Transferable Skills Analysis

Hello, I am POA for a family member receiving LTIP benefits. Date of disability or “qualifying date” was determined to be July 2018. The insurance company demanded he apply for CPP Disability, which he has done. As soon as the application was sent to CPP, the insurance company sent a lengthy questionnaire with a cover letter advising of a policy change effective July 2020. I inquired and they advised that they would be doing a Transferable Skills Analysis (TSA), reevaluating and coming to a COD (Change of Definition) decision by April 2020.
Does anyone have experience with the TSA that they can share? Also, I am suspicious that they need 8 months to do this. Why are they sending a questionnaire now for a decision they plan to arrive at in April 2020?

I don’t have experience so I am guessing.
If the person is awarded CPPD then the chance of being approved past COD is greater OR winning a lawsuit is greater,
CPPD takes 4+ months for a decision so the insurance company probably wants that first decision before they decide on after the COD.
Maybe they send the TSA questionnaire to everyone.

A transferable skills analysis is frequently used to assess the ability of a claimant to perform “substantial gainful work activity” given their RFC (Residual Functional Capacity).

Transfer of skills involves an assessment of skills that a person used on one job which can be interchanged or substituted into another job and is used to determine the employability of the person. Skills are learned by doing. In the context of Disability, transferable skills are defined as the assessment of work functions acquired from performance of skilled or semi-skilled jobs which can be applied to meet the requirements of other skilled or semi-skilled jobs

They are looking to see if your family member is capable of doing another type of occupation that they are reasonably qualified for.

Since you are using the term LTIP, Long Term Income Protection, I am guessing your loved one is a Public Sector employee - perhaps an employee of the Ontario Government. If that’s the case, then the insurance company is simply an “administrator” of the LTIP plan - the insurance company processes the paperwork and applies their professional adjudication knowledge and processes. Actually, a huge number of people collecting “long term disability” probably belong to the type of disability plans like those offered by the Ontario government, Federal government, BC Health Benefits Trust, Edmonton Transit, etc., etc., etc., where the insurance company does not “insure” the plan. The insurance company does not hold a financial reserve on their financial books to cover the cost of future claims. They have no motivation to cut people off to make a profit. The insurance company will not pay anyone with this kind of administrative/hybrid “disability plan” a “lump sum” to get them off their books. The insurance company is simply hired to administer these plans and their motivation is to administer the plan according to the plan, otherwise they will be subject to lawsuits from major stakeholders with deep pockets like the employers/unions who hired them to do it properly. The employer, association, current plan members, existing trust, and/or union are the ones actually paying for the monthly benefits of current claimants. The plans are more nuanced than I’ve documented, but hopefully I’ve communicated the concept.

How do you know if you have one of these plans? Look at your booklet or website. It usually says somewhere this is not insurance. It talks about a “trust”. If you see things like “joint benefits review committee”, this is a good thing. It means that the insurance company really has little power to make a final decision on your destiny. A committee of medical professionals review your claim and there is a formal process you can request. It is NOT the “internal insurance company review”. It is entirely different and, of course, lawyers don’t talk about it because they don’t typically become involved in the same way. You can call your contact at your employer and clarify the plan arrangements with them.

Getting back to the transferrable Skills Analysis (TSA). I believe this timing and process as you described above is completely normal. It might sound useless, especially if your loved one is very incapacitated, but contractually the “insurance administrator/carrier” is likely required to have every claimant fill out this questionnaire. Collecting the inventory of your current skills, capabilities, knowledge and experience at this point is very good timing for your self analysis and to allow specialized analysts to review and work with you to focus on what you “can do”. Some people may think of it as tactic to gather evidence to “force you to work at a demeaning job at low pay” … Perhaps that might happen, but that is unlikely and the opposite could happen if you look at it as creating the picture of what the new me with my current skills/limitations have to offer/sell.

Requiring a claimant to apply for CPP Disability benefits is standard and normal.

Please don’t believe all the horror stories you read about on the internet or in newspapers which give the impression that all processes are sinister and negative outcomes are inevitable. I really feel for people suffering from misinformation unnecessarily.

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I echo Joanne’s comments above. Completely normal. These TSAs are usually done near the 6 months before the end of the 2 year own occupation period.

I had the same experience. They sent me a letter 9-10 month in advance stating that there will be change of definition. Also when I requested my file a year later there was a transferable skills analysis included. Basically TSA stated that my skills are transferable to another occupation as long as I have no limitations. Meaning I can do another job but the symptoms that I have are preventing me from doing it. The person who did a TSA also included different job posting that I would be able to do. This is not something uncommon. Just continue your treatment. Talk more about your symptoms with doctor so he/she records everything.

Also I used this TSA when I applied for CPP disability.

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