Start of Absence
Notification
When a member is absent from work (or expected to be absent) for 6 days or more, a referral to the Joint Early Intervention Service is made. The notification process is outlined by role below.
It is the School District’s responsibility to:
1.
Advise the Health Care Management Specialist (HCMS) and the Union JEIS Coordinator when members have been, or are expected to be, absent for six consecutive scheduled working days/shifts.
2.
Provide basic information to Desjardins and the Union JEIS Coordinator (name, phone number, address, last date worked, etc.) as required.
1.
The Union JEIS Coordinator will make initial contact with the member as soon as possible, ideally before the Health Care Management Specialist calls the member, to communicate the program’s purpose.
1.
The Health Care Management Specialist receives a referral from their assigned school district on or before the member’s sixth day of absence.
Information Gathering
Information will need to be gathered to determine what support can be provided.
1.
Makes an initial telephone call to the member within 24 hours of receipt of the referral (unless the Committee has requested otherwise).
During the initial call, determine if more information can be gathered immediately or make an appointment for a more convenient time to contact the member for an interview. Provide information and tips relating to the member’s issues and ensure the member is aware of relevant community-based resources.
Points often covered in the interview include:
An introduction
Information as to the goals and mandate of the JEIS program and also explains the HCMS role
Confidentiality and privacy expectations
Reason for absence (medical, work-related, other)
Diagnosis, current treatment, symptoms, and functional abilities
Any possible gaps in healthcare services that may be negatively affecting the member
Other resources or programs available, including their Employee Assistance Program, and how these resources can help in their recovery
What the member has access to within their Extended Health Benefits that may be beneficial to the member’s situation
The discussion may also explore the impact of the individual’s health condition on the member’s daily living and on their ability to perform their job duties.
2.
After the initial call and interview with the member, update the Committee, including any next steps and an estimated prognosis for return to work.
3.
Determine the member’s status and required actions as outlined in the table below.
| Status | Action |
|---|---|
| No further assistance needed | If it appears the member’s medical situation is unlikely to go beyond the expected normal recovery period and there are no complicating factors, it is not likely as the HCMS you would suggest any further assistance beyond the general offer of support. |
| Further assistance needed | If you think further assistance can be provided or more information is required to make an assessment, send out a JEIS package within 24 hours of the initial discussions and include:
|
4.
The letter within the JEIS package will indicate the date the member must return the forms to you. The initial deadline allows approximately three weeks for the information to be returned.
If the information is not received by this initial deadline, contact the member again to determine the cause of the delay and to assist if there are barriers preventing the member from providing the information.
Send the member a second letter showing a final deadline for submitting the requested information. The final deadline is three weeks from the date of this letter. This letter is copied to the Committee.
5.
Additional medical information is often requested from the member’s treating physician or through an Independent Medical Examination (IME) in the following situations:
| Situation | Actions |
|---|---|
| Complexity | When the initial Attending Physician’s Statement (APS) is received but, there is complexity to the medical condition, poor completion of the form, lack of clarity regarding the member’s treatment or symptoms, or inconsistencies with the member’s reported functionality. |
| Inconsistencies | You note inconsistencies between the member’s description of their functional abilities and symptoms compared to what the current medical information on file indicates. |
| Request for additional medical information | When additional medical information is requested, the HCMS will contact the treating physician directly and advise the member that they asked for supplemental information. |
| Request for Independent Medical Exam | In the case of an IME, the member would be notified by the HCMS. The Committee would also be advised that a medical assessment is being arranged. |
6.
As the HCMS, you also ensure copies of any assessment are forwarded to the member’s treating physician.
7.
Once all required information has been received and analyzed, the process moves to the Recovery and Return to Work phases as outlined on this website.
8.
When you believe it is likely the member will not recover and return to work during the LTD elimination period and, therefore, may progress to LTD, you may request clinical notes, specialist consultative reports, etc. Including this information at the time of LTD referral allows for a timely LTD claims decision.
9.
You must keep the Committee informed at each step of the process through different methods:
| Method | Actions |
|---|---|
| Email and phone | Normally, at least every four weeks, although this situation-dependent. In cases where there are pending specialist’s appointments, assessments, medical procedures or expected longer-term absence, the contact may vary. |
| Regular meetings with the Committee | Generally, it is monthly, but the timing varies from district to district. The meeting can be virtual or in person.
