Pascale Mapleston of The Benefit Code tells HR leaders at HRFest that quarterly claims reviews can flag workforce health problems before they escalate
Pascale Mapleston, Toronto-based founder and CEO of the Benefit Code, believes competing demands of employee welfare and budget discipline force benefits leaders to fight for attention at the leadership table.
She argues that claims data is the tool that can address that very issue.
“Benefits connect all of your ambitions. They are your secret weapon for building influence, and the data within your benefit plan is like your fingerprint,” she said. “Every organization has a different fingerprint, and that’s based on the actual claims that you’re making, whether it’s disability claims or trends with mental health claims, anxiety, sleep.”
TELUS Health’s Mental Health Index released in March 2025 found that 45 per cent of Canadian employees said they’re satisfied with their employer’s benefits plan but more than half see room for improvement.
These findings underscored one of the opening sessions for plan sponsors and HR leaders at this year’s HRFest held on Nov. 10 and 11 in downtown Toronto.
How to bring benefits data to the C-suite table
According to Mapleston, too few HR and benefits professionals are requesting the right information from their carriers and plan administrators – and fewer still are doing it on a quarterly basis. She urged plan sponsors to stop waiting for annual renewals to examine what their data reveals. Drug Information Number (DIN) breakdowns, disability trend lines and extended health utilization rates all point toward workforce problems that can be addressed before they escalate into costly claims or cultural breakdowns.
“Instead of asking, ‘Can you send us the data?’ You might want to try saying ‘We are trying to understand what if this area of concern is changing from last year’,” she said, emphasizing the key is to lead with a specific question, like whether mental health claims are shifting quarter over quarter, whether sleep disorder or anxiety DINs are climbing year on year, or where the largest cost drivers sit across extended health, dental and drug spends.
“It helps to make the request specific,” she said. “If we're keeping an eye on the prize in terms of what was paid out last year with a high-functioning claim team, and then what's being paid out this year, that difference can lead us down that kind of garden path per se in terms of keeping an eye on a changing organization.”
What the claims data can tell sponsors
To that end, she links data to the benefits plan. Mapleston pointed out that workplace stress follows a predictable pattern, highlighting how leadership turnover, layoffs and economic shifts can all create pressure points that show up in claims data before they show up in disability filings or resignations.
The stress arrives first, she said, and the clinical consequences trail behind it. She drew a parallel with the early stages of the pandemic, when employees appeared to cope before mental health issues surfaced weeks and months later. She suggests claims data follows the same lag.
“That can all be driven ahead of disability claims or extended leaves by watching the claims data,” she said, emphasizing plan sponsors who track DIN volumes and mental health trends year over year can spot a bump in anxiety or pain medication claims early enough to intervene – through management training, team-level conversations or targeted programs – before absenteeism rises and culture erodes.
“If you’re starting to see a bump up in claims, especially on the mental health side, the chronic health, even pain meds, that’s when you start creeping out those programs ahead of the disabilities, ahead of the absenteeism, or even protecting your precious culture,” Mapleston added.
Claims data, engagement surveys tell the same story
She also drew a direct line between claims data and engagement surveys, arguing that the two almost always tell the same story.
“We’ve never seen a survey that didn’t match the drug usage within the organization,” she said, noting that in some cases, the claims data moves first. She cited one organization where short-term disability filings jumped from roughly three per year to 16 in a single year while drug claims had stayed flat. Within a month, the workforce went on strike – a disruption the disability data had already signalled.
“We have never seen a survey that didn’t match the drug claims. A happy workplace equals a happy survey. Sometimes it comes out first in the claims data. The data never lies,” she said.
To that end, Mapleston urged plan sponsors to stop treating claims reviews as an annual exercise tied to renewals. Quarterly is the minimum, she said, because it allows organizations to catch emerging patterns – new large claimants, sudden shifts in mental health or chronic condition trends – before they become structural problems. Waiting for the renewal cycle puts plan sponsors in a reactive position, she said, whereas quarterly data gives them a chance to act while the issue is still manageable.
When claims data reveals a pattern across the workforce, that’s where plan sponsors can build a credible pitch to the C-suite, she said, emphasizing that the format to make the case matters as much as the content.
She pointed to a one-page business plan, which is all the leadership team needs: the identified need, the share of the workforce affected, the proposed rollout and the metrics that will determine whether it is working. She noted that in most cases these proposals turn out to be simple, and many of them carry no cost at all.
“When you’re putting together a request for a change in program, you need to have the reason… What barrier will putting that program in place remove?” she said.
Balancing employee need and plan sustainability
When asked about sending a benefits scorecard directly to employees, rather than keeping it as an internal HR exercise, Mapleston noted it can be a sharper and cheaper alternative to a full engagement survey. She acknowledged how traditional engagement surveys tend to feel cumbersome and resource-heavy, while a simple 1-to-5 scorecard could deliver the same insight with far less overhead.
One suggestion highlighted a scorecard for employees to measure how little or much they know about their benefits plan and what area they would want to investigate first. The areas that could be looked at could consist of mental health, chronic conditions and disability, virtual care, flexible accounts and accessibility and life stage and gender specific health.
“Sometimes many people are asking for support when the budget is just not there. We want to respond to the human need, but we also have to consider a plan that serves as much more of the workforce than just that. If you want to make a change, then you bring your data to the table,” she said.
