Patent Application
20150019278
In some cases, an employee may request that an employer provide a workplace accommodation. For example, an employee with a physical or mental disability might ask an employer to provide special equipment or modify a work schedule because of his or her impairment. Moreover, governmental laws and regulations, as well as employer specific policies, might need to be considered when an employer responds to such a request. The Americans with Disabilities Act (“ADA”) Amendment Act (“ADAAA”), for example, requires an employer to provide reasonable accommodations to employees in the absence of an undue hardship to the employer. When considering a request for accommodation, an employer may need to review a number of factors, including an employee's medical records and the essential functions of the employee's job, in a timely fashion.
As a result, responding to a request for accommodation in an appropriate manner can be a complex and time-sensitive task and can be especially difficult when there are a substantial number of employees and/or requests to be considered. It would therefore be desirable to provide systems and methods to facilitate the processing of employee requests for accommodations in an automated, efficient, and consistent manner.
According to some embodiments, systems, methods, apparatus, computer program code and means may provide a tool to facilitate the processing of requests for accommodations. For example, data received via a communication device indicative of employee claims, including employee claims for one of a plurality of types of employee leave, may be processed. It may then be detected that a particular employee claim is associated with a request for accommodation. It may be automatically determined if medical information associated with the request for accommodation meets predetermined criteria, and an indication of said determination may be transmitted.
Some embodiments provide: means for processing data, received at a leave management system platform, indicative of employee claims, including employee claims for one of a plurality of types of employee leave; means for detecting that a particular employee claim is associated with a request for accommodation; means for automatically determining if medical information associated with the request for accommodation meets predetermined criteria; and means for transmitting an indication of said determination.
A technical effect of some embodiments of the invention is an improved and computerized method to facilitate the processing of requests for accommodations. With these and other advantages and features that will become hereinafter apparent, a more complete understanding of the nature of the invention can be obtained by referring to the following detailed description and to the drawings appended hereto.
Employers may receive requests for accommodations from employees who have physical or mental disabilities. As used herein, a request for accommodation might be associated with, for example, a change to a work environment such as by making existing facilities readily accessible to and usable by an individual with a disability, job restructuring, part-time or modified work schedules, telecommuting, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and/or other similar accommodations for employees with disabilities.
When considering a request for accommodation, an employer may need to review a number of factors, including an employee's medical records and the essential functions of the employee's job, in a timely fashion. As a result, responding to a request for accommodation in an appropriate manner can be a complex and time-sensitive task and can be especially difficult when there are a substantial number of employees (e.g., tens of thousands employees) and/or requests to be considered.
It would therefore be desirable to provide systems and methods to facilitate the processing of requests for accommodations in an automated, efficient, and consistent manner.
Most states also have one or more leave laws with which the employer 110 must comply. Determining requirements and tracking requirements for all of the different types of mandated leave can be a complex task for the employer 110. As a result, the employer 110 might transmit information about leave requests to the leave management system platform 150 (e.g., associated with an insurer) which can review the leave requests and help the employer 110 respond to the leave request appropriately.
According to some embodiments described herein, the leave management system 150 may also help the employer 110 in connection with employee requests for accommodations. The leave management system platform 150 may, for example, receive information about employee claims from the employer 110, including employee leave requests and employee requests for accommodations. According to some embodiments, the leave management system platform 150 may also receive information, such as an electronic message, from a client, an employee or insurance agent, or a leave database 140. The leave management system platform 150 might be, for example, associated with a Personal Computers (PC), laptop computer, an enterprise server, a server farm, and/or a database or similar storage devices. The leave management system platform 150 may, according to some embodiments, be associated with a business organization or an insurance provider.
According to some embodiments, an “automated” leave management system platform 150 may facilitate the processing of requests for accommodations. As used herein, the term “automated” may refer to, for example, actions that can be performed with little or no human intervention. For example, the leave management system platform 150 might detect that a particular employee claim is associated with a request for accommodation. The leave management system platform 150 might also automatically determine if medical information associated with the request for accommodation meets predetermined criteria. For example, it might be determined that additional medical records need to be evaluated. An indication of this determination may then be transmitted (e.g., to an employee, the employer 110, a physician, etc.). The leave management system platform 150 might also generate reports 160 based on the employee claims and/or transmit information to an automated system 170, such as a workflow application or email notification system.
As used herein, devices, including those associated with the leave management system platform 150 and any other device described herein, may exchange information via any communication network which may be one or more of a Local Area Network (“LAN”), a Metropolitan Area Network (“MAN”), a Wide Area Network (“WAN”), a proprietary network, a Public Switched Telephone Network (“PSTN”), a Wireless Application Protocol (“WAP”) network, a Bluetooth network, a wireless LAN network, and/or an Internet Protocol (“IP”) network such as the Internet, an intranet, or an extranet. Note that any devices described herein may communicate via one or more such communication networks.
