Congress of AVAPES on Rehabilitation and Inclusion Dr. jur. Friedrich Mehrhoff, German Social Accident Insurance, Berlin Sao Paulo, November 2011 “Global success factors of Return-to-work”

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 2 German Social Accident Insurance Back to work after work accidents and occupational diseases Close contact to enterprises as their members Liability for safety and health at work and rehabilitation “Rehabilitation” comprises acute treatment, medical rehabilitation and social participation.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 3 Statutory Accident Insurance in Germany A comprehensive service Compensation (financial benefits, pensions) Rehabilitation (medical treatment, vocational and social rehabilitation ) Prevention (preventive measures)

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 4 Facts Around 500 million people in working age are disabled worldwide (WHO-report 2010). 80% of disabilities are not inborn, but developed during life time. Most of them become invalid, unemployed and dependant of long-term benefits.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 5 Thesis Return-to-work strategies attract traditional vocational rehabilitation to the enterprises / employers by prevention programs close to the worksite.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 6 Vocational rehabilitation Return-to-Work as a global movement

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 7 Return on Investment  The state increases the prosperity of the society that corresponds to its workforce and its working longer and harder (demographic factor).  Employers need their skilled workers fit for work on a long-term base and want to strengthen their work capacities.  Health providers are paid for supporting their clients on their way back to work. This main reason of financing a health care system must respected by physicians.  Insurers profit from investing in RTW instead of paying early and permanent compensation. 80% of the costs are paid for only 20% of the cases.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 8 Terms Inclusion Rehabilitation Disability Management Return to work

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 9 Return to Work (RTW) Stakeholders State / social partners Disabled persons / users Service providers / professionals Insurers / payers

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 10 Key questions around the world How employees with disabilities can receive comprehensive medical, vocational and social services out of one hand? How employers can be motivated and supported in their activities by reintegrating disabled employees at the workplaces? How medical services can act close to the working life with the link to vocational rehabilitation and social inclusion? How payers, which pay health services can support these challenges?

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 11 Success factors Strategies Case Management Collaboration among insurers Acceptance by the disabled Early Intervention Holistic Approach

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 12 Key elements of success Early intervention No application! Early information Pro-active management Close contacts to work places

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 13 Key elements of success Bio-psycho-social model (ICF) Employer’s liability The key-role of physicians and clinics Prevention and Rehabilitation Holistic Approach

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 14 RTW - Chain Activities of Services Employability Health and Safety Health Promotion / Wellbeing Disability Management Rehabilitation

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 15 Case Management Paradigm-shift from Compensation to Management Disability Manager as experts Efficiency: 80% of the costs in 20% of cases Individual plans correspond to CRPD Key elements of success

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 16 Art. 26, 1 a / UN-CRPD „Habilitation and Rehabilitation“ “Services and programs begin at the earliest stage, and are based on the multidisciplinary assessment of individual needs and strengths…”

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 17 Disability Management Employer Consensus-based Employee International Labour Organisation ( NIDMAR / Canada ( DGUV ( Employment contract

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 18 Global Standard in Disability Management Qualifying experts Disability Management London Quality audit in enterprises

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 19 Certified Disability Management Professional CDMP Persuade employers Networking Legal knowlegde Medical aids Evaluation Assessment Ethical behaviour Case Management Social competence

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 20 Qualifying experts in Germany German Social Accident Insurance Certification and Recertification Canadian Initiative Disability Managers 25 moduls offered by Educational partners

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 21 CDMP Working in enterprises

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 22

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 23 Audit and Certification in Germany German Social Accident Insurance Financial incentives by insurers Ford Germany Standards for Service providers Auditor in Germany

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 24 Collaboration among insurers Social security branches Federal approaches Needs of smaller enterprises Regional Centers of Competence Key elements of success

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 25 Acceptance by the Disabled  UN-Convention on the Rights of People with Disabilities (CRPD) in  Codification in social and labor law by compulsory duties and incentives for RTW.  Action Plans for implementing CRPD in the society. Key elements of success

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 26 Art. 27, CRPD „Work and Employment“ „ (1) States parties shall safeguard and promote the realization of the right to work, including for those who acquire a disability during the course of employment, by taking appropriate steps, including through legislation, to, inter alia: (k) Promote vocational and professional rehabilitation, job retention and return to work programmes for persons with disabilities.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 27 Conclusion: Criteria for a successful RTW A holistic case management which takes all needs and abilities of persons with health problems into consideration. A strong support from the social partners (employers and employees) make programms in RTW successful.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 28 Actors need strategic partners for combining activities in prevention, acute treatment, medical rehabilitation, vocational and social participation. Employers and Insurers should qualify their staff in disability management standards and finance incentives for comprehensive service of health providers. People with disabilities should be strengthened as their own case manager (participation) based on CRPD (inclusion!).

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 29 Employers need and expect an advice-service “out of one hand” for their reintegration activities covering safety and health promotion and RTW. Rehabilitation International should contribute to provide global guideline and standards in RTW including structural, process and outcome criterias.

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 30 International Cooperation International Labour Organisation (ILO) International Social Security Association (ISSA) Rehabilitation International (RI) International Disability Management Standard Council (IDMSC)

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 31 Further Information

DGUV, Sao Paulo, November 2011 Dr: jur. Friedrich Mehrhoff Seite 32 Thank you for your attention!