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CPP Disability Reconsideration Appeal: 7 Mistakes to Avoid

By David Brannen

So, Service Canada has denied your application for CPP disability benefits. You have received the letter from them and it says you can appeal by requesting a reconsideration. 

You can either hire someone to help you with your appeal or do it on your own. I have previously written a guide to doing your own CPP reconsideration appeal — you can check that out here:
How to do a CPP Disability Reconsideration Appeal [Guide + Sample Letter].

If you decide to appeal on your own, it is critical that you’re aware of the 7 most common mistakes people make when they don’t have a competent representative or lawyer.

This article is also part of our Ultimate Guide to CPP Disability.

Mistake 1:  Missing the deadline to appeal 

Missing the deadline to appeal is perhaps the most common mistake we see people make. Once you receive the letter denying your application, you only have 90 days to request your appeal

Additionally, there are rules for how you need to request the appeal; you are required to request your appeal in writing before the 90 days are over. 

We see lots of people wait to request the appeal until they have all of their supporting documents together. If it takes a long time to receive the medical file or report, this can cause you to send the appeal in at the last minute or to inadvertently miss the deadline. 

You can avoid missing the deadline by requesting a reconsideration appeal immediately after you get the denial letter from Service Canada. Do this in writing using the form provided. Then, attach a cover letter to the form to explain that you are in the process of gathering more documents to support the appeal. Ask that they hold off on making a decision until you forward those documents. 

Once you have made a proper request for reconsideration, the 90-day deadline no longer applies. You should still try to get the rest of your documents and information to them before 90 days pass, but Service Canada won’t have a problem if you need a bit more time. However, if you do pass the 90 days, you will need to demonstrate to them that you are working in good faith to get more documents and not just procrastinating the appeal. If they feel you are dragging your feet and not working in good faith to get more information to them, they can make a decision on the information they have on file.

Mistake 2: Not addressing the reasons for denial

Another common mistake is to do your appeal without directly refuting Service Canada’s reasons for denial. In the letter, Service Canada will usually give you the reasons why they denied your application. The easiest way to appeal is to respond to those reasons head-on. Many people will just ask their doctor to write another letter without directing the doctor to speak to the reasons. Others might have the doctor speak to the reasons for denial when some of these reasons are not medical in nature. 

The best practice is to list out the reasons for denial — a physical, numbered list — and then gather new information, records or medical opinions to rebut each of the reasons. Once you gather any evidence, the best place for you to refute each reason for denial is in a letter you send to Service Canada as part of your appeal. 

Mistake 3: Not addressing the weakness of your case

We all have blind spots to our own problems or weaknesses. Most people don’t have the level of self awareness needed to identify and address the personal shortcomings that might have caused a denial of benefits. It is hard to be objective with your own situation. This problem is not just limited to disability claimants — it applies to anyone who represents themselves, including lawyers! This is why the courts frown upon lawyers who try to represent themselves, friends or family members.

Identifying and addressing the weaknesses with our clients’ claims is one of the most important things we do when taking over the appeals. The most common case weaknesses are facts that support the argument that you didn’t do all you could to to stay at work or to engage in recommended medical treatment. These weaknesses get overlooked because most people believe they did all they could, or have excuses for why they didn’t follow certain medical recommendations. 

Mistake 4: Not understanding the late applications and minimum qualifying period rules

Not understanding your minimum qualifying period (MQP) or whether your claim is considered a “late application” is a common mistake that results in denial. 

Not everyone who has paid into CPP can qualify for CPP disability benefits. To qualify, you must have made the minimum contributions to CPP in 4 of the 6 years leading up to your date of disability onset. This period of 4 of 6 years is known as your minimum qualifying period. This is a bit of an oversimplification; if you want a more nuanced explanation, please see our article and video about the MQP:
CPP Disability Minimum Qualifying Period Explained [+Video]

If you have been off work for over two years and are just beginning to apply for CPP disability, then you will likely have to apply under the “late application” provision. This simply means that your minimum qualifying period has expired — but you can still win approval of benefits by showing your disability onset happened before your minimum qualifying period ended. 

The problem is that most people focus on proving their disability as of the current day (after the MQP has expired) and don’t present evidence to prove the disability onset happened during their MQP. If you are dealing with a late application, I strongly suggest you hire a lawyer. Late application cases are difficult and you can lose a winnable case for technical reasons.

Mistake 5: Not providing adequate medical evidence to support your claim

CPP disability claims are approved by decision-makers. For a reconsideration appeal, the decision-maker is a nurse medical adjudicator who works for Service Canada. Medical adjudicators are required to follow the CPP medical adjudication framework. This framework requires the adjudicator to make decisions based on medical evidence. They cannot rely only on the claimant’s own statements about their medical condition, symptoms, and disability.

A common error is to not provide the right medical evidence to support the appeal. This can happen if you don’t provide any supporting medical evidence, or simply provide the wrong type of evidence. When we take over an appeal for a client, we almost always have to obtain more medical evidence to support the appeal. Common examples of medical evidence include medical reports that answer specific questions; rehabilitation program records; pharmacy records; or medical records from doctors or other health professionals.

The specific medical evidence required is different from case to case; there is no one-size-fits-all approach. To determine what medical evidence is needed, we typically examine the CPP disability application, the claim file from Service Canada, the existing evidence you have provided, and a list of all your doctors and other treatment providers. If you’re attempting your own appeal, you will have to start by examining these sources as well. 

Mistake 6: Making the wrong type of written submissions

Doing written submissions is the most difficult part of the appeal. Written advocacy is a skill-intensive process and most people have no experience or training. 

As a general rule for people representing themselves, less is more when it comes to written submissions. If you find yourself writing more than five double-spaced pages of written submissions or legal arguments, then you are likely going too far.

The danger with writing too much is that you focus on your own testimony and not enough on the evidence that supports your claim. Or, you might focus too much on appealing to emotions rather than making legal arguments by applying the facts to the law.

Mistake 7: Not cooperating with the medical adjudicator

If you are representing yourself, you have to cooperate with requests from the medical adjudicator who is doing your reconsideration appeal. After you have sent in all documents for your appeal, it is common for medical adjudicators to reach out to you for more information. They might want to interview you on the phone or write to your doctors or employers for more information. 

We encounter plenty of people who don’t want to cooperate with these requests on grounds of privacy concerns or because they feel like the adjudicator will be working against them. 

We encourage anyone who is representing themselves to fully cooperate with all requests from the medical adjudicator. In our experience, medical adjudicators are trying to do the right thing and are not cynically trying to build a case against you. Often, their requests for more information can help them get the right documents to support an approval of your claim. On the other hand, if you don’t cooperate with them, it will most certainly result in ongoing denials. 

Next Steps 

Now that you know the 7 most common mistakes, you can move forward with confidence representing yourself. 

If you'd like to feel even more confident, you can download our free CPP Disability Appeal Checklist by clicking below. It outlines the exact steps we take when representing a client in this type of appeal. We hope sharing our process will help you along your journey. 

 

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Tags: CPP Disability

David Brannen
Founder & Managing Lawyer, Resolute Legal
As Resolute Legal's managing lawyer, David spends his days representing people with disability claims and overseeing other disability lawyers within the firm. David is a former occupational therapist and is one of the few lawyers in Canada who focus exclusively on disability-related claims. David is the author of A Beginner's Guide to Disability Insurance Claims in Canada and The Beginner's Guide to CPP Disability.