A study to determine the profile of cas management of long-term incapacity insurance claims for claimants living with mental health conditions in South Africa

Abstract

Introduction Sickness absence and long-term incapacity leave contribute substantially to the overall national service delivery challenges in a working environment. Insurance companies have, over time, seen a substantial increase in the number of disability claims resulting from claimants living with mental health conditions. Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's holistic needs through communication and available resources to promote quality, cost-effective outcomes. The Association of Savings and Investments of South Africa (ASISA) guidelines provide an approach that insurance companies can apply to the clinical management of long-term mental health claims. However, these guidelines do not outline specific case management recommendations to assist insurers in managing long-term incapacity for mental health claims. Insurance case management aims to provide additional support to claimants living with mental health conditions through proactive management of the long-term incapacity claimants. Case management has proven to be successful in other industries, so providing case management recommendations for long-term incapacity claimants in an insurance context is needed. Analyzing the profile of the management of mental health claimants to understand the context of effective case management interventions was thus envisaged. Aims and objectives This study aimed to analyze the management of long-term incapacity insurance claimants living with mental health conditions in South Africa. Objectives included classification of the biographical data, types of intervention programs, and success of return to work for claimants living with mental health conditions within the insurance sector. Research design A quantitative retrospective correlational research design was used for this study. Methods (setting, population, sampling, data collection, and analysis) The data was collected from one insurance company through a purposeful sampling technique. The data variables selected comprised age, gender, body system and diagnosis, occupation, industry, the years considered of the study, claim type, cases referred for case management, type of case management intervention received, and return to work outcome. Data analysis used descriptive and inferential statistics to compare using frequency distribution tables. The odd ratios from the results also indicated probabilities and the strengths of the relationships between the variables, respectively. Significance of the study The results positively contribute to the occupational therapists in clinical practice and case managers in the insurance industry in facilitating triumphant return to work. This study will also benefit claimants to return to work and participate in economic activities. The insurers, on the other hand, will be able to save on the long-term costs of mental health claims and future research opportunities noted for career advancement.