Canada Pension Plan Disability Benefits – What You Need to Know

In a previous post, we mentioned that your LTD insurer, as part of your contract may ask you to apply for CPP Disability Benefits. You might be wondering what this process involves and what to do if your CPP application is initially denied.

Our firm has assisted clients with their CPP Disability Applications and with successfully appealing decisions of the CPP Review Tribunal.

The Application Process:

We will help you right from the beginning, starting with the application. You can find the application online on the Service Canada website. There is an application form, consent forms, a questionnaire form for you and one for your doctor to fill out. When submitting an application, it is very important to make sure that the information provided is accurate and the correct documents are enclosed. Supporting documents must speak to your level of disability and inability to work. Records and medical reports from your family doctor, treatment providers, psychologists, psychiatrists, x-rays, and other diagnostic imaging are examples of documents that can be submitted.

CPP Disability Rules:

According to the Service Canada website, to qualify for CPP Disability Benefits, you must be under 65 years old and meet the following 2 rules:

1. You must have sufficient earnings and contributions:

  • You must have paid into the CPP for at least 4 of the last 6 years, or
  • You must have made valid CPP contributions for at least 25 years including 3 of the last 6 years, or
  • You must have paid into CPP in each year since any previous CPP Disability benefit was cancelled

If you meet the first rule, CPP can then review your medical information to see if you meet rule number 2.

2. You must have a disability that is both severe and prolonged. Severe means you have a mental or physical disability that regularly stops you from doing any type of work (full time, part time or seasonal), not just the work you usually do. Prolonged means that your disability is most likely to be long term and of indefinite duration or is likely to result in death.

What happens after I submit my Application?

If you are eligible to receive benefits, you will receive a letter confirming same. If your application to receive benefits is denied, you are able to submit an appeal, a request for reconsideration.

If you disagree with the decision, you have to request an appeal in writing within 90 days of receiving the decision letter.

What happens if my Application is denied? Can I Appeal the decision?

IF CPP has sent you a decision stating you are not eligible for benefits as you do not meet the criteria for Rule 1 or Rule 2, you can submit an appeal. If you have legal representation, you can authorize your lawyer to do so on your behalf.

If you disagree with the decision, you have to request an appeal in writing within 90 days of receiving the decision letter.

In your request, you have to include the following items:

  1. Your name, current address, telephone number, social insurance number;
  2. An explanation of why you are asking CPP to reconsider its decision;
  3. Any new medical information that could affect the decision; and
  4. Your signature and the date

The average time it takes for CPP to reconsider its decision is 3 months. Sometimes it can take longer as additional information may be requested.

If you do not reach the desired result after appealing this decision, you can appeal again to the Office of the Commissioner of Review Tribunals (OCRT), within 90 days of receiving the decision from Service Canada. You will then be contacted by the Tribunal staff and a hearing will be arranged before a 3 member Review Tribunal (these parties are not members of Service Canada). As above, send any new medical information to the OCRT in advance of the hearing.

If you are unhappy with the decision of the Review Tribunal, you can request permission to appeal to the next level, being the Pension Appeals Board, within 90 days of receiving the decision from the OCRT. You have to receive permission from the PAB before you are able to have your case heard. This is the highest level you can appeal to. You can however submit the decision to for a judicial review, within 30 days of receiving the decision to have the court review if the decision process was conducted in a fair manner.

If you are in the process of applying for CPP Disability Benefits, if your LTD insurer has asked you to apply for these benefits, or you need help during this process, please contact our firm and we can guide you through this process.

 

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