You provide a written report for this meeting containing a brief status update on all active files and new referrals. The report also contains updates on all active and recently closed LTD files completed by the LTD claims adjudicators. The LTD claims adjudicator may attend the meeting. The HCMS typically sends the report 1 – 2 days prior to the meeting to allow the Committee members time to review and determine if there are any questions/concerns. |
| Copy of all member correspondence to the Committee | The exception would be the initial JEIS package or when correspondence contains confidential medical or personal information. This would include letters regarding non-contact, non-participation, suspension of JEIS files due to work-related or other issues, etc. |
1.
Make a care call
If the HCMS advises the Committee that a care call to the member is recommended, the JEIS Union Coordinator of the Committee will follow up with the member to ensure they m understand the program, and encourage them to reach out to the HCMS if they require any support.
The first preference is for the JEIS Union Coordinator to contact the member, but if they are not available, an alternate Committee representative may be asked to contact the member.
2.
Share the information
The Committee may share any relevant factual information related to any workplace, interpersonal, or performance issues with the HCMS.
1.
As a member you must provide the HCMS with the initial information requested.
2.
If a JEIS package is sent, you are responsible to review the information, complete the forms and have your treating physician complete the medical form.
You are required to send back all completed forms to Desjardins within the timeline specified.
If there are any questions or concerns regarding the information and forms in the package, you should contact the HCMS.
3.
If there are concerns about participating in the JEIS program, you should contact your Union to discuss.
Non-Participation
There are steps taken if a member is not participating in the Joint Early Intervention Service.
1.
If a member advises they do not wish to participate in the JEIS program, you as the Health Care Management Specialist will immediately contact the Committee and request assistance with encouraging the member’s involvement. The HCMS may also contact the JEIS Union Coordinator directly to inform them of the non-participation.
2.
If you are unable to make telephone contact with the member after two attempts or you have not received any messages from the member, you will send the normal JEIS package requesting the member to contact you and submit the JEIS Medical Certificate and Authorization forms with a deadline of two weeks from the date you send the package.
3.
If a member is not willing to participate fully in the JEIS program, make every effort to help them understand the value and importance of participation, as well as listen with an effort to try to understand the member’s perspective and reasons for resistance.
If the member does not participate in the program or the member has not contacted you, contact the Committee to inform them of the situation and:
Provide details of the specific dates when you made the first contact, second contact, when you connected with the member, etc.
Copy the Committee on the letter to the member confirming file suspension due to non-participation.
1.
The Committee’s role is to help the member understand the purpose of the program and address any concerns they may have.
2.
The JEIS Union Coordinator from the Committee will contact the member to discuss the value of the JEIS program and the impact of non-participation.
3.
Advise the District and/or Union that the HCMS can be contacted if they require any assistance with encouraging the member to participate fully in the program.
Not a Candidate
Sometimes a member is not a candidate for the support provided through the Joint Early Intervention Service. Steps are taken to review each case to determine next steps.
The most common reasons a member may not be a candidate for the Joint Early Intervention Service are:
The member is unable to work as they are caring for a family member who is ill.
The member is unable to work as he/she is involved in a work-related issue that is interfering with their return to work and there is clearly no underlying medical condition contributing to the member’s inability to return to work.
Work-related issues causing absences can be a challenge given that it is often difficult to determine if the work-related issue was actually initially caused by or exacerbated by an underlying psychological issue not yet identified.
If it remains unclear if the absence is a work-related or personal issue or if there are medical symptoms driving the absence, the HCMS will always err on the side of caution and continue to provide support where appropriate to the Member to assist with a safe and sustainable RTW.
1.
Conduct an in-depth interview with the member and determine their status for the JEIS program as outlined in the table below.
| Status | Actions |
|---|---|
| Not a candidate |
|
| May not be a candidate |
|
1.
The JEIS Union Coordinator from the Committee will contact the member to offer assistance and discuss alternative leave options when the absence is not related to their own disability (e.g., parent, spouse or child illness, or work-related concerns).
2.
The HR Representative, from the Committee, will also initiate contact with the member to understand the member’s perspective and discuss next steps.
3.
The Committee may discuss options or ideas for resolution regarding the member’s case (e.g., arrange a meeting to resolve conflict).
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