1. OMERS Disability Administration Review
OMHRA Fall Conference
Celine Chiovitti, VP, Pension Operations
September 14, 2017

2. Review of OMERS disability benefits administration
Feedback to us indicated:
Leading to a Review:
Feedback
Our process and communications are complicated
Process requires more rigor
Employers control the timing of application
Generally more guidance on complex cases (rehabilitation, modified work programs)
Objectives of our Review
Simplify the experience
Strengthen guidance and training
Streamline workflows
Incorporate Best Practices
This review only addressed considerations and approaches to improve the administration process and did not deal with Plan design issues

3. Two types of OMERS disability benefits that members can apply for…
Disability Waiver of Contributions
Disability Pension
Credited service accrual without
contributions
(member and employer)
Unreduced immediate pension for life
(upon member’s election)
Both types of disability benefits require medical evidence to support the application.

4. The application for disability benefits consists of many steps
Employer
OMERS
Member
OMERS Doctor
OMERS
Sends benefit request forms and/or required information to OMERS
Processes the request and sends forms and instructions to member
Returns completed medical documents to OMERS
Reviews medical information and provides medical opinion
Approves/declines the disability benefit and/or rehab program and informs the member of the decision
The initial application is only approved when the information from all parties is complete. A waiver or disability pension can be processed retroactively.

5. Disability Waiver statistics and trends
Waived contributions
(both sides)
Approximately
$77 Million/year
The number of members on Waiver (2%-3% of active membership) has remained stable and in line with total active membership growth

6. Disability Pension statistics and trends
95% of disability pensioners are age 55+
The number of members on disability pension has been decreasing slightly over the past five years

7. We consulted broadly during our review…
Internal Consultations
Employer Consultations
Member Consultations
Union/ Association Consultations
Peer Practice
Review
Future State
Recommendations
Historical Reviews
Communications
Review

8. Summary of what we heard…
All stakeholders said that our communications are confusing, our process is complex and our current approach allows for too much discretion.
Members/Member Associations
Employers
Internal Concerns
Enforce a consistent application approach for members
More communication with members
Simplify language
Member election
Provide a consistent administration guideline
More tools to address complex cases and rehabilitation.
More rigorous reviews and follow-ups
Automate and simplify process (self-service, enhance e-access, less paper and forms)
Potential for inconsistent practices
Need to simplify communications
Need enhanced internal skills and support
Roadmap to automate processes
Consulted peer plans: HOOPP deals direct with members, OTPP aligns with LTD, OPT outsources administration

9. We will be making changes to our Disability Administration Process in four distinct areas
Communication
Employer Support
Simpler communications in general.
Reduce the number of letters and forms.
Follow up with members who do not respond.
Customize approach to deal with complex cases.
Enhance responsiveness and automate when possible.
Provide clear employer guidelines and require all employers to inform OMERS of member’s absence prior to 5th month.
System
Medical Reviews
Improve processes through OASYS Phase 1 and 2.
Enhance self service functionality and secure portal.
Allow Employers to upload and pull reports on portal.
Create standard operating procedures and guidelines for physicians.
Better define staff role versus physician’s role.
Create ‘Disability Claims Manager’ Role

10. Two key changes to note…
Application Process to be started before the 5th month of absence
If a member will be absent from work due to illness or injury that is expected to go beyond 4 months, employers must notify OMERS by the 4th month of absence
Create New Internal Role ‘Disability Claims Manager’
This role will oversee the disability administration process including the medical doctors
OMERS will send an application form to the member
If approved by OMERS, employers will be informed of the date of approval and must stop member and employer contributions.
Oversee the development of procedures and guidelines for medical doctors
Work with employers on complex cases including modified work, rehabilitation, return to work protocols.
Application: Current Plan provisions and administration:
A member who is considered totally disabled accrues credited service from the later of first day of the fifth calendar month following the month in which the member is considered to be totally disabled OR the day the member ceases to make contributions
Our Employer Administration Manual provides employers with discretion in whether to continue making contributions, while requiring a consistent practice within an employer. The majority of our employers provide the application by the fourth month of absence, while others only submit it after the member receives less than 100% income replacement, or exhausts all sick credits
The Problem with the current approach:
In the absence of clear guidelines and monitoring from OMERS there are inconsistencies within and between employers resulting in disputes
Without a standard approach, it is difficult for OMERS to ensure employers are complying with the Plan text and providing consistent treatment for all members
The Recommended Approach:
Simplify the administration of this provision by requiring all Employers to notify OMERS once a member has been absent from work beyond four months
Disability Claims Manager Current Approach:
Pension Operations has two medical doctors working on a part-time basis to adjudicate all claims (approx. 9,000/year) with little support and capacity to follow up
nature of disabilities and associated legislation (e.g. WSIB) is changing and we need additional in-house expertise to respond to the changing landscape
Disability Claims Manager role with a nursing/medical background to better support the process
We will communicate changes over the remainder of the year and will fully implement by June 2018.

11. Examples of other changes to be fully implemented within 36 months
Themes
Activities
Simplify forms and letters (Medical Review Form, Employer Admin Manual)
Create new letters for members who are making an election between waiver and/or continued sick leave
Notify employer when a member is applying for a disability pension
Communication (0-12 months)
Focused employer training on rehab periods and other complex situations
Establish guidelines and clearer direction
Enable direct channel for employers to contact disability team on complex cases
Employer Support (6-12 months)
Medical Reviews (6-12 months)
Create procedures for the review process (initial and definition change)
Define Physician role versus staff role and create capacity
System (24-36 months)
Allow employers to report an event through e-channels
Develop secure tool to share and receive information
Expand self-service functionality, reduce paper and forms 11

12. Our go-forward approach
Targeted approach to strengthen our disability administration process and improve satisfaction with members and employers.
3. Medical Reviews
1. Communication
2. Employer Support
4. System
FAQs
Plain language
Clear direction
One consistent approach
Customized employer support
Dedicated Claims Manager
Streamlined reviews
LEAP / OASYS
Self-service
Digital tools
0-12 months
6-12 months
6-12 months
24-36 months