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CPP disability benefits are a type of monthly income loss payment made by the Canada Pension Plan. CPP disability benefits are paid to people who become unable to work because of disability. To qualify for benefits you must minimum contribution payments into the CPP program and have a disability that is both "severe and prolonged" as defined by the CPP rules.


The purpose of this guide is to teach you about the CPP disability program. We cover such topics as, how to qualify for benefits, applying for benefits, appealing a claim denial, and how to deal with the issues the come up after approval of benefits. 

 

David Brannen Resolute Legal 250About the Author

David Brannen, Managing Lawyer and Founder of Resolute Legal

David is a former occupational therapist turned disability lawyer.  He has represented hundreds of people in CPP disability claims and appeals. As Resolute Legal's managing lawyer, and member of our support team, he has helped thousands win approval of CPP disability. David is the author of The Beginner's Guide to CPP Disability and The CPP Disability Application Workbook.


What You'll Learn:

  • if you qualify for CPP disability benefits
  • the process to apply for CPP disability
  • how to maximize your chances of success
  • the most common mistakes people make, and how you can avoid them
  • how to appeal a denied claim
  • how to handle common issues that may come up after approval

Who this Guide is For:

  • You are someone who is unable to work because of disability and want to learn more about how to apply for and win CPP disability payments
  • You are someone who is struggling at work and want to learn more about the CPP disability program and if you may qualify
  • You are a friend or family member of someone who may need to apply for CPP disability benefits and you want to learn more so you can help them.

 

1. Overview of the CPP Disability Benefits Program

What Are CPP Disability  Benefits


Canada Pension Plan (CPP) disability benefits are monthly payments made to those who can no longer work because of a disability. The Canada Pension Plan pays several other types of benefits, but this guide will only review disability benefits. To qualify, you must meet the age, contribution, and disability requirements. If you do, Service Canada will pay you every month for as long as you continue to meet the requirements or until you turn 65. If you qualify and have dependent children, then Service Canada will make an extra payment for each child.

Eligibility for CPP Disability Benefits

No everyone is eligible to receive CPP disability benefits, even if they are disabled and have paid into the CPP disability program. To qualify for CPP disability benefits you must meet the age, contribution and disability requirements. Let's look at each requirement in more detail.

Age Requirements

You must be between the ages of 18 and 65 at the time of your application. However, citizens between 60 and 65 cant receive CPP disability and CPP retirement at the same time. If youve received CPP retirement for 15 months or less, then you may qualify to have your retirement converted to disability.

Contribution Requirements

To meet this requirement, you must have made minimum qualifying payments in four of the last six years or three of the last five, if you have contributed for at least 25 years. You calculate these figures using the years leading up to the date you became unable to work due to disability, called your date of onset, not the date you apply for benefits. If you don’t meet this requirement based on your past work, you may qualify for credits from other sources, including spousal credit splitting, the child-rearing exception or pension credits from other countries.

Disability Requirements

How serious is your disability? If you meet the age and contribution requirements, the last hurdle is to prove you have a severe and prolonged disability as defined by the CPP Act. A severe disability is a physical or mental disability that stops you from doing any substantially gainful employment on a regular basis. A prolonged disability is one that is long-term and of indefinite duration or is likely to result in death. It is not enough to prove you have a severe and prolonged disability; rather, you must show that the onset of the disability was before the end of your qualifying period. Failing to prove onset of disability during the qualifying period is a common mistake that will result in a denial of an otherwise legitimate claim for CPP disability benefits. 

To learn more: How to Know if You are Eligible for CPP Disability Benefits (+Video)

Date of Onset and Minimum Qualifying Period

 Your date of onset (DOO) must happen during the time when you met your contribution requirements, called the minimum qualifying period (MQP). You can meet all other requirements and pay into the CPP program but still not qualify, if your date of onset didnt happen during this period.

In my experience, few understand DOOs and MQPs, resulting in mistakes during the application and appeals process. Claimants often point to a DOO that falls outside the MQP and fail to present evidence of disability, treatment, and work efforts during the MQP. So let’s try to make these complex subjects easier.

