Canada Pension Plan – Disability

What is Canada Pension Plan – Disability?

If you have worked for some time, it is likely that you have contributed through your employer or at year end tax time to CPP.  For most of us, this is supposed to help us with our retirement.  However, CPP also offers a program for people who become “severely disabled” before they retire.  This program is only for those who have contributed enough over the years (and there are specific rules for how these years are counted and how “drop out” periods are dealt with, such as years you might have spent at home raising children).  The amount received is tied to how much has been paid into the program by the person making the application.

To qualify, your mental or physical disability has to be “severe” and “prolonged”, which means it is more difficult to get accepted for CPP-D than it might be for some other benefits, such as ODSP.  For CPP-D, you can receive full benefits, regardless of how much money you have or assets.  However, your payments are limited by your contributions by law, and it does not include benefits, such as drug coverage, glasses and dental care.  You can also live anywhere in Canada with CPP-D benefits (sometimes even other countries).  However, “severe” means that your disability prevents you from regularly working in ANY remunerative employment, regardless of what type of job it might be.  If you worked in a white collar job, and now with your disability you are only able to do a part-time light housekeeping job, you still won’t qualify.  While your age, education, and certain other factors do count, they do not outweigh the medical evidence you have for your disability.  “Prolongued” means that your disability is long continuing (likely permanent or long standing) or will likely result in your death (e.g. terminal cancer).

How Do I Apply for CPP-D Benefits?

You can call the Toll Free number on the Service Canada site or you can obtain an application from any Service Canada location.  You must be able to verify your identity, etc. with certain documentary requirements.  With your SIN number, Service Canada can track down your contributions to determine that you have paid enough into the system to be able to make a claim.  Once that is determined, the CPP-D Application is divided into two parts: one for you to fill out, and the other for your doctor to fill out.  With your application, you should attach as many medical records as you have that help point to the severity of your condition and your inability to work.  You must also show how you have tried to continue to work or to find other work that is “lighter duty”.  After your package is completed, send it to your nearest regional office (listed in the CPP-D package) and wait.

What happens if I am turned down for CPP-D Benefits?

Your first denial will come from Service Canada.  You need to reply within a certain time frame by sending any new medical information and arguments as to why you should qualify by a certain date to their Reconsideration Unit.  This is where another reviewer will take a look at your file and with new evidence, determine if they will uphold the original decision or change it.

If you are denied CPP-D Benefits again, your appeal is to the Social Security Tribunal’s General Division.  This is where you fill out a completely different form and start your appeal at the Tribunal level.  Again, the Tribunal is an independent body that includes adjudicators that are not part of Service Canada that made the original decision, and these people are trained in the law that applies to CPP and other federal benefits.  At this point, you should get legal representation as it can be tough to argue your own inability to work as this has to be shown objectively, and meet the definition in the law.

There are different ways the Social Security Tribunal holds its hearings:  videoconferencing, in-person or by telephone.  Your best bet is to have an in-person hearing or one by videoconference, where the adjudicator holding the hearing and you can see and speak to one another in real time.  This way, the adjudicator will be able to observe you, particularly if your disability affects your appearance, the way you walk or your need for assistive devices.  Once this hearing is over, its decision will be mailed to you and your legal representative.  If you are turned down again, your next option is the Social Security Tribunal Appeals Division, which is usually handled in writing and if they find in your favour, they may order a new hearing or just change the decision to deny you benefits.  Hearings before the SST should be attended with a legal representative to improve your chances of getting accepted.

Browne & Associates Legal Services has competent legal representation available for prospective appellants for CPP-D.  We have been handling this for almost twenty years.