Boarding is an outdated term that is still in circulation but legally does not have any meaning. It is a term that people associate with losing their job because they aren’t medically able to do it any more. People associate it with money and sitting at home getting paid. This is a misconception that sets your patient up for failure, failure in your rehabilitation
and failure in returning to work. Boarding’s correct term is Incapacity and this is either due to poor performance or ill health. And there isn’t money linked directly to it. We are physiotherapists – so why should we worry about whether the person loses their job or not. Surely that is out of our scope.
Not true – you as the physiotherapist, are well positioned to influence whether the goals your patient sets are focused on rehabilitating so they can remain employed or focused on chasing the pot of gold that isn’t there. But you need to know your facts and know your place.
So before I explain more about incapacity, let me discuss a few critical concepts.

IMPORTANCE OF WORK

Evidence suggests work is good for health. If someone loses their job they lose their socioeconomic status, their identity, life roles, social contacts and frequently their purpose. The secondary losses can be devastating for the individual and their family, these include depression, anxiety and the burden of dependency on others. The literature shows that unemployment is associated with poorer health outcomes, and an increased risk of suicide.
In a country where unemployment is so high, the larger socioeconomic impact is huge and in many cases avoidable.

WHAT IS EMPLOYMENT?

So where work is for money we cal it employment, so let us understand what employment constitutes. Employment is a contractual arrangement where theemployee agrees to meet the requirements detailed in the job description i.e. if they do A,B and C then in return the employer pays the employee D, an agreed wage, salary etc.

See in the diagram below, reproduced with permission from labour lawyer, Andrew Breetzke. The top line shows that this employment relationship between the employer and the employee, is governed by a number of pieces of legislation.

The line going down perpendicularly indicates that most big employers, but not all employers, as part of the employment package, contribute towards a pension or provident fund.

Pension fund is usually made up of two parts:

  • Retirement annuity
  • Disability Insurance Policy

Should the employee no longer be able to meet those contractual obligations, then their employment could be at risk. And at this point the legislation in the contractual relationship comes into play as well as the rules of the Pension Fund.

PENSION FUND

The employer will from time to time review the Pension Fund contracts and the rules of the fund specific to that contract. As with anything, the more expensive contracts will usually have more benefits than the cheaper options. These fund rules need to be available to all employees. However these rules are complex and are often not well understood by the employee.
In essence, the rules of the fund will determine what, when, how and if anything gets paid from the:

In essence, the rules of the fund will determine what, when, how and if anything gets paid from the:

  • Retirement Annuity
  • Disability Insurance

What is very important to know is that whether any money gets paid out or not, it is not the decision of the doctor, the physio, the OT, the employee or even the employer. Only the fund will make those decisions based on the rules of that specific fund.

RETIREMENT ANNUITY (RA)

When an employer contributes towards a retirement annuity as part of the contractual arrangement, a portion is usually paid also paid from the employee’s salary. If someone loses their job, then this money should be transferred to another fund so that the investment for retirement continues. We all know that the last few years before retirement is when the value really increases significantly.
However, should that money be withdrawn early and not reinvested, not only will it be taxed but it will also mean that they will now not have any investment for retirement.

DISABILITY INSURANCE

The second part of the Pension Fund, is the disability portion. If an application is made to this fund, then it will be evaluated to see if the person meets the criteria of the disability policy. What is important to know is that the fact the person may no longer be able to do their specific job, does not mean that they will be successful in their disability application.

The employee’s / claimant’s skills and functional ability could be transferable to another type of job and therefore they would not not qualify. The fact that there is most likely no such job available, is not the concern of the fund.

Even in cases where the disability is granted, there will be regular re assessments and usually after 2 years, if the person is able to do any job in the open labour market, then the payments will stop. The chances of re-entering the labour market after 2 years is extremely unlikely.

INCAPACITY

If we agree that boarding means losing your job for a medical reason, then we need to use the correct terms as the wrong words create confusion.

When an employee loses his job, there must always be a process that happens before the final decision is made.

There are 3 possible reasons for dismissal:
– Misconduct – e.g. theft
– Operational requirements – e.g. retrenchment because of changes in the business
–  Incapacity – inability of the employee to fulfill the requirements of the job.

Should the employee lose their job due to incapacity, then an application can be made
to the fund to see what will happen regarding their retirement annuity and their
disability policy.

THE PHYSIOTHERAPIST’S ROLE

As a physiotherapist, you have access to information that can determine if your patients inability to perform the physical activities needed for their job, are temporary or permanent.

If the job description is not well documented or the condition or job is complex, then an Occupational Therapist can determine the minimum job requirements and can assess the match of the person to the job.

These are important assessments in the process of temporary or permanent incapacity and also in the assessment of disability. But this is not the purpose of this article. What i am talking about is something more subtle. For your patient’s rehabilitation to be successful you need to understand what success looks like to your patient. If your patient believes that by losing their job they are going to be paid a large sum of money that will solve many of their problems, then you are going to have a hard time getting that patient to contract fully in your treatment program and you are all being set up for failure.

To be able to get your patient to buy into his rehabilitation, you need to understand what your patient believes will happen work and money wise if they are not able to return to work. By making sure you understand the rules at play, you can ask you patient questions to get them thinking and questioning their focus. You are not there in an advisory role and you are not a lawyer, you are simply asking open ended questions to make sure your patient has investigated their assumptions and that they are clear on where they could be headed.

If you can help your patient to understand the benefits of work and the uncertainty of the future if they lose their job, then you may have a patient that invests fully in their rehabilitation. If they do this then the hope is that they can get back to work and continue contributing to their retirement annuity, putting food on their family’s table and again finding purpose in their lives.

ARTICLE WRITTEN BY:

Lindsay Scott
B.Sc. Physiotherapy (UCT)
Founder of Workability Pty Ltd
To find out more about Workability please go to our website or contact Lindsay directly

lindsay.scott@workability.co.za
www.workability.co.za

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