1. Return to Work - ISSA Guidelines - EUMASS-Congress, Ljubljana June 9, 2016 Dr. jur. Friedrich Mehrhoff, German Social Accident Insurance (DGUV), Berlin

2. Global Facts Around one billion persons with disabilities (pwd) exist worldwide, 20% of the population in each country. 80% of disabilities are not inborn, but developed during life time, mostly during the working age. Most of them become unemployed and dependent on long-term benefits of social security. Seite 2 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

3. Finding the way back to the working life after injuries or diseases Seite 3 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff Seite 3

4. Terms Return to work Job retention Disability Management Rehabilitation 4 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

5. Three-step-model for social security 1.Reintegrate employees into the familiar working-place 2.Maintain the relationship to their employers 3.Invest in finding new working-areas Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff 5

6. Return to Work – a business case 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 employability. Healthcare providers are paid for supporting their clients on their way back to work. This one of main reasons of financing health care professionals! Social security institutions, which pay for medical services and for professional and social participation must change the role from a player to a player. 6 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

7. German Social Statutory Insurance Work Accident Insurance Health Care Insurance Long-Term Care Insurance Pension Insurance Unemployment Insurance www.deutsche-sozialversicherung.de (English version) Seite 7 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

8. German Social Accident Insurance Back to work after work accident 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. Seite 8 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

9. Trend: Activating Social Security 1.Social Security Schemes respect the paradigm-shift from only compensating claims and paying pensions to creating structures and processes towards pro- active rehabilitation programs. 2.Return-to-work (RTW) strategies attract personal- centred management programs to the state, the enterprises, insurers and service providers by using preventive measures close to the worksite. Seite 9 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

10. But: Return to Work is also a human right! Seite 10 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

11. Convention of the Rights of Persons with Disability (CRPD), Art. 27 „Work and Employment“ „(1) States parties shall safeguard and pormote 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. Seite 11 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

12. International guidelines on RTW International Social Security Association (ISSA), Geneva Rehabilitation International (RI), New York International Disability Management Standard Council (IDMSC) (Since November 2013) Seite 12 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

13. Target group  Return to work and rehabilitation programmes are part of a pro- active approach of fundamental importance to social security institutions.  Social security institutions are payers of health care, pensions, unemployment benefits in cases of injuries and diseases and act within a political and legal framework.  RTW guidelines are addressed to the senior management for providing appropriate structures and processes in social security institutions. Seite 13 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

14. Success factors in RTW Social Security Scheme Case Management Collaboration among stakeholders Qualification of Experts Holistic Approach Early Intervention participation of the individual Seite 14 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

15. Medical Rehabilitation close to the working-place increases the productivity of a person Seite 15 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

16. Key elements of success Bio-psycho-social model (ICF) of the WHO as a tool Prevention and rehabilitation Liability of the employers Holistic Approach Seite 16 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

17. Preventing early retirement – German approach New Legal obligation since 2004 – Disability Management (DM) Employers have to offer DM procedure if employee is ill more than six weeks per year and frequently or in time intervals of absence from work Federal Labor Court decision 2007: if employers do not provide evidence that they have offered a disability management program they may not dismiss the employee because of illness 17 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

18. Prevention and Return-to-Work Pro-active Social Services Employability Health and Safety Health Promotion / Wellbeing Disability Management Rehabilitation Seite 18 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

19. Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff Seite 19

20. Keep in mind! Merely six weeks of sick-leave reduce return-to-work success down to 50%. Seite 20 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

21. 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…” Seite 21 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

22. Key elements of success Early intervention Waiting for application of claims leave insurers (payers) in a passive role. Early information initiated and assisted by enterprises or physicians. Cooperation with stakeholders in enterprises including company-physicians. Seite 22 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

23. Art. 193 German Social Code 7 (social accident insurance ) “ Enterprises are obliged to report each accident at work, which causes more than three days of sick-leave” Similar legal obligations refers to the reports of diseases suspected by occupational risk factors Seite 23 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

24. Identify complex cases that need additional management Seite 24 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

25. Case Management Paradigm-shift from compensation to an activating management and cooperation between physicians and case-managers. 5% of cases need rehabilitation management. These complex cases cause insurers 80% of their costs. ICF-oriented indicators of an efficient rehabilitation management close to the needs of pwd. Key elements of success Seite 25 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

26. Different perspectives – a barrier for occupational participation Seite 26 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

27. Participation of the Individual  UN-Convention (CRPD) demands to focus on abilities instead of deficits.  Action plans for implementing participation, inclusion, diversity and individualism.  New approach: Pwd as peers. Persons with amputations assist other amputees. Key elements of success Seite 27 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

28. Need of coordination Seite 28 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

29. Key elements of success Collaboration among stakeholders Social security institutions must coordinate RTW activties in early detection and case-management. Federal approaches by creating an umbrella association of rehabilitation in each country. Needs of smaller enterprises give the floor for Regional Centers together with general practicioners (GP). Seite 29 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

30. Global Standards for professionals in RTW Disability management www.disability-manager.de Qualifying experts www.ifdm2016.com.my Kuala Lumpur Quality audit in enterprises 30 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

31. Qualification of experts in RTW Disability Managers Employer Consensus-based Employee International Labour Organisation (www.ilo.org) NIDMAR / Canada (www.nidmar.ca) DGUV (www.dguv.de) Employment contract Seite 31 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

32. Certification of training program and examination for „Disability Management Professionals“ (CDMP) and „Return to Work Coordinators“ (RTWC). Key elements of success Qualification of Experts in RTW Seite 32 Dr. jur. Friedrich Mehrhoff Return to Work | EUMASS Congress, Ljubljana June 09, 2016

33. International Partners in Disability Management www.idmsc.ca www.iapdm.net 1)dguv.de 2)vdima.de oshc.org.hk acc.co.nz crsaustralia.gov BPJS.id bbrz.au wellworkingmatters.uk www.nidmar.ca www.cspdm.ca inami.be avape.br crrc.cn cosco.my Seite 33 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

34. Nine key elements of success Skills Persuade employers Networking Legal knowlegde Medical aids Evaluation Assessment Ethical behaviour Case Management Social competence Seite 34 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

35. Thank you for your attention! friedrich.mehrhoff@dguv.de Seite 35 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff

36. Useful links www.disability-manager.de www.ifdm2016.com.my www.dguv.de www.issa.int www.idmsc.org www.riglobal.org Seite 36 Return to Work | EUMASS Congress, Ljubljana June 09, 2016 Dr. jur. Friedrich Mehrhoff