Date of Onset (DOO)

You must pick a date to call the day that your disability became “severe and prolonged” as defined by the program. Even if your disability happened gradually, the law requires a calendar date to stand as the point where your disability prevented you from steady work. A traumatic injury event often makes the DOO obvious, although not always (some go back to work and then feel effects from the event later). However, a chronic illness makes your DOO more difficult to pinpoint.

And also remember that your DOO doesn’t stand for the day your disability started, but the day it became “severe and prolonged” as defined by the program. This date may line up with your last day of work, but it could happen before you stopped working completely. Choosing an appropriate DOO can make or break your claim.

Minimum Qualifying Period

This concept seems to be the most difficult to grasp. It’s a bit like car insurance. Car insurance will only cover an accident if it happened during a period when you paid your premiums, right?

Well, the program will only provide disability payments if your disability started during a period when you paid into CPP.

You pay CPP on each paycheque as a mandatory payroll tax, deducted by your employer. So you should have CPP coverage as long as your CPP tax came out of your paycheque in four of the last six years, or three of the past five years if you have 25 years of contributions. The MQP’s end date is often two years after your last year of CCP contributions.

For example, let’s say you have your DOO as October 31, 2016, and you stopped work on November 5, 2016. If you paid into CPP for at least 2013 to 2016, then your MQP should run until December 31, 2018. Therefore, you would need to prove your DOO happened before December 31, 2018.

Late Application Provision

If you apply for CPP disability benefits after your MQP expires, Service Canada will notify you that you have submitted a late application and give you the end date for your MQP.

Applying late doesnt mean you lose your benefits. It just means that you need to prove that your DOO happened before the end of your MQP. Canadian law includes a “late application provision” to allow you to apply after your MQP expires.

For example, Mary’s application is dated May 25, 2018. She receives a letter saying that her application is “late” because her minimum qualifying period expired on December 31, 2017. Service Canada will then check Mary’s claim under the late application provision and determine if her DOO happened before December 31, 2017. If so, then Service Canada would move on to determine if Mary meets the other requirements.

However, if Service Canada finds that Mary’s DOO occurred after December 31, 2017, it will deny the claim as not meeting contribution requirements. With the right evidence and arguments, Mary could have this decision overturned on appeal.

CPP Disability Benefits for Children

If you win your claim for disability benefits and have dependent children, then they too will each qualify for a benefit. You apply for children’s benefits as part of the regular application. Qualifying children must be under the age of 18 or be a full-time student between the ages of 18 and 24.

This benefit is set at $244.64 per month per child, although this amount increases each year by inflation. The payment usually goes to the parent or guardian, but children older than 18 may receive the benefit directly.

2. Applying for CPP Disability

Before you Begin

Early action can improve your chances of winning your claim. Above all, make sure you have accurate and thorough records of your disability from your health professionals. That means you must go to your regular appointments, describe your symptoms and problems carefully, and show that you’ve tried everything your doctors suggest, even if you disagree.

The better your records track your condition and attempts at treatment, the more likely you are to have your claim approved. You want clear reports that show how you struggled to work and get better. A lack of specific details can make it very hard to have your claim approved, even if you are disabled.

How to Apply

You apply for CPP disability benefits by filling out the official paper forms and submitting them to Service Canada. These forms include the Application Form (you fill out) and the Medical Report form (your doctor fills out). Service Canada will only accept a paper application delivered by mail or dropped off at a location designated to accept CPP disability applications.

Learn More: How to Apply for CPP Disability Benefits [Guide + Video]

3. Claim Decisions

Service Canada has designated and trained agents to approve or deny your claim, so you must address these decision-makers specificallyIn fact, you may need to present your claim differently depending who will decide. Claimants new to the process tend to focus on what they find convincing, rather than what the decision-maker would find convincing. Don’t make this mistake!

The odds of being approved for CPP disability are stacked against you. A 2014-15 study by the Auditor General of Canada found that only 43% of claims are accepted at the initial application and that only 53% of claims are approved for those who appeal all the way to the Tribunal. This is why it is so important to take a strategic approach to your application and appeals. 

To learn more about the Auditor General's Study into the CPP Disability Program, check out our article: CPP Disability Approval Rates Explained.

