the most out of your private health insurance package.

What is an Episodic Disability?

Episodic disabilities are often invisible and are, by nature, unpredictable. It can be hard for people living with episodic disabilities to fit into programs that are only view disability as a static state. Conditions that can cause episodic disability include HIV, MS, Arthritis, Diabetes, Epilepsy, mental health conditions, and others. People with episodic disabilities may also experience intermittent work capacity, and may not have made sufficient contributions to some income support programs in order to be eligible for benefits. This can make income security hard.

Offer both Long Term Disability (LTD) and Short Term Disability (STD) Insurance to Employees

For people with episodic disabilities, time away from work may be necessary in order to recover their health. STD and LTD, offered together, provide the most comprehensive coverage of income replacement. In particular, STD is important in order to cover the elimination period for accessing LTD.

Without STD, a person with an episodic disability could potentially be off work for several months (typically the elimination period is 3 months) without any income replacement of any kind. Employment Insurance Sick Benefits might address this period for some people living with episodic disabilities, however, many people with intermittent work capacity are not able to make adequate contributions in order to qualify, and there are no other publicly funded medium term income replacement programs. STD provides an important interim support to people living with episodic disabilities until they can transition onto LTD.

Some STD products can include the following provisions which would be of particular benefit to people living with episodic disabilities:

• Opportunity to qualify for benefits when not experiencing “Total Disability”
• Opportunity to work in a reduced capacity, with benefits

Some LTD products can include the above provisions as well.  LTD is extremely important for people living with episodic disabilities who may otherwise find themselves off work for health reasons without any other source of income.

Ask for a Recurrent Claims Clause

A recurrent claims clause allows for an individual to qualify for STD or LTD based on a reoccurrence of an established and qualified disability taking place within a specified period of time. Recurrent claims clauses are useful in that the new episode is treated as the same as the last episode and the individual is not then required to submit a new claim. There are usually time limits on these clauses; some limit the recurrence period to 6 months.

Waiver of Elimination Period

In offering LTD, it is possible to request a Waiver of the Elimination Period. This essentially allows for an individual with a recurrent disability to qualify for support during an episode without the requirement of fulfilling a new waiting or elimination period. There are reports of elimination periods that extend for up to 5 years allowing for individuals experiencing recurrent periods of disability to immediately qualify for claim. Employees and employers are encouraged to ask for a “Waiver of Elimination Period” to best support employees living with episodic disabilities.

Rehabilitation Services

Rehabilitation Services can be profoundly important in supporting an individual throughout the claims process and back to work safely. Of particular importance is the use of consistent disability case managers, who know the individual, understand their health condition as episodic and have a good understanding of the demands of their particular job. Rehabilitation services can also include specialists in Return-to-Work facilitation, Vocational Rehabilitation and Functional Rehabilitation.

Access to Specialist Advisers

Many insurance companies offer programs that include specialist advisers particularly those with expertise in mental health conditions and treatment, as part of their disability management teams. Mental illnesses are amongst those conditions considered to be episodic in nature. If possible, having access to specialist advisers who can provide insight and knowledge into the episodic nature of mental illness and other conditions is of great benefit in supporting employees with episodic disabilities.

Employee Assistance Programs (EAPs) and Wellness Promotion Programs

These types of programs are offered by insurers in conjunction with insurance products. They provide mental health and substance use support services, as well as other wellness promotion programs. These types of supports are worth investigating as they offer confidential and speedy access to specialists who may be able to assist employees living with episodic disabilities in managing issues related to living and working with an unpredictable health condition. Employees living with episodic disabilities must negotiate difficulties related to confidentiality, requesting accommodations, managing their health, stigma and disclosure. EAPs can provide timely supports for managing stress that could potentially prevent or minimize episodes of illness for employees with unpredictable health conditions, and are therefore worth investigating with an insurance provider.

Partial Permanent Disability Coverage (PPD)

This was once a more common private insurance product, but nowadays not many insurers offer PPD. For employees living with episodic disabilities, however, PPD coverage offered a number of advantages. This type of private insurance acknowledged that, for some, a disability was going to impact their ability to work full-time either permanently or for many years, but it still provided for working throughout. It did not require total disability to qualify, and in that way it offered a ‘top-up’ for individuals who were able to work at least part of the time. Many individuals living with episodic disabilities are able to work at least part of the time during illness episodes. PPD coverage provides an alternative for those individuals who are able to work somewhat during an illness episode. It is worth investigating whether or not your insurance company offers, or is willing to offer, PPD coverage, to better support employees living with episodic disabilities.