The leave management system platform 150 may store information into and/or retrieve information from the leave database 140. The leave database 140 may be locally stored or reside remote from the leave management system platform 150. Although a single leave management system platform 150 is shown in
At S210, data received at a leave management system platform is processed. The received data includes employee claims for one of a plurality of types of employee leave. The plurality of types of employee leave may include, for example, workers' compensation leave, short term disability leave, and/or long term disability leave. The leave management system platform may be associated with an insurer, and the data indicative of the particular employee claim may be received from an employer of the particular employee.
At S220, the leave management system platform may detect that a particular employee claim is associated with a request for accommodation. In some embodiments, the particular employee claim is itself a request for accommodation that was submitted by an employee. In other cases, the particular employee claim is instead a leave request and the detecting comprises determining that the leave request satisfies a predetermined rule. For example, in some embodiments the leave management system platform might treat all short term disability leave requests that have a particular International Classification of Disease (“ICD”) code as a potential request for accommodation (e.g., employees requesting short term disability leave for back pain might automatically be considered as requesting a modified chair or desk).
At S230, it is automatically determined if medical information associated with the request for accommodation meets predetermined criteria. For example, the automatic determination might comprise automatically determining that medical information associated with the request for accommodation is insufficient, in which case the leave management platform might automatically request additional medical information. An indication of this determination may then be transmitted at S240. The indication might be transmitted to, for example, an ability analyst, an absence coordinator, an employee advocate, the particular employee, an employer of the particular employee, a job accommodation network consultant, an account manager, a return to work coordinator, a loss control consultant, and/or an attending physician associated with the employee who submitted the request for accommodation. In some embodiments, the leave management platform may further automatically analyze the data indicative of employee claims and provide at least one report that includes a recommended accommodation related adjustment to a workplace environment.
Referring now to
Another LAN 320 may be a network of an insurance company, by way of example. A firewall unit 325 may be configured to provide data security services with respect to systems and networks, LAN 320 and the devices in communication therewith. The firewall unit 325 may be a standalone device including one or more processors, data storage devices, and input and output connections. A server 330 may act as a front-end web server that formats and serves web pages to client devices 370 running browser software. In an embodiment, a processor of server 330 may execute steps of a method of prompting users for data relating to absence events, requests for employee leave, requests for accommodations, and other data employed by comprehensive leave management systems or other systems in accordance with embodiments. In an embodiment, server 330 may function as a web front-end for another device or system, such as server 350, which may execute steps of a method of administering employee absence related programs. In an embodiment, either server 330 or server 350 may serve as a single point of contact for receiving data relating to an absence event or request for accommodation. Mainframe computer system 340 may be a system that receives data from server 350 and performs functions related to managing and tracking absence events. Data storage device 335 may be in communication with LAN 320 and be accessible by server 350, mainframe computer system 340, web server 330 and other systems, for storage of and access to data related to administration of employee leave and requests for accommodations. A workstation 347 may be in communication via LAN 320 with the data storage device 335, mainframe computer system 340, server 350, web server 330, and/or other devices and systems, for administrative and other functions.
In some embodiments, communication between server 350 and individuals, such as employees and employers, may be via a telephone network 380, such as a public switched telephone network, a voice over Internet protocol network, or a combination of a PSTN and VoIP network. By way of example, a fax telephone number may be configured to receive intake data for a new leave event related to two or more categories of employee leave and/or a request for accommodation. Prepared forms may be available for individuals to complete with intake data. The prepared forms may serve as a structured fax format by which data may be transmitted from a fax machine via the telephone network 380 to an insurance company fax machine. Server 350 may be configured to extract data from a digital image (e.g., a fax or emailed pdf file), cause the data to be stored in one or more databases, and perform analytical functions on the data. For example, the server 350 may classify the data according to type of leave, such as short term disability, long-term disability or family and medical leave, and/or requests for accommodations. If the data in the received fax omits required data, contains obvious errors, or otherwise triggers a rule requiring a response, the server 350 may be configured to provide an output in the form of an image file for a responsive fax.
In some embodiments, an Interactive Voice Response system (“IVR”) may be used for the submission of data. A voice telephone 384 may be employed by a user to reach, via telephone network 380, an IVR server 352. The IVR server 352 may prompt the user to provide identification information via voice or keypad, and then prompt the user to provide data corresponding to required data for submission of a new claim related to employee leave, such as employer and employee data, type of leave, request for accommodation information, and other data. The IVR server 352 may communicate with the server 350 (via LAN 320) to analyze data during a telephone connection between IVR server 352 and the telephone 384 and provide instructions for IVR server 352 to generate prompts for additional information, to indicate that data has been received, or to convey other information.
