WHY THE VIRTUAL MEDICAL DIRECTOR
These are all optional employee resources, while the VMD is an employer resource to control cost. EAP’s offer support for mental health issues, and virtual care is for minor issues. The VMD enables ‘best care and best outcomes’ which others do not.
Short-term salary insurance adjudication process is administrative and only verifies the absence note from the employee’s physician. While years ago, this worked, it is far less effective for today's complex claims. Without any medical adjudication, these are the expressway to LTD with lost productivity, disruption, uncertainty & use of group benefits, while the link to work remains. On this expressway to LTD, VMD is the roadside assistance.
For absent employees, whatever the indemnity regime, there are few barriers to LTD, while link to work obligations, claims and uncertainty remain. The VMD’s medical approach often prevents progression to LTD.
“We are concerned about your health and our corporate policy is for our Medical Director to review your medical record relating to this absenteeism. They help us manage absenteeism and if necessary, they can assist you & your physician as your personal physician concierge. All medical information will remain confidential & there is no charge for this service.”
“Under provincial employment laws, in order to manage our business, it is mandatory for employees to cooperate by signing the VMD authorization for a review of your medical record relating to the absence.”
The jurisprudence is clear that employers are within their rights to verify absenteeism or accommodation requests, or when an employee is repeatedly absent, or when the validity of these claims is not clear. Employees who refuse may be subject to disciplinary action, up to and including dismissal. HR or legal counsel should be consulted.
Corporate policy should reflect that any absenteeism beyond 10 days, consecutive or cumulative, is subject to verification by the Medical Director, through the signing of an Authorization form, so that the program can be applied fairly to all employees.
The VMD’s process of VERIFICATION & VALIDATION enables early identification of serious mental health issues, where the VMD cooperatively assists the treating physician to refer the employee to nationally renowned mental health specialists in our network for in-depth assessment and treatment, funded by the employer, on pre-approval of a fixed cost Plan of Action. While this care is optional, it is rarely turned down by employees.
For absenteeism exceeding the threshold number of days, which we recommend be set at 10 consecutive or cumulative days in any 12-month period, upon reception of the completed Employer Case Initiation form and the signed Employee Authorization, which is mandatory, the VMD will:
- Retrieve & Review: Medical record
- Verify: The 'Why' of the absence/accommodation
- Validate: Is absence/accommodation for a valid reason
- Communicate: Report finding to employer within rules of confidentiality
- Propose Next Steps: Follow up next physician note, close file, or Plan of Action
- Propose Plan of Action: Including the costs of any required third-party services
The employer alone decides whether to implement the VMD Plan of Action. Private medical services (MRI, CT scans, etc.) only upon prior written approval by the employer.
We recommend that this be done for absenteeism exceeding 10 consecutive or cumulative days.
“We have engaged a Medical Director to help us manage our business and to help our employees as their personal physician concierge.” (See above ‘Authorization’ section)
“We are concerned about your health, and we have asked our Medical Director to review your medical record and to offer you their assistance.”
Yes – The jurisprudence is clear. While the right to privacy protects an employee's health/medical information, this right is not absolute and must be reconciled with the right of the employer to obtain medical information from an employee for the purpose of sound management of their organization.
While case law recognizes the employer's right to better manage their workplace, this right is limited to circumstances of reasonable grounds or suspicions about the employee's medical condition, such as:
- Doubtful or fraudulent absenteeism
- Repetitive absences
- Long-term absence
For absence greater than 10 days, employees are required to sign the authorization for the VMD to retrieve and review that part of their medical record related ONLY to the absenteeism or accommodation in question.
While the employer has the right to information concerning an employee’s ability to perform their job, they CANNOT “improvise as a doctor" to do so. It is generally suggested that a medical expert, such as the Virtual Medical Director, be used to review the medical record and to assess an absent employee’s ability to perform their job – in effect a different type of ‘expertise.’
No confidential medical information is divulged to the employer. Only the information necessary to establish an employee's ability to work is disclosed to the employer. Following our medical record review, we provide the employer what case law allows:
- The nature of the illness or injury, as follows:
- Non-medical: Work-life balance, workplace, family
- The expected return-to-work date or the next medical visit
- The ability of the employee to perform their duties
- The doctor's name and contact information.
While less than 1% of all employees deliberately abuse absenteeism, many ‘honest’ employees take extra unjustified time away off work, simply because overwhelmed physicians and disarray in the system make this tempting and easy. Collectively these two groups can drive more than one half of absence costs.