Advice to Pay Services

These services are available to companies who would like additional advice regarding whether an employee’s claim to either STD or LTD should be paid out by the employer. These are especially useful to a smaller employer who may not understand episodic conditions or that with appropriate supports and time away, valued employees with episodic disabilities can recover and return to work.

At Work Services

These services offer specialist input on how to provide accommodations to an individual worker in order to keep them at work. Ergonomic assessments and expertise in adaptive technology can comprise part of this service that can be purchased as an add-on to other insurance products or as a stand-alone insurance product.

For more information on episodic disabilities please visit the Realize website.

Disclaimer: This Fact Sheet is provided for information purposes only. Please consult with your insurance provider directly for details relevant to your unique circumstances.

Copyright Realize 2017

Download a pdf version of this fact sheet

What You Should Know About Accommodation in the Workplace

By Deanna Matzanke for Realize

If you are living and working with an episodic disability and you need some modifications or adjustments to your hours, your work environment, or your duties, so that you can do the job that you are being paid to do, then you should know that you are entitled to request accommodation at your workplace. And your employer is required to go through the process with you to put the right modifications in place.

What is accommodation for a disability?

The word “accommodation” in the context of the workplace is a very misunderstood word.

Because it has a legal definition, many people have lost sight of what the word actually describes. The Oxford English dictionary gives the best definition:

Accommodation is: The process of adapting or adjusting to someone or something.

That’s it – no more complicated than that. And the great thing about this definition is that it defines it as a process, not an end result or a thing.

There is, however, a legal definition that requires employers to offer accommodation to a job applicant or an employee with a disability who requests it. Each province has a human rights code that has a definition of accommodation. And for those companies that must comply with the federal human rights code, there is also a definition. These codes have the following in common:

• The accommodation measures must be reasonable.
• The accommodation measures must be related to a disability.
• The accommodation measures must be necessary for the employee to be able to do the key duties of their job. (i.e., the minimum tasks required of the job).
  • The accommodation measures should not be for your convenience only.
• The accommodation measures cannot cause undue hardship.
  • This means that the actions the employer would have to take to put in place accommodation measures would not result in a significant difficulty (usually related to health and safety) or expense for the employer.
• The employer and the employee (or job applicant) must both cooperate in the process of deciding what accommodation measures would work best.

What do you have to do?

Once you make a request for accommodation due to a disability, you will be expected to:

• Cooperate in providing information as quickly as possible to your employer. This might include answering questions or providing information regarding your abilities and, or restrictions or limitations, and will probably include information from health care professional(s), where appropriate, and as needed
• Be willing to try different measures on a trial basis so that you and your employer can see if the accommodation measures are right for you and them
• Participate in the development and regular review of an Accommodation Plan, and
• Let your manager or supervisor know when the accommodation measures in your Accommodation Plan are no longer needed or need to be updated and cooperate with any discussions or assessments to make changes to your Accommodation Plan.

What do you not have to do?

You do NOT have to disclose your diagnosis to your employer. You need to provide information on what accommodation measures you need in order to do your job, but you do not have to tell your employer that you have an episodic disability related to HIV, depression, arthritis or any other health condition.

What does your employer have to do?

When you make your request, your employer will be expected to:

• Participate in discussions on possible accommodation solutions
• Collaborate with subject matter experts, both internal to the company and external to the company where applicable, who may be requested to provide input or services. This may include a need to consult with appropriate medical or disability specialists in the process
• Collaborate with you to develop an Accommodation Plan, and
• Demonstrate flexibility throughout the process as well as show a willingness to explore creative or innovative solutions (within operational requirements and only up to the point of Undue Hardship). Flexibility may also be required in the administration of policies, procedures and working schedules or conditions.

What does accommodation look like?

One size does not fit all. There is no phrase that describes the accommodation process any better. This is because each individual with a disability is unique. Moreover, the accommodation process is designed to reach a solution that is unique to that individual. Nonetheless, there are categories of accommodation measures that might be part of an Accommodation Plan.