In another embodiment, a system may be configured for initial claim intake to a live telephone operator 380 at a telephone linked via telephone network 380 to a voice phone. The live telephone operator 380 may be at a workstation 347 in communication, such as via LAN 320, to server 350, for example. The system may be configured to generate on a screen of workstation 347 a display of questions for the telephone operator, and a display of an input screen for receipt of data input by the operator. The workstation 347 may be configured to transmit data to server 350 for further processing. The server 350 may be configured to analyze data received from workstation 347 and provide instructions for the telephone operator 380 to address follow-up questions to the other party on the call or to recite one or more scripts including information and/or questions.
In some embodiments, a comprehensive leave management computer system may be configured to perform leave management tracking and coordination and to handle requests for accommodations. A comprehensive leave management computer system may receive intake information and furnish the data to individual administration systems, such as workers' compensation and short term disability administration systems. An individual administration system, such as a workers' compensation system, may process a claim, and data regarding the claim may be furnished to the comprehensive leave management computer system. The comprehensive leave management computer system may also store data relating to the processing of the claim from individual administration systems. The comprehensive leave management computer system may be configured with reporting tools to provide reporting on administration of all types of leave and requests for accommodations.
In some embodiments, the comprehensive leave management computer system may be configured to apply rules relating to coordination among individual leave management systems. For example, if a workers' compensation claim is contested or denied, upon receipt of data indicative of the contest or denial, the comprehensive leave management computer system may transfer data relevant to the claim to a short term disability administration computer system. As workers' compensation claims are generally only approved for occupational injuries, and short term disability claims are only approved for non-occupational injuries or illness, denial of a workers' compensation claim as relating to a non-occupational injury indicates that the employee may have a short term disability claim. By way of further example, if a claim is being handed by the short term disability administration computer system, and a workers' compensation claim for the same incident is approved, the comprehensive leave management computer system may transfer data relevant to the claim to the workers' compensation system, and may provide data to the short term disability administration system to close the claim.
The comprehensive leave management computer system may manage communication with employees, employers, physicians and others. If data or documentation is required relating to a claim, such as a request for accommodation, the individual administration systems may send requests for the information to the comprehensive leave management computer system. The comprehensive leave management computer system may then conduct searches of a database maintained by the comprehensive leave management computer system. The search may include searches of databases maintained by other individual administration systems. The comprehensive leave management computer system may, if the requested information is not identified in any of the databases, formulate an automated inquiry, via any suitable method of communication, including email, postal mail, fax and other methods of communication, to the employee, employer, physician or other person to obtain the requested information. The comprehensive leave management computer system may be configured to prompt an employee to place a telephone call to the employee, employer, physician or other person. Advantageously, duplicative requests for information from physicians, employees and employers may be avoided.
The comprehensive leave management computer system may be configured to provide output signals, to store data, to print reports and otherwise to communicate data indicative of results of performance of analyses and processes. By way of example, the comprehensive leave management system may be configured to provide reports, in printed or electronic form, identifying potential workplace improvements (e.g., to reduce a likelihood of injury to employees). Reports may be generated, stored in data storage devices, forwarded via email, made accessible on web servers or other resources, printed in hard copy, faxed, or otherwise made available for review or stored. Reports may include data as to individual claims, individual employees, summary or complete data regarding employers, worksites, classes of employees of employers, claims suitable for subrogation, and other classifications of data.
The comprehensive leave management computer system may facilitate the processing of requests for accommodations. For example,
If the advocate/return-to-work coordinator determines that accommodations may be possible based on known information 420, a leave event may be created in the leave management system, a notification with a medical assessment form may be generated, and appropriate tasks may be created 424 (e.g., in a leave management system). If the medical information is not complete and sufficient 426, information may be documented in the leave management system 428 and the process may end. If the medical information is complete and sufficient 426, the advocate/return-to-work coordinator may initiate further communication with the employer 430.
A copy of a letter sent to the employee may be provided to the employer 412 who can start an interactive process with a Job Accommodation Network (“JAN”) referral 432 to determine if an accommodation can be made with the employee 414. The JAN referral 432 may be associated with services provided by the U.S. Department of Labor's Office of Disability Employment Policy (“ODEP”). The employee may then be advised of the final decision 416, and the result may be documented in the leave management system 428 and the process may end. By leveraging the abilities of an existing leave management system, an efficient processing of requests for accommodations may thereby be provided in accordance with some embodiments.
