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GAYATHRI VADIVELGAYATHRI VADIVEL

CASE MANAGERCASE MANAGER

RETURN TO WORK DEPARTMENTRETURN TO WORK DEPARTMENT

RETURN TO WORKSOCIAL SECURITY ORGANIZATION MALAYSIA

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OverviewOverview

�� Introduction to SOCSO & SOCSO BenefitsIntroduction to SOCSO & SOCSO Benefits

�� Section 57 of the Social Security Act 1969Section 57 of the Social Security Act 1969

�� The Return to Work ProgramThe Return to Work Program

�� Success StoriesSuccess Stories

�� ConclusionConclusion

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The Social Security OrganisationThe Social Security Organisation

�� Also known as Also known as PertubuhanPertubuhan KeselamatanKeselamatan SosialSosial

(PERKESO/ SOCSO)(PERKESO/ SOCSO)

�� Established in 1971 to administrate the Social Established in 1971 to administrate the Social

Security Act 1969.Security Act 1969.

�� SOCSO covers about 5.3 million workers which SOCSO covers about 5.3 million workers which

is 43.6% of the Malaysian Workforce. is 43.6% of the Malaysian Workforce.

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PERKESOPERKESO’’S Social Insurance SchemeS Social Insurance Scheme

�� All Industries employing one or more employees (since All Industries employing one or more employees (since

1/7/1992)1/7/1992)

�� Employees employed under a contract of serviceEmployees employed under a contract of service

�� Wage ceiling for under a contract of serviceWage ceiling for under a contract of service

�� Wage ceiling for coverage: RM3,000/month (since Wage ceiling for coverage: RM3,000/month (since

1/5/2005)1/5/2005)

�� Principle of once coverage always covered applies when Principle of once coverage always covered applies when

employeeemployee’’s monthly wage exceed RM3,000/months monthly wage exceed RM3,000/month

�� Voluntary coverage for those never covered and earning Voluntary coverage for those never covered and earning

wages exceeding ceiling with consent of employer and wages exceeding ceiling with consent of employer and

employeeemployee

�� Not Covered: Govt. sector workers, selfNot Covered: Govt. sector workers, self--employed, employed,

informal sector, domestic servants, foreign workers (since informal sector, domestic servants, foreign workers (since

1992)1992)

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WHAT IS SOCIAL SECURITY ?WHAT IS SOCIAL SECURITY ?

�� An assurance given to the Insured Persons when An assurance given to the Insured Persons when

they are no longer able to generate income due they are no longer able to generate income due

to unforeseen circumstancesto unforeseen circumstances

�� To provide financial benefits, rehabilitation & To provide financial benefits, rehabilitation &

vocational training for Insured Persons with vocational training for Insured Persons with

difficulty of coping in life due to industrial difficulty of coping in life due to industrial

accidents, invalidity or death through the accidents, invalidity or death through the

benefits that are provided by SOCSObenefits that are provided by SOCSO

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PREVENTION REHABILITATION COMPENSATION

SOCIAL SECURITYORGANIZATION

WORK INJURY INSURANCE=

SOCIAL SECURITY

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Social Security SchemesSocial Security Schemes

The two main schemes provided by SOCSO:The two main schemes provided by SOCSO:

MAIN SCHEMES

INDUSTRIAL

ACCIDENTS INVALIDITY

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INDUSTRIAL ACCIDENTINDUSTRIAL ACCIDENT

�� Medical BenefitsMedical Benefits

�� Temporary Disability Benefits (MCTemporary Disability Benefits (MC’’s)s)

�� Permanent Disability Benefits ( % of impairment)Permanent Disability Benefits ( % of impairment)

�� Dependants BenefitDependants Benefit

�� Funeral Benefits (RM 1500)Funeral Benefits (RM 1500)

�� Rehabilitation BenefitsRehabilitation Benefits

�� Education Benefits ( children of SOCSO recipients of Education Benefits ( children of SOCSO recipients of

the Permanent Disability Payment of more than 20%) the Permanent Disability Payment of more than 20%)

