32.66 In 1996, we indicated in our chapter that the Department did not conduct sufficient reassessments of Disability files and that it should more clearly flag cases

to be reviewed.

32.67 The Department has significantly increased the number of reassessments since 1996. In the past three years, it has conducted 36,600 reassessments of Disability cases and terminated benefits in 8,300 cases. According to the data for the last three years, the Department reassesses the files of approximately four percent of the Disability benefit beneficiary population each year. An analysis of cease rates, by type of reassessment conducted, indicates that the Department is doing well in its selection of files for reassessment and gives priority to cases that have the highest probability of no longer being eligible for benefits.

32.68 The Department has advised us that the effort to decentralize the reassessment work in the regions will result in a temporary reduction in the number of reassessments conducted. Experienced assessors will have to devote time to training their colleagues in the regions, which means that they will have that much less time to conduct reassessments. As a result, the Department expects to be able to conduct only 8,000 reassessments in 1999-2000. We have further noted that the number of reassessments has declined in each of the last three years, dropping from 14,000 in 1996-1997 to 11,800 in 1997-1998, then to 10,700 in 1998-1999.

32.69 We acknowledge that the Department's current efforts to regionalize reassessment are an investment in the long-term success of the reassessment program. Nevertheless, we urge the Department to not allow too great a decline in the number of reassessments conducted each year; this will help the Department to ensure that it can identify, within a reasonable period of time, those beneficiaries who are no longer eligible for benefits, and to avoid a major backlog of work.

17.88 In the context in which the concept of severe and prolonged disability is defined in a broader sense, reassessment needs to be an integral part of the control process. Tighter control on the quality of decisions and greater emphasis on operational controls, such as reassessment, would reduce the risk of paying benefits to persons no longer eligible.

17.89 Reassessment consists of monitoring and reviewing those files of beneficiaries who may no longer meet eligibility criteria. Monitoring is exercised on a file flagged for reassessment when the application is accepted. When the assessor deems there to be a strong probability that the beneficiary may eventually regain the capacity to work, the appropriate time for reassessment is entered in the file. Control and detection are done by other methods (for example, checking Revenue Canada's record of earnings, complaint from a third party, identification of specific characteristics, a link with another program or other sources of information). Verification of information received from the beneficiary may also be used in reassessment. "Return to work" notices are submitted voluntarily by the beneficiary and indicate to the Minister that a return to work has occurred. Exhibit 17.12 shows the results of reassessment.

17.90 Over the years, the number of Disability beneficiaries has risen considerably, to such an extent that, in the mid-1980s, it was necessary to cut back on reassessments as most resources were assigned to processing applications. During that period, only urgent cases were reassessed. In our 1993 Report, we concluded that the Department's reassessment activities were inadequate. Since our 1993 Report, the Department has taken steps to improve its reassessment program by dedicating additional resources, developing a new computer system, undertaking staff training, implementing an integrated communications strategy and

expanding reassessment resources for future years. Although a reassessment unit was established, the results obtained indicate that the number of benefit terminations

was no greater than in preceding years. Exhibit 17.13 illustrates the benefit termination trend for the past 20 years due to recovery of the capacity to work.

17.91 Beneficiaries who have a reasonable chance to improve medically are identified for subsequent reassessment at the time the application is accepted. However,

most of these cases are never reviewed. Over the past three years, the staff have reviewed 1,575 beneficiary files previously flagged. While the Department cannot

determine the exact number of files originally flagged, it estimates that thousands of prescheduled reassessments have not been processed on time due to the fact that

system problems have prevented CPP administration from identifying those cases. The Department does not give high priority to this type of reassessment,

concentrating its efforts instead on handling "return to work" cases. Thus, it appears that important information gathered from the initial adjudicators is almost lost in

the process. Exhibit 17.14 illustrates a case where the information obtained at the time the application for benefits was accepted was not properly used.

17.92 Some control and detection methods to identify ineligible beneficiaries are still being tested. It is difficult to draw conclusions from the results obtained to date

on the real potential for future savings. Very few reassessments of this type have been done. If we exclude the "return to work" notices and prescheduled

reassessments, only 6,114 reassessments were done over a three-year period.

17.93 Checking the income reported in the beneficiaries' record of earnings is the method most commonly used by CPP administration in its control and detection

reassessments. Based on examination of files for this type of reassessment, we found that better follow-up (average processing time at present is 15 months once

earnings have been identified) combined with improved flagging of files would reduce the workload and increase the success rate. Exhibit 17.15 illustrates an

example of delays experienced.

17.94 Since 1993, reassessment has focussed on "return to work" notices and development of a computerized system designed to improve the capacity for analyzing

client characteristics. The project has enabled the Department to acquire new tools for improving its reassessment methods and increasing its knowledge. Although

the system appears promising, it will be useful only to the extent that it is able to identify high-risk cases.

17.95 Close to half of the reassessments done over the past three years refer to "return to work" notices. Because beneficiaries voluntarily submitted the information,

the savings resulting from these cases are unrelated to any monitoring, detection or control efforts by the Department. The total potential savings, as of March 1996,

were estimated at $52 million, of which $45 million is attributable to cases involving "return to work".

17.96 New measures to reduce disincentives to work, introduced by the Department in 1995, modify the continuous eligibility criteria. We believe that this policy

directive reflects some of the realities faced by disabled persons trying to re-enter the labour market. One of these measures is to maintain benefits for three months

after the individual returns to work. However, the three-month eligibility extension is not consistent with the Act, which defines a severe disability as one where a

person is incapable regularly of pursuing a substantially gainful occupation. This policy directive establishes a new fundamental design feature for the reassessment

function. The impact of this policy directive has not been determined.

17.97 We found that the approach of some organizations in the private sector to reassessment is far more proactive. Exhibit 17.16 describes the approach, which

consists of a follow-up of all files where potential for improvement in the situation exists. Those files are generally identified at the initial application. Beneficiaries

deemed to have a long-term disability must, at regular intervals, submit a statement of continued eligibility; other beneficiaries are followed up until they return to the

labour force. To adopt such an approach would require a cost/benefit analysis, as additional administrative costs as well as a decrease in program costs may be

expected.

17.98 Reassessment remains an essential tool for confirming eligibility. It must be as effective as possible, especially in a context in which the number of clients is

rising and activities are being decentralized. Few beneficiaries have in fact been reassessed. More than 160,000 new cases have been accepted over the past three

years. The total number of active cases is actually 300,000 and only 14,685 have been reassessed over the last three years. It is difficult to determine how many

reassessments should be done until the Department has a better understanding of the clientele profile.

17.99 The reassessment project initiated in 1993 has not yet demonstrated that it would enable the Department to control continued eligibility of all beneficiaries.

Most of the prescheduled reassessments are rarely done. Many beneficiaries escape reassessment because of shortcomings in follow-up and in the flagging and

selection of files to be reviewed. Our concerns include the low profile of this activity and the possibility that some clients do not notify the Department when they

return to work or when their health improves. The risks are high that large sums of money are paid to beneficiaries who no longer meet the Plan's eligibility criteria.

17.100 The Department should:

provide follow-up based primarily on information collected at the time an application is accepted;

conduct more reassessments and clearly flag the cases to be reviewed; and

heighten the visibility of reassessment as an element of eligibility control.

A recent Treasury Board submission has secured additional resources to enhance the reassessment activities.