If the short term disability analyst/absence coordinator determines that a claim matches one or more vendor programs 510, the claim may be referred to an employee absence coordinator 514 via a same-day diary and verbal or written consent may be obtained. The employee absence coordinator may access the referral diary queue 520 and/or leave management system (e.g., twice a day) and evaluate employer options and employee requirements 522. If the employer options do not match the employee requirements 522, the outcome is documented in the leave management system 532 and on-going short claims coordination may be performed 534 (e.g., including an evaluation of other clinical disciplines).
If the employer options match the employee requirements 522, the employee is contacted to discuss program options 526, and a vendor contact and follow-up action plan may be initiated and documented 528 in the leave management system as appropriate. If the contact with the employee is successful with the anticipated level of participation 530, the outcome is documented in the leave management system 532 and on-going short claims coordination may be performed 534. If the contact with the employee was not successful 530, a second attempt at contact may be initiated with the employee and/or vendor 536, documented in the leave management system, and the file maybe returned to the ability analyst and/or absence coordinator 538.
If the request can be considered 604, the employer advises the employee that the insurer will review the request 614, and the employer contacts the insurer to provide employee details 616. If the insurer has authorization to request the employee's medical records 618, a request for the records is sent to the attending physician 620. If the insurer does not have authorization to obtain the employee's medical records 618, an authorization request is sent to the employee 622 and received 624 before contacting the physician 620.
When the medical records are received 626, they are reviewed in relation to the accommodation request 628, and the result of the medical assessment is communicated to the employer 630. If the employer does not have enough information to make a decision 632, additional medical clarification may be received 634 and/or the JAN may be consulted. When the employer has enough information to make a decision 632, the employer communicates the decision to the employee 606. If an insurer was involved with the request 608, the employer notifies the insurer 610, and a leave management system log is updated 612.
According to some embodiments, a system may be configured to determine, for a given employer, analysis of leave and accommodation requests over a time period, such as one year, a period of months, or a period of years, data including: a frequency of absence under each plan providing for leave, including demographic information regarding users (age, gender, job classification, location, tenure), overlap between plans; changes in absence over time; comparison of absence rates against benchmarks for other businesses in the same industry. The data may also include an average cost of accommodations, in general and on a per plan basis, with changes in cost over time, comparison of cost benchmarks for other businesses in the same industry, identification of outliers or other drivers of higher costs.
Referring to
Computer system 805 may also be configured to access, via firewall device 830 and one or more networks 835, which may include Internet, one or more servers 840 controlling access to databases storing industry benchmark data 842. Analyst 807 may cause computer system 805 to retrieve data from industry benchmark database 842. Computer system 805 may retrieve data, perform analyses of the data, and displays on screens and/or on printouts, with tables and graphs.
Referring to
Referring still to
Data module 918 is in further communication with a number of databases such as claim data database 930, employer data database 932, industry claim data database 934, and absence law and policy data database 936. The absence law and policy data database 936 might store, for example, information federal and state requirements associated with requests for accommodations. Databases may include both internal and/or external/third party databases. By way of example, external databases may include employer databases for access to employee data, and databases of individual leave management systems, such as workers' compensation administration systems and short term disability administration systems. Server 910 may be configured for bulk upload of data for leave management, such as data relating to individual claimants, such as name, address, birth date, service years, job description, type of claim, date of claim, description of claim, and dates of leave, from databases and spreadsheets on client device 952 to a database associated with the server. One or more modules may be configured to perform data validation steps prior to storing bulk uploaded data. Server 910 may further be configured to permit bulk download of data, such as claim data and analyses of claim data, to a client device.
In operation, server 910 is in communication with client devices, such as computer 952 or smartphone 954 via a network 950, which facilitates interaction with server 910, using, by way of example, one or more graphical user interfaces. As used herein, devices, such as client devices 952, 954 may exchange information via any communication network. Utilizing client devices 952, 954, an employer may initiate new claims for intake, review the status of claims, and upload reports and analyses. An employee may also use client devices 952, 954 to access server 910 and to obtain data concerning the employee's claims and documents related to the claims.
Referring to
Referring now to
According to some embodiments, handheld wireless communications device 1110 may include a processor and memory device or memory devices in communication with the processor, as well as wireless antenna assemblies and one or more displays, such as touch screen displays, in communication with the processor. In an embodiment, a memory device of handheld wireless communications device 1110 has stored therein an application program including processor executable instructions for receiving submissions for claims for requests for accommodations and analyzing submitted claims for eligibility. The application program instructions, when executed by the processor of the device 1110, may cause the processor to provide an output to cause displays to prompt a user to enter information required to request an accommodation. The prompts may request information including the name and employer of the employee and a general reason for the requested accommodation. The device 1110 may display additional questions specific to the type of accommodation being requested by the employee.