1. Workstation access and adjustments:
   This might include changes to your work area design or changes to the way in which you access your workplace and all facilities, or changes to technology and equipment such as a headset for your phone or software that helps to read documents out loud for you.
2. Hiring and employee practices:
   This might include changes to the procedures used for testing, selection, training, and termination.
3. Work procedure adjustments:
   This might include changes to the specific requirements of your job, such as

• • modifying or restructuring your duties,
  • modifying your working hours,
  • adopting flexible work practices (See Fact Sheet: Flexible Work Options – Knowing what to ask for.)
  • relocating your job or your workstation, and
  • modifying policies in the workplace.

4. Providing specific services, facilities, work aids or equipment:
This might include providing interpreters, particular equipment, attendant services, a quiet place for rest or assistance with particular aspects of a job.

5. Reassignment of an individual employee:

This might include a change of position or the reassignment of specific tasks to another position.

How do you approach your employer to request Accommodation?

First of all, remember that this is the law and that your employer is required to go through the process to determine what accommodation measures you will need. But that probably isn’t the first thing you want to remind your employer about. Approaching your employer with good information, some thought, and a cooperative attitude is more likely to get you what you need without having to rely on the legal obligations. Of course, if your employer is not cooperating or refuses to discuss your request, then you can remind them of their legal obligation.

1. Do your homework: Explore what kinds of options might be reasonable in your workplace.

• • What kind of accommodation do you think you might need?

1. 1. • Usually, for someone living with an episodic disability, flexible work practices are the best options for accommodation (See Fact Sheet: Flexible Work Options – Knowing what to ask for.)
      • Any of the other kinds of accommodations above might be helpful as well.
      • Even if you don’t know what the right solution is, suggest something that you can try for a trial period.
      • Remember that you can ask for as many accommodation measures as you believe are necessary (not just convenient).
   2. Are there certain operational requirements in your workplace that have to be met? For example: customer service hours or health and safety measures.
   3. How would these operational requirements be impacted by the kind of accommodation you are requesting?
   4. Would the work of any of your colleagues or co-workers be affected by the accommodation and how will that be managed?
2. Put your request in writing and ask to discuss it in person with your manager or supervisor.
   1. Your request should include the answers to the questions in number 1, and
   2. Be sure to state that you are willing to discuss and try different options and that you are looking forward to being able to work to your full potential with the accommodation measures in place.
3. Refer your employer to information that will help them help you:
   1. Ontario Human Rights Commission
   2. Realize: Managing Episodic Disabilities in the workplace New e-learning modules
   3. JAN – Job Accommodation Network
   4. Workplace Strategies for Mental Health

Download a pdf version of this fact sheet

Flexible Work Options – Knowing what to ask for

By Deanna Matzanke for Realize

Did you know that your workplace does not need to have a policy on flexible work for you to ask for a flexible work option?

What is Flexible Work?

Flexible work means having the opportunity to discuss and implement different ways to do your work that may be a change from the standard way of how, where and / or when you do your work. That might include

• reorganizing your work duties
• changing or altering your work location, and / or
• changing or altering your work schedule.

Flexible work does not change the basic terms and conditions of your employment it just introduces a different manner of getting the work done.

What does Flexible Work look like?

Some of the most common types of flexible work are:

Flex time (or flexible work hours) means having the opportunity to change or vary your normal consecutive work hours, workdays, or work week. It is the most common kind of flexible work.

Flex time can help you manage different issues related to your episodic disability such as difficulties with pain and stiffness in the morning, regular medical appointments, or increasing fatigue in the afternoon.

Flex time hours usually require a period of core hours during the day when you must be available for meetings or other operational requirements. Core hours will be different from business to business.

Compressed work week means having the opportunity to establish a new work schedule that increases the number of hours in your workday and decreases the number of days in your work week or, in some cases, changes the number of weeks in your work cycle. This means working out a new work week.

A Compressed work week might be a good choice if you have regular medical appointments or treatments that take more than a few hours or leave you feeling unable to continue work afterwards, as long as you have the capacity to work longer hours for the days when you are at work.