�� Attendance AllowanceAttendance Allowance

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INVALIDITYINVALIDITY

�� Invalidity BenefitsInvalidity Benefits

�� Invalidity Aid Benefits (Invalidity Aid Benefits (BantuanBantuan IlatIlat))

�� Attendance AllowanceAttendance Allowance

�� Dependants BenefitDependants Benefit

�� Funeral BenefitsFuneral Benefits

�� Rehabilitation BenefitsRehabilitation Benefits

�� Education Benefits (Children of the Invalidity Education Benefits (Children of the Invalidity Recipients)Recipients)

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COMPENSATION

SOCIAL SECURITY

THE ACTUAL SCENARIO

PREVENTION REHABILITATION

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Contribution & Benefit Payment

1,380,972,917

1,213,709,000

1,095,136,0001,047,728,000

990,051,000

898,726,000878,532,000

879,435,000

237,629,000290,287,000

366,951,000

499,086,000

573,670,000

672,988,000

757,512,000

1,143,628,000

890,210,000

754,000,000

638,384,660

585,788,000

506,477,000

383,906,000

316,184,310

100,216,000

120,177,425

139,379,955

214,975,390 211,905,426

288,981,198

629,640,000 722,400,000

830,176,000

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000

1,200,000,000

1,400,000,000

1,600,000,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Contribution Benefit Payment

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Statistic Payment Of Statistic Payment Of Temporary Temporary

Disablement BenefitDisablement Benefit -- SOCSOSOCSO

68,600,000

66,200,000

63,200,000

61,990,000

71,177,000

71,176,576.71

56,000,000

58,000,000

60,000,000

62,000,000

64,000,000

66,000,000

68,000,000

70,000,000

72,000,000

RM

2000 2001 2002 2003 2004 2005

YEAR

Payment

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Statistic Payment of Statistic Payment of Permanent Permanent

Disablement BenefitDisablement Benefit -- SOCSOSOCSO

178,090,000

167,500,000

166,700,000

147,190,000

153,500,000

171,535,279.46

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

180,000,000

RM

2000 2001 2002 2003 2004 2005

YEAR

Payment

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Statistic Payment of Statistic Payment of

Invalidity PensionInvalidity Pension

103,300,000

118,200,000

147,000,000

158,370,000

173,100,000188,716,507.03

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

180,000,000

200,000,000

2000 2001 2002 2003 2004 2005

YEAR

Payment

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Statistic Total No. ofStatistic Total No. of

Certified InvalidCertified Invalid

6,343

3,363

7,497

3,580

7,640

3,220

6,624

2,276

7,961

2,770

7,687

2,854

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2000 2001 2002 2003 2004 2005

Application Invalidity Pension Certified Invalid

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Certified invalid < 40 years oldCertified invalid < 40 years old

About 4079 insured persons have been certified About 4079 insured persons have been certified

invalid since 1996.invalid since 1996.

624 cases reported in 2006.624 cases reported in 2006.

�� WHATS HAPPENING TO THE 4079 CASES WHATS HAPPENING TO THE 4079 CASES

RECEIVING PENSION ?RECEIVING PENSION ?

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Statistic: receiving MC > 100 daysStatistic: receiving MC > 100 days

About 5000 cases reported annually of insured About 5000 cases reported annually of insured

person having MC of more than 100 daysperson having MC of more than 100 days

51107 reported cases since 1996.51107 reported cases since 1996.

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Statistic: Permanent Disablement Statistic: Permanent Disablement

Benefit > 40%Benefit > 40%

2709 cases reported since 1996.2709 cases reported since 1996.

235 Cases reported in 2006235 Cases reported in 2006

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ImplicationsImplications

�� Malaysia is loosing its productivity edge. (About 5000 Malaysia is loosing its productivity edge. (About 5000 cases reported annually of insured person having MC > cases reported annually of insured person having MC > 100 days)100 days)

�� Young /skilled workers who are prime movers of the Young /skilled workers who are prime movers of the economy are out of work due to injury/diseaseeconomy are out of work due to injury/disease

�� Companies are spending more to reCompanies are spending more to re--train and replace train and replace the injured workers.the injured workers.