In some embodiments, a memory device may have stored, as part of an application program, instructions which, when executed by the processor, cause the processor to determine whether the submitted information is sufficient for an eligibility determination to be made, before transmission of data indicative of the request for leave to server 1140. The memory device may have further stored, as part of the application program, instructions which, when executed by the processor, cause the processor to determine whether the claim is eligible before transmission of the information to server 1140. The instructions may further, when executed by the processor, cause the processor to provide a signal to the display to cause the display of the result of the determination. Thus, in an embodiment, a handheld wireless device 1110 may prompt the user for information sufficient for a complete request for accommodation via a display, receive via a user interface, such as a touch screen or keypad, data necessary for the determination, and determine, based on the received data and stored rules, whether the employee is eligible for the requested accommodation. The handheld wireless device 1110 may then generate a display having text and graphics that inform the user whether the accommodation is eligible, and provide information and documents setting forth the rights and responsibilities of the employee, depending upon the result of the determination. In some embodiments, one or more of these functions may be performed by a processor of the server 1140.
The embodiments described herein may be implemented using any number of different hardware configurations. For example,
The processor 1210 also communicates with a storage device 1230. The storage device 1230 may comprise any appropriate information storage device, including combinations of magnetic storage devices (e.g., a hard disk drive), optical storage devices, mobile telephones, and/or semiconductor memory devices. The storage device 1230 stores a program 1212 and/or a leave management system application 1214 for controlling the processor 1210. The processor 1210 performs instructions of the programs 1212, 1214, and thereby operates in accordance with any of the embodiments described herein. For example, data received via a communication device 1220 indicative of employee claims, including employee claims for one of a plurality of types of employee leave, may be processed. The processor 1210 may then detect that a particular employee claim is associated with a request for accommodation. The processor 1210 may then automatically determine if medical information associated with the request for accommodation meets predetermined criteria (e.g., whether or not the medical information is sufficient and complete), and an indication of the determination may be transmitted.
The programs 1212, 1214 may be stored in a compressed, uncompiled and/or encrypted format. The programs 1212, 1214 may furthermore include other program elements, such as an operating system, clipboard application a database management system, and/or device drivers used by the processor 1210 to interface with peripheral devices.
As used herein, information may be “received” by or “transmitted” to, for example: (i) the leave management system platform 1200 from another device; or (ii) a software application or module within the leave management system platform 1200 from another software application, module, or any other source.
In some embodiments (such as shown in
Referring to
The request identifier 1302 may be, for example, a unique alphanumeric code identifying an accommodation request that has been submitted by an employee. The request description 1304 may summarize and/or categorize the accommodation being requested (e.g., a standing desk or a larger display monitor) and the date 1306 may indicate when the employee submitted the request. The medical status information 1308 might indicate, for example, that the accommodation request is supported by sufficient medical documentation, that additional documentation has been or will be requested, or that the insurer or employee is waiting to receive additional records (e.g., from an attending physician). The request status 1310 might indicate that the employee's accommodation request has been resolved (granted or not granted) or that resolution is still pending.
Thus, embodiments described herein may provide systems and methods to facilitate the processing of employee requests for accommodations in an automated, efficient, and consistent manner.
The following illustrates various additional embodiments of the invention. These do not constitute a definition of all possible embodiments, and those skilled in the art will understand that the present invention is applicable to many other embodiments. Further, although the following embodiments are briefly described for clarity, those skilled in the art will understand how to make any changes, if necessary, to the above-described apparatus and methods to accommodate these and other embodiments and applications.
Although specific hardware and data configurations have been described herein, note that any number of other configurations may be provided in accordance with embodiments of the present invention (e.g., some of the information associated with the databases described herein may be combined or stored in external systems).
Applicants have discovered that embodiments described herein may be particularly useful in connection with ADAAA requests for accommodations. Note, however, that other types of requests may also benefit from the invention. For example, embodiments of the present invention may be used in connection with requests associated with state or other governmental laws and regulations.
Moreover, some embodiments have been described herein as being accessed via a wireless device, such as a smartphone or tablet computer. Note, however, that embodiments may be implemented using any device capable of executing the disclosed functions and steps. For example,
The present invention has been described in terms of several embodiments solely for the purpose of illustration. Persons skilled in the art will recognize from this description that the invention is not limited to the embodiments described, but may be practiced with modifications and alterations limited only by the spirit and scope of the appended claims.