Job sharing means having the opportunity to voluntarily share the duties, responsibilities, and hours of at least one full-time job between two employees. This kind of arrangement requires that you carefully outline each partner’s individual job duties and responsibilities in order to cover operational requirements and business.

Job sharing is a fantastic way to work part time without having to look for a specific part-time job. For those who are living with a disability that doesn’t allow them to work a full 8-hour workday, this is an arrangement that has a great deal of possibility.

Work at an alternate location (work from home office) means having the opportunity to regularly work from a home office or other alternate location for all of, or a portion of, your work week.

This kind of option is extremely helpful for people living with episodic disabilities. Working from home can eliminate the pain and fatigue of commuting and allow you to be more productive for a longer period of the day. It can provide a quiet, safe place for those who need a break from constant client interaction, or if you have a medical appointment or treatment that is closer to home than work, the commuting time can be reduced and rechanneled for work.

During the COVID-19 pandemic, working from an alternate location became the norm for many people whose jobs could be done remotely – although for many types of work this is simply not possible. As the health concerns and social distancing restrictions of the pandemic ease, people living and working with an episodic disability may wish to explore with their employer the possibility of beginning or continuing to work at an alternate location.

How do you decide which type of Flexible Work is the right one for you?

If you are considering approaching your employer about Flexible Work, it helps to be prepared and know what option would work for you. By following the steps below, you can be better prepared to ask for the option that best meets your needs.

When thinking about Flexible Work as a work option, consider the following:

• Make sure you understand what the different options are and how they might work
• Make a list of the duties or tasks in your job that require you to be at work at a particular time or at a specific location or to be working within a team on a hands-on task, and
• Also make a list of the duties or tasks in your job that could be done at a different time and may not be dependent on other people or require that you access a program or information at the workplace that you cannot do from home.

Then, focus on your needs and abilities. Here are some questions you should consider:

• Is there a particular time of day that I am more productive or less productive?
• Can I arrange my schedule to take advantage of the more productive times?
• Can I split my work hours to provide an extended break and then start working again?
• Would arriving later / earlier, or leaving earlier / later, help me to manage my symptoms so that I can better concentrate on work?
• If I am only really productive in the mornings, is there someone else who would like to share my job and work in the afternoons?
• Does my workplace have technology that would allow me to do my work from my home or another location when I need to? i.e. Can I sign into my email or workstation remotely?
• Am I able to focus on work when I am not in the workplace?
• Could I work at home all the time, or one to two days a week, or 2-3 days per month and how would this help me be more productive?

Once you have answered these questions for yourself, review your responses and select the option that works for you.

How do I approach my employer?

Deciding what type of flexible work could be of benefit to you is only half the battle; you also have to approach your employer to see if it might be an acceptable option for them. Below, find several steps to consider in preparing yourself to discuss flexible work with your employer. The better prepared you are, the easier the meeting will be.

Once you’ve chosen an option, draw up a sample plan or schedule.

Flex time: If you think you want to ask for flexible work hours, set out your suggested work week. For example:

Day	Monday	Tuesday	Wednesday	Thursday	Friday	Total Hours for Week
Each Week	8:00 am – 4:30 pm (7.5 hrs)	9:00 am – 5:30 pm (7.5 hrs)	8:00 am – 4:30 pm (7.5 hrs)	9:30 am – 6:00 pm (7.5 hrs)	8:00 am – 4:30 pm (7.5 hrs)	37.5 hrs

Compressed work week: A work-week should not exceed 40 regular hours, unless it is part of a schedule like this… For example:

Day	Monday	Tuesday	Wednesday	Thursday	Friday	Total Hours for Week
Week 1	8:00 am – 6:00 pm (9 hrs)	8:00 am – 6:00 pm (9 hrs)	Non-working day	8:00 am – 5:00 pm (8 hrs)	8:00 am – 5:00 pm (8 hrs)	34 hrs
Week 2	8:00 am – 5:00 pm (8 hrs)	8:00 am – 5:00 pm (8 hrs)	8:00 am – 6:00 pm (9 hrs)	8:00 am – 5:00 pm (8 hrs)	8:00 am – 5:00 pm (8 hrs)	41 hrs

Job-sharing: You and your proposed partner should come up with a schedule that ensures that you are sharing the job equally. For example:

