Are you considering applying for Canada Pension Plan (CPP) disability benefits? This article shows you the step-by-step process to prepare an application.
As a disability claim lawyer, I recommend that you consider doing your initial application for CPP disability benefits on your own, without hiring a lawyer or advocate. Contrary to popular belief, many people are approved for disability benefits on the initial application. If you can get approved on your own, you will save having to pay a lawyer or disability advocate.
In this article I focus on the steps to apply for CPP disability, to learn more about the CPP disability program and the secrets to success, check our Beginner's Guide to CPP Disability, Online Edition.
What’s in This Guide
- Applying for CPP Disability Benefits: An Overview
- Webinar Replay: How to Apply for CPP Disability Benefits
- Your Application in 7 Steps
Step 1: Make sure the time is right to apply for CPP disability benefits
Step 2: Get the Forms to Apply for CPP Disability Benefits
Step 3: Fill out the Application for Disability Form
Step 4: Get Your Doctor to Fill Out the Medical Report Form
Step 5: Prepare a Cover Letter
Step 6: Assemble Your Application Package for CPP Disability Benefits
Step 7: Mail the Application Package to Service Canada
Applying for CPP Disability Benefits: An OVERVIEW
Before we dive into the steps for how to how to apply for CPP disability benefits, I want to give you the big picture.
CPP disability is a program of the Federal Government of Canada. It falls under the authority of the Department of Employment and Social Development Canada. The CPP disability program is administered by Service Canada through offices across Canada.
If you have paid into the Canada Pension Plan, then you may qualify for CPP disability benefits upon becoming unable to work due to an injury, illness or medical condition. If approved, disability benefits are paid to you each month. The average payment for 2018 is $971.23 and the maximum payment is $1,335.83 per month.
You apply for CPP disability benefits by filling out forms and sending them to the appropriate Service Canada processing centre. They will only accept a paper copies of the forms (you can't apply online or email PDF forms). Service Canada will not review your claim until you submit both the application form and the doctor's medical report form.
If Service Canada approves your application, you will get a payment for past benefits owed. You will then also receive a payment each month until age 65 or until you are no longer disabled. If your application is denied, you can appeal the denial within Service Canada. If they deny your application again, then you can have your case decided by a judge with the Social Security Tribunal. The Social Security Tribunal is a type of administrative court that makes final decisions on people's right to payment of CPP disability benefits.
Webinar Replay: How to Apply for CPP Disability Benefits
A Practical Guide to CPP Disability Benefits: Your Application in 7 Steps
Step 1: Make sure it's the right time to apply
It sounds obvious, but you should only apply for CPP disability benefits when there is a chance you could be approved. Therefore, the timing of WHEN you apply can be critical.
Most people who apply for disability benefits have a chronic medical condition that causes them to gradually lose the ability to work over time. With chronic illness people usually don't suddenly lose their ability to work, rather it is a more gradual loss of ability. Things get worse and worse and eventually everyone reaches a breaking point, where they can no longer work. However, before you take a sick leave from your job to apply for CPP disability, you need to make sure you have your ducks in a row:
Have you worked long enough to meet the minimum qualifying period? Before you stop work, you need to make sure you meet the minimum qualifying period for benefits. To qualify for CPP disability, you need to have worked 4 of the last 6 years before you go off on disability, or 3 of 5 years, if you have 25 years or more of contributions. If you don’t meet either of criteria, you may need keep struggling a bit longer until you meet the minimum qualifying period.
Is your medical condition, treatment and disability documented in the medical records?
You will have a much greater chance of having your claim approved, if your medical condition and its effects on your work are well documented in medical records. If you suffer from a chronic condition, it is important that you discuss your difficulties with work with your doctor long before you stop work. Ideally, your medical records will note that your medical condition affects your work and will show the treatment you have undergone to try and remain in the workforce. You need to be able to show you and your doctor tried many treatment options aimed at keeping you in the workforce, but ultimately those efforts proved unsuccessful.
Do you have your doctor's support? It is critical that you don't stop working until your doctor supports your decision to do so. The CPP disability administration will never approve claims for people who do not have the full support of their doctor. Often Service Canada will likely deny your claim even if your doctor supports you. If your doctor is not supportive, or is just neutral, then you have no chance of winning disability benefits.
What do you do if your doctor doesn’t agree that you are unable to work due to disability? This is a difficult situation that you need to handle very carefully. Understand that doctors are humans, and there is a wide range of competence, attitudes, and biases between individual doctors. You have a few options depending on why you believe the doctor is not supportive of of your claim for disability benefits:
- Your doctor needs more convincing. With chronic illness, it is hard to say when it becomes unreasonable for someone to keep working. It is hard for a doctor to know when you cross the line from being reasonably able to work in discomfort to it being unreasonable for you to work. Sometimes, all that is needed is for you to show to the doctor that you have done all you can do to remain employed. A lawyer experienced with disability benefits cases can give you examples of how you can show your doctor that you have done all you can do. There is no dishonesty or trickery involved.