�� The Malaysian Workforce will be too dependent on The Malaysian Workforce will be too dependent on foreign workers?foreign workers?

�� High iHigh insurance nsurance costscosts

�� 80% of contribution money have been paid out80% of contribution money have been paid out

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SOCSOSOCSO’’ss InitiativesInitiatives

SOCSO took the initiative to address these SOCSO took the initiative to address these

problems at grassproblems at grass--root level by enhancing the root level by enhancing the

benefits with the implementation of the Returnbenefits with the implementation of the Return--

ToTo--Work Work ProgrammeProgramme, incorporating Section 57 , incorporating Section 57

of the Employees Social Security Act for the of the Employees Social Security Act for the

Insured Persons.Insured Persons.

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Section 57(1)Section 57(1)““An Insured Person suffering from or An Insured Person suffering from or claiming to suffer from invalidity or claiming to suffer from invalidity or permanent disablement may be provided permanent disablement may be provided by the Organization, free of charge by the Organization, free of charge facilities for physical or vocational facilities for physical or vocational rehabilitation.rehabilitation.””(Employees Social Security Act 1969)(Employees Social Security Act 1969)

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Return to WorkReturn to Work

�� This This programmeprogramme was established with the was established with the

objective of assisting objective of assisting SOCSOSOCSO’’ss Insured Persons Insured Persons

with employment injury as well as those claiming with employment injury as well as those claiming

for invalidity pension to be able to return to for invalidity pension to be able to return to

work through a work through a biopsychosocialbiopsychosocial and and

multidisciplinary approach.multidisciplinary approach.

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Pilot ProjectPilot Project

SOCSO has started this SOCSO has started this programmeprogramme (February (February 2005 2005 –– February 2006) in KL & Ipoh as a pilot February 2006) in KL & Ipoh as a pilot project which focused only on musculoskeletal project which focused only on musculoskeletal disorders (back and neck).disorders (back and neck).

However, there was inadequate multidisciplinary However, there was inadequate multidisciplinary intervention, thus limiting the full potential intervention, thus limiting the full potential outcome of this rehabilitation outcome of this rehabilitation programmeprogramme..

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21 (30%)21 (30%)Number of those who did not Return To WorkNumber of those who did not Return To Work

49 (70%)49 (70%)Number of those who Return To WorkNumber of those who Return To Work(out of those who completed)(out of those who completed)

70 (55%)70 (55%)Number of those improved physicallyNumber of those improved physically

127127Number of Insured Person enrolled in the Number of Insured Person enrolled in the

programmeprogramme

Out come of the Pilot Project

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Limitations of the Pilot ProjectLimitations of the Pilot Project

�� Less Effective Case ManagementLess Effective Case Management

�� Limited to only back & neck injuries. Limited to only back & neck injuries.

�� Inadequate Psychosocial intervention.Inadequate Psychosocial intervention.

�� Lack of understanding and support from Insured Lack of understanding and support from Insured

Persons.Persons.

�� Delayed intervention period for rehabilitation. Delayed intervention period for rehabilitation.

(Patients have been unemployed for 1.58 years)(Patients have been unemployed for 1.58 years)

�� Insufficient awareness amongst all related parties.Insufficient awareness amongst all related parties.

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How can we improve this?How can we improve this?

�� More effective case management (personalized)More effective case management (personalized)

�� Integrating a Integrating a programmeprogramme to look into the macro to look into the macro

point of viewpoint of view

�� By appointing appropriate service providers for By appointing appropriate service providers for

effective rehabilitation.effective rehabilitation.

�� Awareness campaigns & educational Awareness campaigns & educational

programmesprogrammes

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Case ManagementCase Management

�� The main component of the RTW.The main component of the RTW.

