Many employers have also had to deal with a relatively new benefit challenge for relating to the administration and adjudication restraints placed upon self-funded, short-term disability salary continuance plans.

In essence, developments in privacy legislation severely restrict an employer’s ability to adjudicate claims due to limitations regarding access to employee medical information.

Most small and mid-sized employers do not have trained medical personnel on staff or on contract. These employers are, therefore, ill-equipped to act as claims adjudicators, and the current regulatory environment on privacy makes them “claims payers only” in self-funded arrangements.

In response many small and mid-sized employers have had to retain the services of an insurer or another third party professional to act as the claims adjudicator. Such arm’s length providers offer two critical services that an employer cannot provide: access to confidential medical information for the purpose of claim settlement, and medical modelling expertise in order to adjudicate claims.

Each sponsor will have to take the time and make the effort to explore all of the factors to come up with the best possible solution for that organization.

This article was taken and revised from the December 20, 2004 edition of Canadian HR Reporter

The Leslie Group Limited is able to assist in the review of your salary continuation plan and the implementation of a third party adjudicator. Please contact us if you require assistance in this area.

The Leslie Group Limited

The Leslie Group is a full service benefits consulting firm that is, in keeping w ith market conditions and legislative changes, committed to providing you with the best advice needed to manage your group benefits program. We would be pleased to address any questions and can be reached at (416) 510-8966.