Day	Monday	Tuesday	Wednesday	Thursday	Friday	Total Hours for Week
Employee 1	8:30 am – 11:30 am (3 hrs)	8:30 am – 11:30 am (3 hrs)	8:30 am – 1:00 pm (4.5 hrs)	8:30 am – 1:00 pm (4.5 hrs)	8:30 am – 12:15 pm (3.75 hrs)	18.75 hrs
Employee 2	12:30 pm – 5:00 pm (4.5 hrs)	12:30 pm – 5:00 pm (4.5 hrs)	2:00 pm – 5:00 pm (3 hrs)	2:00 pm – 5:00 pm (3 hrs)	12:15 pm – 5:00 pm (3.75 hrs)	18.75 hrs

Write down the points that you would like to make when you approach your employer / supervisor / manager and arrange for a meeting.

Remember, you do NOT have to disclose what your disability is.

Here are some suggested points to consider:

1. Say that you would like to make sure that you are contributing your best to your work.
2. Explain that you have an episodic condition and that some alterations in your work-schedule could be very helpful in ensuring that you can contribute your best on a regular basis. You may want to use the definition of an episodic disability below to help your employer / supervisor / manager understand.
3. State that you are aware that the company / organization does not have a formal policy on flexible work, but that you have a suggested a plan and would like to discuss the possibility of implementing it.
4. Stress that this is a suggested plan for discussion and that due to the unpredictable nature of episodic disabilities, there may be times when the schedule may need to be temporarily altered. But in general, you feel that this schedule will provide the best approach for great work.

Episodic disability is:

A chronic or recurring condition that has periods of good health that may be interrupted by periods of illness or disability. Often it is difficult to predict when these “episodes” of disability will occur or how long they will last.

Download a pdf version of this fact sheet

Long Term Disability Insurance: Support for Longer Absences from Work

By Lisa Betel, MISt., and Wendy Porch, M.Ed.

If you are living with an episodic disability and need more than a few days off work due to your condition, you need to understand what options are available to support your income. For longer absences, these options may include Long Term Disability insurance (LTD). Often, LTD coverage is provided as part of a group insurance plan through your employer. If you have private life or accident and sickness insurance, you may have LTD coverage as well. You can purchase individual LTD coverage; however, it is typically quite expensive. Generally, LTD policies cover any injury or illness that prevents you from being able to work. Some policies exclude certain illnesses, while others exclude work-related injuries or illnesses.

Not all employers offer Disability Insurance, and there are no legal requirements that mandate it being offered. Disability Insurance is a type of private insurance that provides coverage, in the form of a percentage of an employee’s income, for employees who are unable to work as a result of either an injury or illness. This is usually provided as part of an employee benefit package, although some employers choose not to offer it.

Qualifying for Long Term Disability Insurance (LTD)

Most plans start LTD after other benefits, such as sick leave and Short-Term Disability (STD) benefits, have been exhausted. Many people utilize Employment Insurance (EI) Sickness Benefits after completing STD, but prior to LTD benefits starting. (Most STD benefits last between 6 months and 1 year). Most LTD benefits start 120 days after leaving employment (after EI Sickness Benefits, 15 weeks plus 2 weeks waiting period = 119 days, are exhausted). Your LTD benefit may be for only a specific length of time (i.e., 2 years) or may last until retirement.

Medical documentation is usually required from your doctor in order to qualify for LTD. The required forms will probably ask your doctor to provide a diagnosis and indicate what your prognosis may be and when you might be expected to return to work. Make note of what is required by your doctor. Most companies require that a form be filled in by the doctor and will not necessarily accept a short note in place of the forms. Some doctors may charge a fee for completing these forms and it is the employee’s responsibility to pay any fees charged by the doctor. After the insurance company receives your claim, they may ask for additional information from you, your employer and/or your doctor. They may even ask to interview you, your employer or your doctor over the phone, and ask some additional questions. Once they have reached a decision as to whether or not you qualify for LTD, they will inform both you and your employer.

Exclusions from Group Benefits

Depending on the province or territory, there may be circumstances under which it is possible for an employer to deny or limit an employee access to group benefits based on the existence of a “pre-existing condition”. “Pre-existing conditions” are illnesses or health conditions that the employee was living with before signing up for the insurance plan. However, the laws that apply to this vary from province to province. If this is a worry for you, it is recommended that you access legal advice related to your specific situation.

