CASE STUDY 1 | CASE STUDY 2 | CASE STUDY 3 | CASE STUDY 4 | CASE STUDY 5

CASE STUDY 1

Costly Ill-health Retirement avoided after Occupational Health Intervention

Background

	Senior insurance manager aged 52. Thirty years service. Salary - £60,000 pa.
	Quality worker, innovative, excellent reports.
	Company does not have an in-house occupational health service.

Presenting Symptoms at Work

	Sudden inability to write reports (first work related symptom noted in January 1998).
	Resulted in sickness absence due to depression.
	Referred to an occupational physician [OP].

Occupational Health Physician noted the following

	Constant travel away from home during the week.
	Divorcing wife – but living in the same house at weekends.
	Annual senior management medicals revealed a three-year history of alcohol misuse.
	4-month absence from work with depression in previous year.
	Company offered him EAP Help Line.
	Employee referred to clinical psychologist following senior management medical.

Employer's Viewpoint

	Employee being considered for ill-health retirement.
	Costs of ill-health retirement:
	6 months on full pay	£30,000
	6 months on half pay	£15,000
	Enhanced immediate pension	£40,000 pa (+ increases)
	Costs of paying enhanced immediate pension	£400,000
	Replacement and disruption costs	£10,000

Occupational Health Intervention

	Referral by occupational physician to psychiatrist and clinical psychologist to treat depression and provide better coping strategies for employee. Private Medical Insurance covered the referrals.
	Rehabilitated back to work within 6 months.

Outcome

	Self-confidence and self-esteem restored.
	Employee returned to full productivity with the help of an assistant.
	Fully functional in job within two months of return to work.

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CASE STUDY 2

Permanent Health Insurance Claim Reinstated: able to undertake Other Work

Background

	37-year old investment banker, working in emerging markets.
	Employee perfectionist by nature - liked control.
	Suffered from irritable bowel syndrome.
	Employee became stressed due to work related pressures.
	Covered by Permanent Health Insurance [Permanent Health Insurance] for employees with absence of more than 26 weeks.

Presenting Symptoms at work

	Downturn in the market: difficulty achieving targets.
	Started to have trouble with bowel condition and become stressed; panic attacks at the railway station and when dressing for work.
	Corporate culture discouraged admission of any ill health for fear of not getting bonus.
	Stayed at work coping with symptoms for 5 more months: after getting bonus, went off sick.

Employer's and Employee’s Viewpoints

	Employer’s application for Permanent Health Insurance disallowed despite letter from gastroenterologist and psychiatrist.
	Employee had panic attacks and subsequently could not communicate directly with employer. Since she felt she had a genuine illness, was upset at denial of Permanent Health Insurance.
	Her boss initially demonstrated a caring attitude about her ill health.

Occupational Health Intervention

	Occupational physician liaised with GP, psychiatrist and gastroenterologist.
	Report by occupational physician sent to Permanent Health Insurance provider and Permanent Health Insurance then reinstated.
	Close liaison continued between GP, occupational physician and psychiatrist (using cognitive therapy).
	Four months allowed to review progress of interventions and decide the employee's future fitness for work.

Outcome

	Likely to be fit for work - but not for her current job.
	Permanent Health Insurance provider confirmed financial package for employee, enabling employer to terminate employment whilst allowing employee the opportunity to undertake other appropriate work.

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CASE STUDY 3

Managed Return to Full-Time Work following Stress-related Sickness Absence

Background:

	Call centre employee age 42. Married with husband on shift work and a son of 18 with severe acne.
	Change in business activities.
	Good at job - always willing to do extra hours to help out.
	Employee acutely anxious about son's acne causing him social stigma.
	Covered by Private Medical Insurance.

Presenting Symptoms at Work

	Sickness absence for one month with 'stress'. Given antidepressants by GP.
	Unable to drive car due to loss of confidence.

Employer's Viewpoint

	Occupational physician asked to assess the employee.
	Manager focused on business targets and was relieved that someone else was dealing with the problem. Wanted to know when the employee would return to work and what work she would be fit to do.
	Manager was supportive.

Occupational Health Intervention

	Occupational physician liaised with GP and obtained agreement to refer the employee to a psychiatrist for cognitive therapy.
	Psychiatrist arranged for the son to be seen by another psychiatrist for his condition.
	Employee started to return to work three half days/week; given the least stressful calls.
	Employee set personal targets for increasing the number of calls she was able to handle every day.
	Employee progressed to working three full days/week before deciding when she felt able to return to full time work.

Outcome

Returned to work full time.

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CASE STUDY 4

Depression/Anxiety from Travelling: No Pre-employment Health Assessment

Background

	Customer Support Engineer aged 32. Salary - £48,000 pa.
	On call 24 hours (pager).
	A lot of travelling (Middle East) and confrontation with dissatisfied customers.
	Employer had no procedure in place for pre-employment assessment of a candidate’s fitness for the job.

Presenting symptoms at work

	Inability to meet required hours.
	Anxiety when travelling by airplane.
	Resulted in 7 months sickness absence due to depression and anxiety.

Employer’s Viewpoint

	After working for only 2 months, employee absent from work due to sickness.
	Employee covered by Permanent Health Insurance after 6 months sickness absence.

Occupational Health Intervention

	Occupational physician assessed employee and noted that he:
	(a) Suffered with depression and anxiety as a teenager;
	(b) Left previous job due to stress of travel to and from workplace;
	(c) Had a history of several years with anxiety related to travel.
	Referred by occupational physician to a psychiatrist for assessment with the consent of GP.

Outcome

	Employee Received Permanent Health Insurance after 9 months in employment, although having only worked for 2 months.
	Company incurred unexpected costs due to hiring an employee who was not fit for the job.
	Company continued to be at risk of employing staff who were unfit for the job by still not introducing pre-employment health assessments.

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CASE STUDY 5

Successful Return to Work 4 Days/week after Inability to Cope and Depression

Background

35-year-old executive assistant to VP with four years service.

Family

	Left school at 16, married at 19 years of age and had 2 children aged 14 and 10.
	Returned to work when youngest child was 6 months old.
	Husband’s business failed 5 years previously, at which time both she and her husband had depressive episodes.

Changes at work

	Did not want a ‘career’, but her boss was promoted to VP and gave her a bigger job.
	Her new role included new projects with increased workload, additional pressures, and managerial responsibilities.

Events leading up to inability to cope

	Declining support from her parents who had recently retired and moved away.
	Regularly visiting her husband in hospital after working a 10-hour day.
	Cancelling a business meeting in Paris due to her husband’s condition: then working from home to catch up on workload on the day before her holiday.
	Returning from holiday to 270 emails, as well as uncertainty about the status of the plans for an offsite meeting which she and a colleague were responsible for planning.
	Working from home the next day at which point she felt unable to cope, culminating in a panic attack for which she was medically treated.

Occupational Health Intervention

	Seen by occupational physician who referred her privately to a consultant psychiatrist.
	Initially treated as an outpatient, but eventually admitted for treatment for 3½ weeks as husband also became depressed at this time.
	Occupational physician liaised with consultant psychiatrist and psychologist to monitor condition and to determine when employee would be fit to be rehabilitated back to work.

Outcome

	After 6 months’ sickness absence, employee was rehabilitated back to work part-time with no management responsibilities.
	Employee improved her ability to manage pressures, and also recognised her limitations.
	She asked to be placed in a position with no management responsibilities, and requested a 4-day working week.
	She successfully returned to work 4 days a week.

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