THE INSURANCE REHABILITATION ASSOCIATION OF FINLAND (VKK): FINLAND

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1 THE INSURANCE REHABILITATION ASSOCIATION OF FINLAND (VKK): FINLAND 1. Organisations involved Insurance Rehabilitation Association of Finland (VKK) Finnish Motor Insurers Centre Federation of Accident Insurance Institutions Finnish Pension Alliance (TELA) Rehabilitation service providers 2. Description of the case 2.1. Introduction The Insurance Rehabilitation Association of Finland (VKK) is a non-profit association created in 1964, during the years of consolidation of the welfare state in Finland. Under Finnish legislation, employers are legally required to take out insurance to cover the costs arising from an occupational accident or disease. This insurance also covers the costs incurred from treatment and required aid equipment, daily allowance for temporary incapacity and accident pension or disability pension if, after 1 year, there is permanent disability. Before any pension is paid by the insurance company, the legislation requires that an assessment be carried out to determine possible rehabilitation options. This inclusion of rehabilitation as an integral part of statutory compensation makes it both a right and an obligation; that is, no earning compensation is awarded until rehabilitation possibilities have first been assessed. This means that the assessment of rehabilitation possibilities is the first step in any compensation procedure launched by the insurance companies. To coordinate rehabilitation efforts and streamline this procedure, the non-life insurance companies for work-related accidents and diseases and road traffic accidents created the Insurance Rehabilitation Association of Finland (VKK). Members include the Finnish Motor Insurers Centre, the Federation of Accident Insurance Institutions and the Finnish Pension Alliance (TELA), and it is funded solely by the insurance institutions. In 2014, it had 35 employees. State-funded social security is managed by the Social Insurance Institution of Finland (KELA), which arranges vocational rehabilitation for those who are not entitled to rehabilitation based on employment pension or on accident or motor liability insurance. The employment administration is responsible for services for persons who are unemployed or threatened with unemployment Aims VKK plays an intermediate role between the non-life insurance companies (for workers compensation and motor liability) and the person in need of rehabilitation. It helps insurance companies plan rehabilitation programmes for their clients and implement their rehabilitation services. It provides advice, guidance and support to the rehabilitee to promote his/her return to work. Traditionally two-thirds of VKK s beneficiaries have suffered occupational accidents or diseases; the other third have suffered road accidents. Within workers compensation and traffic insurance schemes, VKK plans both vocational rehabilitation and rehabilitation for improving and sustaining functional capacity. Vocational rehabilitation aims to support the person to go back to or stay at his/her current workplace, or to find a different job. Rehabilitation focusing on improving and sustaining functional capacity, however, is about helping the 0

2 person regain independence in daily life. The present case study focuses only on vocational rehabilitation to help return to work What was done, and how? Following an occupational accident or illness, the insurance company in charge of compensating the worker for loss of income assigns VKK to assess the need and prospects for rehabilitation. The person him-/herself, an attending physician or an employee of a medical rehabilitation facility can also commission VKK to undertake this assessment, which must be approved by the insurance company and a case opened accordingly. A secure internet tool exists for preparing commissions, reporting and updating information during the rehabilitation process and giving mutual feedback Assessment of rehabilitation needs Before the insurance company will pay for vocational rehabilitation, a causal link needs to be established between the health problem suffered by the person and the issue covered by the insurance (occupational accidents/diseases or road traffic accidents). Once this link has been established, a VKK rehabilitation counsellor carries out an assessment for the commission to determine if vocational rehabilitation and return to work are possible. Counsellors are assigned based on the place of residence of the client, his/her first language, and the nature of the rehabilitation in question. The VKK counsellor, together with the rehabilitee, makes an assessment of future prospects for vocational rehabilitation and return to work. The employer may also be consulted at this stage. The criteria used for this assessment include: the person s health; limitations imposed by the injury or disease on work; earlier work experience or training to help re-enter the labour market; education; age; living conditions; employment prospects. Other issues addressed include whether or not on-the-job rehabilitation (for example through trial work, job coaching or training) is possible and if re-entering the labour market may require vocational education (such as apprenticeship, vocational upper secondary education, polytechnic or university studies). The counsellor meets with the person to discuss his/her health, educational background, work history, current employment situation, family situation and other social matters. If necessary, VKK can also contact the employer to request an evaluation of the rehabilitee s return-to-work prospects. The employer is asked about the type of support that could be provided to the returning worker (for example adaptation of working schedule or tasks) and an assessment is made of those arrangements that may be covered by the insurer (for example adapted technical equipment). The approach is multidisciplinary: the rehabilitation counsellor can request a statement from one of VKK s specialist doctors regarding, for example, the limitations on working ability. The assessment can also include an evaluation by a doctor, psychologist, social worker, physiotherapist or occupational therapist Rehabilitation plan Following the assessment, the counsellor draws up a rehabilitation plan outlining the options for future rehabilitation and providing recommendations to the insurance company with regard to the prospects for rehabilitation and successful return to work. Although some information will be shared with the employer, for example with regard to on-the-job training, issues of confidentiality prevent information such as compensation amounts from being shared. The objective of the rehabilitation plan is to enable the person to obtain work appropriate to his/her state of health, and matching his/her previous pay level. The counsellor may also conclude that a return to the open job market is not possible. Based on the 1

