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Disability assessment

“Soma ensures an appropriate, accurate and equitable claims outcome – so that those who deserve to, get paid, and those who don’t, don’t.” – Dr Doug Baard, MD

Employers without the relevant knowledge and independent professional expertise will find that inappropriate disability claims management yields decreased benefit levels and/or contribution increases. The accountability of trustees also becomes a potentially damaging legal and industrial issue, not only as a group but more importantly also in their individual capacities.

This is why Soma’s multi-disciplinary team (peopled by Occupational Therapists, Physiotherapists, Nurses and Medical Doctors, and supported by a Medical Advisory Board of prominent medical specialists) provides detailed objective medical reports, statistics and other data (including job simulations and/or covert surveillance where appropriate) relating to temporary disability or total and permanent disability, based on which trustees can approve or reject a claim. Impairment evaluation is an objective quantification of the actual loss of function whereas disability assessment is the determining of an individual’s overall capacity to meet personal, social and occupational demands. In this regard it is critical that treating doctors do not mislead the employee to expect a specific outcome leading to unreasonable expectations and confusion both in the minds of the employee and employer.

The Soma Initiative is therefore able to take disability assessment accountability for handling impairment claims and to adopt responsibility for claim recommendation of approval or repudiation, while significantly reducing the possibility of risk to business reputation and to the disability scheme or fund itself.

 

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