Actions of the insurer

Time off and recovery period

1. Listen to the worker and show interest in his/her health, notably during the first contact.

2. † Understand the reasons for the work stoppage and complete the medical information provided by the physician. For example, review the list of symptoms and functional limitations identified by the worker, his/her family physician or another healthcare professional, but also explore capabilities to consider workplace accommodations.

3. Consider the duration of the absence prescribed by the worker’s family physician.

4. Seek the opinion of a medical consultant or other health professional, if necessary.
5. Refer to the insurance contract after consulting the health professionals to confirm the required interventions.

6. Conduct an analysis of the situation and determine if the worker is entitled to sick leave benefits or if another medical expertise is required.

7. Specify that sick leave is regulated and must be justified.

8. Inform the worker of any information relating to the insurer’s accompaniment.
9. Remind him/her of the terms and conditions of the insurance contract (e.g., definitions, applications, eligibility conditions, exclusions/limitations).

10. Provide support and offer advice to the worker on sick leave (e.g., assistance with administrative procedures).

11. † Reassure the worker that his/her cognitive and functional abilities will restore themselves during the recovery process.

First contact with the worker by the workplace

Not applicable

Evaluation of the worker (abilities) and his/her work (job demands)

12. Promote a multidisciplinary approach to employee health assessment issues.

13. Meet with the worker and do follow ups on a regular basis (e.g., every 3 to 4 weeks), either alone or in the presence of the employer and health professionals, or their representatives.

14. Encourage the worker to gradually take over tasks of his/her daily and domestic life, as well as his/her leisure activities, for the benefit of his/her recovery and rehabilitation.

15. † Encourage the worker to develop coping strategies that are pertinent to his/her situation.

16. Suggest that the worker consult mental health professionals.

17. † Transmit, if necessary, the information collected from the worker to his/her psychotherapist (e.g., medical history, previous medical reports), insofar as the worker authorizes it.
18. When the worker’s condition improves, consult a health professional to assess the worker’s functioning and his/her barriers to returning to work.

19. Identify the barriers to RTW perceived by the worker and the strategies that could help overcome them.

20. Consider assessments of the worker’s health status when thinking about extending the sick leave.

21. In case of permanent limitations, propose to the worker a RTW with possible accommodations, or ask the employer if another position is available in the organization (relocation process).

Development of a RTW plan with workplace accommodations

22. Discuss the possibility of implementing work accommodations as early as the first few weeks of sick leave with the worker and the employer.

23. Contact health professionals to gather information about the nature, duration and cost of the planned interventions. Take this information into consideration so that the work rehabilitation plan is not abandoned during its implementation.

24. Propose a work rehabilitation plan if necessary.

25. Ensure that the work rehabilitation plan meets the criteria and the regulations of the insurance company.

26. Offer, when appropriate and if necessary, a meeting at the workplace with the worker, the employer and the rehabilitation counsellor.

27. Share with key people the information relating to the conditions of a RTW plan and the potential work accommodations.

28. When functional limitations of the worker persist, propose a RTW with possible work accommodations, or ask the employer if another position is available within the organization (relocation process).

29. If the worker is considered fit to RTW, contact the employer to find out if the former position is still available so that the potential work accommodations can be implemented. The decision-making process must be carried out collaboratively (e.g. employer) and must take into consideration the work accommodations from a medical point of view (e.g. prioritizing worker health). The insurer then acts as an intermediary between the health professional and the employer.

30. Make any decision regarding the worker’s RTW in consultation with the other stakeholders involved in the case (e.g., health professionals, employer, manager). After this consultation phase, compare the prognosis, the functional limitations, and the symptoms with the nature of the worker’s position, the responsibilities that are attached to it and the proposed work accommodations. Based on the results of this analysis, initiate the worker’s RTW (gradual or not), or extend the sick leave.

31. If the worker has permanent limitations, facilitate and finance professional reorientation interventions.

Work resumption (day 1)

Not applicable

Follow-up of the RTW

32. Promote communication between the stakeholders of the RTW, notably for the flow of the information relating to his/her functional limitations and the work accommodations requests.