ReferralInitial Needs

Assessments

Monitor

Review

Rehabilitation

Planning &

Coordination

Completion

&

Evaluation

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Integrated return to work modelIntegrated return to work model

Hospital Employment

providers

Workers

compensation

and income

support

Vocational

RehabilitationReturn to Work

Medical /

Psychological

Rehab

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Return to Work HierarchyReturn to Work Hierarchy

�� Same job same employerSame job same employer

�� Similar job same employerSimilar job same employer

�� Different job same employerDifferent job same employer

�� Same job different employerSame job different employer

�� Similar job same employerSimilar job same employer

�� Different job same employerDifferent job same employer

�� Self EmployedSelf Employed

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Target GroupsTarget Groups

�� Injured workers on Temporary Disablement Benefit Injured workers on Temporary Disablement Benefit (MCs). (MCs). –– early interventionearly intervention

�� Recommendation by the Recommendation by the Medical BoardsMedical Boards for workers for workers applying for Permanent Disablement Benefit.applying for Permanent Disablement Benefit.

�� Recommendation by the Recommendation by the Medical BoardsMedical Boards for workers for workers below 50 years of age applying for Invalidity Pension .below 50 years of age applying for Invalidity Pension .

�� Workers who have been certified invalid but will be Workers who have been certified invalid but will be able to benefit from certain job modifications.able to benefit from certain job modifications.

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Why Early Intervention?

Probability of returning to workProbability of returning to work%

Time

6 months absent: 50% will RTW

12 months absent: 20% will RTW

24 months absent: 10% will RTW

(Source: National worker Comp Symposium,

June 2000 – Australia)

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SOCIO SOCIO –– ECONOMIC ECONOMIC

ASPECTSASPECTS

Injured WorkersDowntime/Loss of manpower

Workers on Prolong

Medical Leave

Production Cost Increase

Overtime/New employee

Economic impact on society,

Higher Cost of Living

Social & Economic StressLoss of focus at work

Negative

Socio-economic

Cycle

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What improvements HAVE been done?What improvements HAVE been done?

�� SOCSO has appointed Case Managers from a SOCSO has appointed Case Managers from a

multidisciplinary backgroundmultidisciplinary background

�� Program started of with 5 case managers in 2007Program started of with 5 case managers in 2007

�� Due to the success of the program and high demand, Due to the success of the program and high demand,

currently there are 35 case managers currently there are 35 case managers

�� (From January 2010, each state will have an appointed (From January 2010, each state will have an appointed

case manager to handle SOCSO cases)case manager to handle SOCSO cases)

�� Appointed more service providers to broaden the range Appointed more service providers to broaden the range

of treatmentof treatment

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TYPE OF REHABILITATIONTYPE OF REHABILITATION

�� Stroke / Neurological RehabStroke / Neurological Rehab

�� Musculoskeletal (Back )Musculoskeletal (Back )

�� OptometryOptometry

�� Hand & MicrosurgeryHand & Microsurgery

�� Pain ManagementPain Management

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CHALLENGESCHALLENGES

�� A large group of companies are yet to employ A large group of companies are yet to employ

persons with disabilities in their workplace.persons with disabilities in their workplace.

�� Workplaces with inadequate disabled friendly Workplaces with inadequate disabled friendly

facilities.facilities.

�� Lack of awareness (Benefits of employing Lack of awareness (Benefits of employing

PWDsPWDs))

�� No regulation for employment of No regulation for employment of OKUOKU’’ss / /

PWDsPWDs

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The next steps forwardThe next steps forward

�� To expand the RTW To expand the RTW ProgrammeProgramme nationwide.nationwide.

�� Employ more Case Managers.Employ more Case Managers.

�� Aggressive awareness campaigns.Aggressive awareness campaigns.

�� More participation of employers, employees, the More participation of employers, employees, the

dependents, related parties/agencies, insurance dependents, related parties/agencies, insurance

companies to be more involved in this companies to be more involved in this

programmeprogramme. .