Once on Long Term Disability Insurance

Most LTD benefits pay 50%-70% of your previous income. LTD policies require the insurance company to pay an ongoing amount, usually in a monthly payment. Benefits will be paid either by cheque or by direct deposit, if the appropriate arrangements have been made. Most do not have indexing for the rate of inflation. If during employment you paid 100% of the LTD premium cost, then your LTD income is not taxable, but otherwise your LTD is considered to be taxable income. Most contracts also have a provision that any income support received from other sources, such as Canada Pension Plan Disability (CPP-D) is deducted dollar-for-dollar from your LTD income. If you are awarded CPP-D benefits, the insurance company gets to deduct the amount of the CPP-D benefit from the amount of LTD benefit it is paying to you. Since CPP-D benefits save the insurance company money, many policies require that you apply for CPP-D benefits, and some even require you to appeal if your claim is initially denied.

The insurance company will expect to communicate with you (the employee) and your healthcare providers regarding your recovery and expected return to work date. The insurance company will also expect you to undertake appropriate medical treatment for your condition and that you are willing to undergo independent medical exams at their request. Anyone receiving benefits is expected to participate in insurance company provided vocational rehabilitation programs.

Restrictions on Benefits

When receiving LTD benefits there may be restrictions on the kinds of activities you can undertake, particularly related to earning any other kind of income. Benefits may not be paid if you are not receiving appropriate treatment as recommended by your treating physician; are not participating in an insurance provider-approved rehabilitation program; or are on a leave of absence, strike or lay-off, except where the insurance provider has specifically agreed to the continuation of coverage or may be required to continue it by law.

Depending on your LTD plan, you may not be allowed to complete any work for wage or profit except as approved by the insurance provider, nor can you receive money from other income support sources without reporting it. Benefits are usually not paid while you serve a prison sentence or are confined in a similar institution. Benefits may also cease if you are absent from Canada due to any reason, unless you have received written agreement from the insurance provider in advance to pay benefits during this period.

There may be other restrictions as well, so it is important to check the details of your specific LTD plan.

Returning to Work

The insurer will expect you to return to your own occupation as soon as it is safe and healthy for you to do so. While you are receiving benefits, the insurer will talk to you about returning to work at the appropriate time. If it becomes apparent that you will not be able to return to your own occupation, you will be expected to consider any reasonable offer of modified work with your employer and/or participate in any training required to qualify for an alternate occupation.

Typically, the insurer pays your benefits for two years after you become disabled so long as you are unable to do the job you were doing when you became disabled. After two years, in order to continue receiving benefits, the evidence must show that you are unable to do any job for which you are reasonably suited. If you are unable to work in any reasonable capacity, the insurance company will want to see proof, in the form of medical forms or reports from your doctors. Benefits are usually payable until you turn 65, so long as you continue to meet the policy requirements.

Recurrent Claims

The process for re-applying for insurance following a relapse in your condition varies across employers and insurance providers. Some insurance contracts have “recurrent claim clauses”. These clauses may streamline the re-application process so that if you have a relapse of an established health condition that causes you to have to go back on disability insurance, you may be able to fill in less paperwork and/or need less documentation from your doctor. It is important to note that not all insurance contracts have recurrent claims causes, so to find out ask your HR department and/or insurance company for more information about your insurance.

A Note about Privacy

Details regarding your diagnosis, medical history or medical conditions are not to be shared with your employer unless you have expressly consented to this being shared, usually through signing a form that says so. Read the forms given to you by the insurance provider carefully so that you know who, and under what circumstances, your medical information might be shared.

Relevant Resources:

• A Guide to Disability Insurance by the Canadian Life and Health Insurance Association
• Le Guide sur l’assurance invalidité par l’Association canadienne des compagnies d’assurances de personnes.
• What You Should Know About Disability Insurance by the MS Society of British Columbia
• Insurance and Your Rights by the Canadian Diabetes Association

PLEASE NOTE: This fact sheet was developed as an information resource only. All benefits and insurance plans are different so for the details of your plan, please check with your HR department, your Supervisor/Manager, or your union representative. If you require advice regarding your specific circumstances, seek legal assistance.