Start of Absence
When a member is absent from work (or expected to be absent) for six days of more, a referral to the Joint Early Intervention Service (JEIS) is made. At the start of an absence there are different phases, Notification, Information Gathering, Non-Participation and Not a Candidate. For details, see below.
Notification
1.
Advise the Health Care Management Specialist (HCMS) at Desjardins 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 HCMS and the Union JEIS Coordinator (name, phone number, address, last date worked, etc.) as required.
1.
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.
Receive a referral from the 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.
Make an initial telephone call to the member within 24 hours of receipt of the referral (unless the District Joint JEIS 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:
2.
After the initial call and interview with the member, update the District Joint JEIS 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 unlikely any further assistance beyond the general offer of support is needed. |
| Further assistance needed | If 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.
Ensure the JEIS package indicates the date the member must return the forms, usually within three weeks.
5.
Request additional medical information 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 | There are 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, contact the treating physician directly and advise the member of the request. |
| Request for Independent Medical Exam | In the case of an IME, the member and the District Joint JEIS Committee need to be notified this medical assessment is being arranged. |
6.
Ensure copies of any assessment are forwarded to the member’s treating physician.
7.
If it is likely the member will not recover and return to work during the LTD elimination period and, therefore, may progress to LTD, request clinical notes, specialist consultative reports, etc. Including this information at the time of LTD referral allows for a timely LTD claims decision.
8.
Keep the District Joint JEIS 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 District Joint JEIS Committee | Generally monthly, but the timing varies from district to district. The meeting can be virtual or in person.
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. Send the report 1 – 2 days prior to the meeting to allow the District Joint JEIS Committee members time to review and determine if there are any questions/concerns. |
| Copy of all member correspondence to the District Joint JEIS 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
2.
Share the information
1.
Provide the HCMS with the initial information requested.
2.
If a JEIS package is sent, review the information, complete the forms and have your treating physician complete the medical form.
3.
If there are concerns about participating in the JEIS program, 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, immediately contact the District Joint JEIS 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 unable to reach the member by telephone after two attempts or no messages have been received from the member, send the normal JEIS package requesting the member to call and submit the JEIS Medical Certificate and Authorization forms with a deadline of two weeks from the date the package is sent.
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 try to understand the member’s perspective and reasons for resistance.
If the member does not participate in the program, contact the District Joint JEIS Committee to inform them of the situation and:
1.
Help the member understand the purpose of the program and address any concerns they may have.
2.
The JEIS Union Coordinator from the District Joint JEIS Committee will reach out to the the member to explain the benefits of the JEIS program and the potential consequences of not participating, include the risk of losing eligibility for LTD benefits.
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:
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, 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 District Joint JEIS 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 District Joint JEIS Committee, will also initiate contact with the member to understand the member’s perspective and discuss next steps.
3.
Discuss options or ideas for resolution regarding the member’s case (e.g., arrange a meeting to resolve conflict).