�� Award Scheme to motivate more employersAward Scheme to motivate more employers

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The next steps forwardThe next steps forward

�� A holistic approach of case management A holistic approach of case management

(referrals, planning, monitoring, follow(referrals, planning, monitoring, follow--through)through)

�� Change of mindset: Change of mindset: ““Employment is the best Employment is the best

form of social securityform of social security””..

�� The government to take the leading role in The government to take the leading role in

coordinating and promoting RTW? (SOCSO coordinating and promoting RTW? (SOCSO

only covers 40% of the Malaysian workforce)only covers 40% of the Malaysian workforce)

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SOCSO RTW StatisticsSOCSO RTW Statistics

Insured Persons Reactions to the Programme

(Accumulated 2007-2008)

62%

38%

Motivated

Not Motivated

N=703

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SOCSO RTW StatisticsSOCSO RTW Statistics

Accumulated Status of the RTW (2007-2008)

77%

11%

4%

8%

Return to Work

Under Rehabilitation

Acute Stage

Job Seeking

N: 439

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SOCSO RTW StatisticsSOCSO RTW Statistics

Cases Based on the RTW Hierarchy (Accumulated 2007-2008)

47%

8%

16%

2%

3%

24%

Same Job Same Employer

Similar Job Same Employer

Different Job Same Employer

Same Job Different Employer

Similar Job Dif ferent Employer

Different Job Dif ferent Employer

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CASES ACCORDING TO INJURY CASES ACCORDING TO INJURY

OR DISEASESOR DISEASES

No. of Cases According to Injury/Diseases

8%1%

19%

28%3%

30%

8%

0%

3%

Head

Neck

Trunk/Back

Upper Limb

Multiple Locations

Lower Limb

General Injuries

Unspecified Location Injury

Psikologi

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SUCCESSFUL CASESSUCCESSFUL CASES

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SUCCESSFUL CASESSUCCESSFUL CASES

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SUCCESSFUL CASESSUCCESSFUL CASES

SELF EMPLOYED

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Some of the Successful CasesSome of the Successful Cases

AMBUCHELVAM AL

SINGARAN, 35 YEARS OLD.

DIAGNOSIS: STROKE WITH

DIABETIS AND

HYPERTENSION

STATUS: CLAIMING

INVALIDITY BUT REJECTED

RETURN TO WORK WITH THE

SAME EMPLOYER DOING HIS

PRE-INJURY DUTIES

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Some of the Successful CasesSome of the Successful Cases

INSURED PERSON: SELVAM

AL APPANAN

DIAGNOSIS: RIGHT ANKLE

FRACTURE

STATUS: TEMPORARY

DISABILITY

RETURN TO HIS PRE-INJURY

DUTIES WITH THE SAME

EMPLOYER AT PALM OLEO

SDN BHD.

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ConclusionConclusion

““Disability is God given but Disability is God given but

handicap is manhandicap is man--mademade””

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ConclusionConclusion�� This ReturnThis Return--ToTo--Work Work ProgrammeProgramme with the collaboration of with the collaboration of

all the parties, will ensure that the Insured Persons in particuall the parties, will ensure that the Insured Persons in particular lar and the Malaysian Workforce in general will achieve the and the Malaysian Workforce in general will achieve the following:following:

�� Competitive and healthy workforce. Competitive and healthy workforce.

�� Maximization of MalaysiaMaximization of Malaysia’’s human resource potential.s human resource potential.

�� Increase productivity at work place.Increase productivity at work place.

�� Improves MalaysiaImproves Malaysia’’s economy by reducing the downtime.s economy by reducing the downtime.

By 2020, Malaysia will be a developed nation with great human caBy 2020, Malaysia will be a developed nation with great human capital pital value.value.

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GayathriGayathri VadivelVadivel

03 03 -- 4264 55044264 5504

gayathri.vad@perkeso.gov.mygayathri.vad@perkeso.gov.my