3 plan and the recommendations, the insurance company then decides whether or not to pursue rehabilitation. In 40 % of cases, the prospects for rehabilitation are deemed insufficient to justify the costs of a returnto-work programme and the person then receives compensation for loss of income from the insurance company (85 % of annual earnings until retirement and 70 % after) or receives a disability benefit if justified. The person may also be directed by VKK to rehabilitation for improving and sustaining functional capacity, which is provided under the public health care system or the municipalities. Sixty per cent of VKK s clients suffering from an occupational accident/disease or motor accident follow a return-to-work programme. A rehabilitation plan leading to a return to work can cover many different measures, from workplace rehabilitation or vocational training to transfer to a new job or the provision of business support funding for self-employed workers. In most cases, workers need vocational reeducation, with completion of secondary or higher education degrees, to re-enter employment. Workplace rehabilitation includes: Work try-outs, which estimate the rehabilitee s working capacity or suitability for certain tasks or occupations. These are arranged at the rehabilitation facilities, the person s own workplace or a separate place of work and normally last a maximum of 3 months. Training try-outs, which estimate the rehabilitee s capacity to successfully complete any vocational training that has been planned. In practice, the training try-out is limited to short study blocks of just a few days in a training facility. Work training, which is practical work experience in a job which has been deemed suitable for the rehabilitee. Workplace adjustments, such as assistive devices and equipment that allow the client to work (for example a customised chair, ramps or a fresh-air helmet). Business support funding can be granted to a rehabilitee who wants to become an entrepreneur, provided certain conditions are fulfilled. These include an economically viable business with the capacity to support a regular salary, and with the rehabilitee able to contribute at least 50 % of the necessary initial investment. This financial support is made up of a combination of interest-free loans and subsidies granted by the insurer and does not necessarily exclude the possibility of applying for other public grants Implementation of the rehabilitation plan Once the insurance company has approved the implementation of the vocational rehabilitation plan, the rehabilitation counsellor in VKK monitors the plan and supports its progress. If problems arise during the course of the rehabilitation, the rehabilitation counsellor appraises the situation and makes a recommendation to the insurance company about possible supplementary measures. Neither VKK nor the insurance companies have dedicated rehabilitation or training facilities; instead, rehabilitees use various private and public providers of rehabilitation services, such as public health care units, public employment offices, private vocational training institutes, private rehabilitation facilities. VKK, through the counsellors, works in cooperation with these service providers as well as with the rehabilitee s potential employers. The services offered by these providers vary in content. The employment services, for instance, provide occupational guidance, evaluation of employment prospects and work-training services. They can also provide information about training and education options. When the vocational rehabilitation nears completion, the VKK counsellor meets the client to assess his/her employment prospects, with the objective of finding employment in his/her new occupation immediately after the vocational rehabilitation has ended. When the rehabilitation has finished, the rehabilitation counsellor prepares a report on the results of the rehabilitation for the insurance company. VKK continues to monitor the rehabilitee for a maximum of 6 months after the rehabilitation plan is completed. 2