- Your doctor is incompetent or biased. If you truly believe you cannot work much longer, and have taken steps to show your doctor you have done all you can do, and your doctor still doesn’t support you, then you need to get a new doctor.
There is a wide range in competence and attitudes between doctors in Canada. Just because your current doctor doesn’t support you, does not mean your case is hopeless. Doctors may lack an understanding of certain illnesses or conditions, or they may simply be biased or prejudiced against anyone who applies for disability benefits. Such doctors are rare, but I have certainly encountered them in my law practice, and they create problems for their disabled patients. Changing doctors should always be the last resort and only done after you are satisfied that you have really done all you can do to show the doctor you legitimately cannot keep working.
Step 2: Get the CPP Disability forms
You apply for CPP disability sending in a completed Application Form and Medical Report Form. The current version of the CPP Disability Application Form is SC ISP-1151 (2019-01-02). This version of the form was a major update over the form that was used from 2010 to 2018. Make sure you use this new version of the Application Form. The current version of the CPP Disability Medical Report Form is ISP-2519 (2018-10-03).
To have a “complete application”, you need to fill out and submit BOTH the Application Form and the Medical Report Form. You fill out the Application Form and your doctor fills out the Medical Report Form.
Step 3: Fill out the Application Form
Here is what the form looks like:
This Application Form is divided into sections from A to I. Lets review each section:
Section A - Information About You
This is the easiest section. In A1 you fill in your personal information and address. A2 is important because the Quebec Pension Plan differs from the Canada Pension Plan. You can't make applications under both the QPP and the CPP.
Section B - Contributions to the Canada Pension Plan
This section deals with information Service Canada needs to determine your eligibility. If you don't meet the basic requirements for eligibility, the information from this section allows Service Canada figure out if you qualify for any of the exceptions that can increase your eligibility credits, including:
B1 Credit Splitting - this only applies if you are separated or divorced from former spouse;
B2 Pension credits from other country - this only applies if you paid into the national pension plan of another country (e.g., paid into the US Social Security Program while working in US)
B3 Child Rearing Pension Credits - this applies to anyone who was the out of the workforce to raise a child under age 7, and was the primary caregiver for the child.
Take your time to consider if any of these exceptions apply to you. Having additional pension credits from these exceptions can mean the difference from being eligible to apply to lacking the credits to apply.
C - Information about your medical condition(s)
This is perhaps the most important section of the Application. It deals with your medical conditions, medical tests, past and future treatment and a functional assessment of your abilities.
Take special care with C1, which asks when you feel you could no longer work because of your medical condition. Many people will simply put the last day they actually worked, but that is often not the right date to use if you have struggled and been ineffective at work for some time. You need to choose the correct date because it will affect your eligibility for benefits. In other words, choosing the wrong date can result in you being ineligible for benefits, even if you are disabled.
D - Information about your doctor or nurse practitioner
Take the time to make sure you fill out the correct name and contact information for your doctor or nurse practitioner. Often the Service Canada will want to contact your doctor for more information, and if you have errors in this section it can cause delays.
E - Information about your work
Take care will filling out this section, as some answers will almost certainly disqualify you for being approved for benefits. For example, in E1 if you say you have not stopped working completely, this will be a big red flag for Service Canada. You would need to make sure you provide context and explanation for why you are still able to work in a part time capacity. If you are able to work enough to earn $16,000 or more per year, then you will be deemed to be capable of gainful employment, and ineligible for CPP disability benefits.
Section E7 is also very important, but we seem many people get it wrong. It asks if you have ever had to do a lighter job or different type of work. Many people will just say "no", when they should be saying "yes". Think of this question more broadly as being "have you ever had to change how you do your job because of your disability or limitations?" If you are applying for CPP disability, and your disability is from a chronic condition, then the answer to this question is always "Yes". You would have struggled at work for months or years and would have made some changes to your work routine, whether it was "official" or not. Were you getting help from co-workers? Did you stop doing certain job duties or avoid them? Take a lot of time with this section as it is one of the most important sections of the application.
F - Benefits for your Children
Again, the biggest mistake we see people make with this section is rushing and not filling in all the information. Make sure you have your children's social security numbers included. This will be needed for the children to be approved for benefits. So, if your children don't have a social insurance number, then you need get it and put the number on your application.
G - Payment Information
Service Canada only pays by direct deposit, so you need to fill in this information. Make sure you have it correct or it may result in delays in payment or payment processing errors.
H - Consent for Service Canada to obtain personal information
From a legal perspective, this is a very broadly worded consent for release of personal information. Normally, I would never want a client to sign such a broadly worked consent because it could be open for abuse. For example, I would never recommend you sigh such a broad release for an insurance company. However, we have never known Service Canada or its agents to abuse this type of consent for personal information. They have worded it broadly for convenience and expediency, so they can go and get the information they need without having to check back with you on multiple difference consent forms.