4 Timing Once a commission is received by VKK, the assessment of rehabilitation prospects and the development of the rehabilitation plan can take from several weeks to 2 years; the average is 4 months. The implementation of the return-to-work plan can take from a couple of months up to 4 years; the average is just under 3.5 years What was achieved? In 2013, VKK received 831 commissions (including 213 commissions from employment pension institutes). The health problems affecting the persons in need of rehabilitation varied, but the most common were brain injuries, upper limb injuries, lower limb injuries, allergic eczemas and asthma. After the implementation of the rehabilitation plan, 71% of people returned to work, which is considered successful. Over the past few years, this return-to-work rate has fluctuated between 70% and 80%. Most people did not return to their previous jobs but found another occupation, sometimes in the same company but most of the time in a different company. This may be because there is no obligation for the employer to keep the worker in the same job. In addition, the long timespan between the health problem and the return to work makes it difficult for smaller companies to hold the original job for the person. Smaller companies also find it more difficult to tailor working conditions to individual workers. A 2007 study showed that the costs incurred by the insurance companies for vocational rehabilitation were between one-eighth and one-twelfth of the costs incurred without vocational rehabilitation and with no return to work (that is, when they pay for loss of income until and after retirement), even taking into account those people for whom vocational rehabilitation is not possible. The experience of a beneficiary, Janne O. (Rissa, 2014) Janne O. worked at the Suolahden planing mill. One day, he cut his hand up to the wrist in one of the planers because of a safety defect. His right hand was amputated at the Finland Central Regional Hospital and he was accommodated with a prosthesis. After a few months of sickness absence, he returned to his workplace, where he took on a different occupation as head of the factory. However, he could not wear his prosthesis for more than minutes at a time because it weighed on his nerves and caused him significant pain. After refusing a second corrective operation, he decided not to wear a prosthesis any more. He stayed in this management position for 1.5 years, but ran into a disagreement with the owners. Janne wanted to invest in employee safety and wellbeing but the owners refused this. Janne therefore sought the advice of the VKK to assess his options and evaluate what sort of position/occupation would fit his work ability. In parallel, thinking about what kind of job he wanted to do and supported by VKK in this process, Janne approached the owner of a car dealership called CarCaravan to enquire about the possibility of taking up a position there, despite his disability. As the owner of the car shop was very positive, Janne received a temporary trainee position followed by a 2-year contract. VKK s rehabilitation counsellor directed Janne to the right rehabilitation providers, in particular to a Helsinki vocational school where Janne would learn about the theory while working part-time as an apprentice at CarCaravan to learn the practice. Janne s whole rehabilitation costs, from his medical rehabilitation to his apprenticeship in the automotive sector, have been covered by the insurance companies, including compensation for the loss of income, daily allowance and disability benefits. He will graduate in autumn 2014 and is enjoying his new job very much. 3

5 2.5. Success factors and challenges The following success factors have been identified: Individual approach: One of the critical success factors of VKK is its individualised approach to the person in need of rehabilitation. The counsellors know their clients needs well and adjust their approach and working methods, their guidance and support, to tailor them to the individual s situation. Multidisciplinary approach: In its assessment of rehabilitation needs and prospects, VKK uses a multidisciplinary approach, with medical doctors, psychologists, social workers, physiotherapists and occupational therapists. Cooperation of stakeholders: Coordination between the various actors is an important factor for the successful implementation of rehabilitation. VKK serves as an intermediary between the medical profession, the insurance companies, the vocational rehabilitation service providers and the employment offices. Motivation/attitudes: Positive motivation of the rehabilitee and the attitudes of those surrounding him/her (family, managers, colleagues) are key factors. Local knowledge: The rehabilitation counsellors have a good knowledge of the local employment market and the educational system, allowing for more specific advice to rehabilitees. Evaluation and monitoring: VKK monitors the implementation of the rehabilitation plan closely and regularly discusses employment prospects with the rehabilitee. It also monitors the situation of the rehabilitees for 6 months following the end of the programme, which allows it to evaluate the success or shortcomings of the approach. The following challenges have been identified: Late interventions: The timespan between the identification of the health problem/accident and the start of the vocational rehabilitation can be very long (1 year on average). Early intervention is identified as a critical success factor in any rehabilitation intervention, so this time should be reduced as much as possible. Improved communication and coordination between the public health system, which is responsible for medical rehabilitation, and the occupational healthcare system, which oversees vocational rehabilitation and re-entry into the labour market, would help to achieve this. A change of attitudes may be needed from the medical profession to start thinking about vocational rehabilitation sooner. Lack of incentives for SMEs: As mentioned, returning to the same job is often possible only in large companies. Smaller companies lack incentives to rehire an employee after a certain number of years of vocational rehabilitation. The long time before the rehabilitation process starts is also an obstacle for smaller companies, as they often need to hire replacements quickly Transferability Transferability to another Member State is directly possible only in Member States with similar systems for rehabilitation and compensation, that is, where the main responsibility for compensation and rehabilitation is on the insurance companies but rehabilitation is provided by a number of small rehabilitation service providers. In such cases, setting up an intermediary such as VKK between the insurance companies and the rehabilitation services providers should be possible. Otherwise, some other means of effective referral, coordination and funding would have to be found within the national context, which might have an impact on success. 4

6 2.7. Further information Insurance Rehabilitation Association (Vakuutuskuntoutus VKK r.y.) Hämeentie 19 B Helsinki Finland Contact person: Juha Mikkola, Managing Director, VKK 3. References and resources Interview with Juha Mikkola, VKK Managing Director. VKK website in English: Mikkola, J. (2013), Return-to-work in Finland: current challenges, paper presented at Return-to-Work Strategies Roundtable, Helsinki, 23 September. Mikkola, J. (2007), Does rehabilitation pay off? Money saved through vocational rehabilitation given under motor liability and workers compensation insurance compared to rehabilitation costs, summary of MBA thesis, unpublished. Rissa, K. (2014), Höylä murskasi käden, TAPATURMAvakuutus, 2/2014, pp Retrieved 27/10/2015 from: 5