I believe you are better served to give Service Canada authority to collect information on your behalf. In our experience, Service Canada's medical adjudicators are objective and use this consent to seek information or documents that would support your claim, rather than to abuse the consent to seek only information to build a case against you. That has never been our experience with CPP medical adjudicators, although I suppose a rogue adjudicator could exist.
Section I -Declaration and Signature
If you are capable of signing your own application, then that is what you should do. This form allows for an authorized representative to sign on your behalf; however, we have experienced very inconsistent treatment of this by various medical adjudicators. Some will insist the ONLY the applicant can sign, even though this is clearly not what is indicated on the form.
Sign the form with a pen, rather than by using an electronic signature. We have attempted to use electronic signatures, with legally compliant certificates of authentication, and they will sometimes still be rejected by some Service Canada offices.
Step 4: Get your doctor to fill out the Medical Report Form
Along with Section C of the Application, the Medical Report is one of the most important parts of your claim for CPP disability benefits. In my experience, many applicants and doctors have the wrong impression about what is needed to create a “good” medical report.
Many people believe that a doctor has to say “the magic words”: “my patient suffers from a severe and prolonged disability” or “my patient is disabled and cannot work”. Anyone who has worked with disability claims with the CPP Program or insurance companies will tell you there are never magic words when it comes to qualifying for disability benefits. Unless the doctor gives reasons and supporting information for his or her conclusion that you are disabled, then the CPP administration will give the opinion very little credit.
A common mistake is for a doctor to write on the Medical Report that you are disabled or suffer a severe and prolonged disability and then write very little supporting information, or give vague statements about your symptoms, impairments and prognosis. This is a recipe for disaster.
Rather than looking for magic words, the CPP adjudicators will look at the totality of your doctor’s information and opinions as it relates to your specific medical condition and impairments. It’s much better that your doctor give comprehensive descriptions of your diagnosis, symptoms, prognosis, physical restrictions, and mental restrictions.
You doctor should explain how your symptoms and impairments would be expected to interfere you you ability to work on a day-after-day basis. Your doctor's opinions must be well supported by medically acceptable clinical and laboratory diagnostic techniques. The better your doctor explains the rationale for his or her opinion that you are disabled, the more likely it is that the CPP adjudicator will accept the opinion.
The Medical Report is the bare minimum medical evidence that you need to submit with your application. CPP disability will approve applications based only on the Medical Report, but that tends to happen when your diagnosis makes it clear your condition is severe and prolonged. Such conditions include, AIDS, aneurysm, brain tumor, cancer, carcinoma, cerebral hemorrhage, cerebral infarction, cerebrovascular accident (CVA), coma, end stage amyotrophic lateral sclerosis (ALS), end stage degenerative neuromuscular disorders, glioma, Guillain-Barré syndrome, Hodgkin’s disease, leukemia, liver failure, lymphoma, massive stroke, melanoma, muscular dystrophy, myeloma, neoplastic disease, renal failure, and sarcoma.
On the other hand, if your medical condition can have a range of severity and duration, then you will need to gather other medical evidence, in addition to the Medical Report. Such conditions include, Fibromyalgia, Chronic Pain, Multiple Sclerosis, heart conditions, mental illness, Chronic Fatigue Syndrome, Complex Regional Pain Syndrome, Epilepsy, Carpal Tunnel Syndrome, Lyme Disease, Lupus, Spinal stenosis, Osteoarthritis, Degenerative Disc Disease, and more.
Step 5: Prepare a Cover Letter
You should write a cover letter to go with your application forms. While technically a cover letter is not necessary for your application, if done right it can improve your chances of success.
Your cover letter should be addressed to your local Service Canada CPP Office and reference your name and social insurance number. In the first paragraph you should say that you are attaching the forms to apply for CPP disability benefits and then list all the forms and information that you have attached.
Then in the main body of the letter you should give more information about your education, work history, and impact of your disability over time. When describing your medical conditions and disability, explain how your medical condition and impairments gradually made it harder and harder to work over time (if that applies to your situation). Explain what you did to modify your work and to try and stay at work. Explain why those modifications and changes were not enough to allow you to stay at work. Explain how your disability and impairments have affected your home life and ability to do housework and other leisure activities.
The biggest mistake most people make is not writing enough information. Other mistakes include focusing on making legal arguments or on your diagnosis per se. This letter is your opportunity to tell your story and to allow the CPP adjudicator a much better understanding of how your disability has affected your life.
Step 6: Assemble your application package
You should now have everything ready to go to apply for CPP disability benefits. Organization is important, so gather everything together. You should now have:
- A Completed and signed Application for Disability Benefits
- A Completed Medical Report Form
- A Completed and signed Cover letter
Step 7: Mail your application package to Service Canada
You're almost there. The last step is to mail your complete application documents to Service Canada. Service Canada has designated regional CPP disability processing