Who Decides If You Are Approved or Denied

Medical Adjudicators

At the application and reconsideration stages, a medical adjudicator employed by Service Canada makes the decisions. These health professionals (almost always nurses) have received training on handling disability claims for the CPP program. Remember that the adjudicators will focus more on the medical than the legal parts of claims. And just like everyone else with busy desk jobs, they have bosses to keep happy and an endless stream of work every day.

Tribunal Judges

At the Social Security Tribunal stage, a tribunal member, usually a lawyer with CPP training, will decide your claim. Tribunal members serve as judges, some for CPP disability hearings and others for appeals. Like medical adjudicators, tribunal members have a constant flow of new appeals and pressure to hold hearings and issue decisions quickly.

How CPP Disability Claims are Decided

There is no official process for how claims are decided; however, Service Canada has guidelines for its medical adjudicators called the Canada Pension Plan Medical Adjudication Framework. This frameworks outlines the decision-making process used by the medical adjudicators when deciding your initial claim and reconsideration appeal. 

Tribunal judges don't have to use Service Canada's Medical Adjudication Framework; rather, their obligation is to follow authoritative legal decisions from earlier Tribunal Decisions or from the Federal Court of Appeal. These prior court decisions have established the rules for how judges must decide whether a claim should be approved or denied. 

How to Prove your Claim

Medical adjudicators and judges can only make decisions based on the evidence they see, and certain rules limit what they can see.

Therefore, medical adjudicators and judges can only decide based on properly presented admissible evidence. That means that you may have facts that prove a point, but you can’t use them because they don’t follow the rules. That also means that a medical adjudicator or judge may rule against you if you don’t present all the facts that help you.

These rules for proof apply to claims and appeals. You have to prove your claim using evidence the tribunal judge will accept. Some claimants assume their claims have to be approved because they really can’t work. But you absolutely must prove it properly, using the right evidence and presentation. You can make personal statements if you want, but offering medical records and outside opinions will get you a lot farther.

Types of Evidence

You prove your case with evidence. The three most common types of evidence are: 1) Lay Witness Evidence; 2) Expert Evidence and 3) Documents. Lay witnesses testify based on their personal knowledge and observations, rather than expertise. Expert witnesses offer scientific opinion based on education, experience and credentials. Documents are the most important type of evidence. They refer to documents created in the course of business, such as medical records and employment records.

Protecting your Credibility

One of the most important factors in your case is your trustworthiness and believability. In the legal setting this is referred to as credibility. If the medical adjudicator or judge believes you have strong credibility, you are likely to win, even if your evidence is otherwise weak. On the other hand, if the medical adjudicator or judge believe you have poor credibility, you will likely lose, even if your supporting evidence is strong. This is why protecting your credibility needs to be your first priority. 

Your personal believes about what makes you credible don't matter. This is a common mistake you must avoid.  What matters is how medical adjudicators and judges assess credibility. 

4. Claim Denials and Appeals

 Common Reasons for Denial

What happens if Service Canada denies your application for CPP disability? There is a good chance you made one or more of the common mistakes we see most people make. There are many reasons given for denial, but the most common are:

  • you can't do your old job, but there are other jobs you could do
  • you have symptoms and problems but they are not severe enough to disable you from all work
  • you have filed a "late application" and there is no evidence you were disabled when you last were eligible to apply
  • you have serious symptoms or disability, but it is not prolonged because you have upcoming medical appointments or treatments you have not tried yet.

How to Appeal

If the medical adjudicator denies your initial application, you have the right to appeal his or her decision. There is a multi-step appeals process that starts with a reconsideration appeal within Service Canada and ends with a hearing before the Social Security Tribunal (SST). These levels of appeal are as follows:

  • Reconsideration appeal (Service Canada)
  • Tribunal Hearing (Social Security Tribunal – General Division)
  • Tribunal Appeal (Social Security Tribunal – Appeal Division)

Each level of appeal has its own rules and procedures you must follow. A common mistake is to lose the appeal based on a failure to meet the procedural requirements. The most common procedural mistakes are to miss the 90-day deadline to ask your appeal or to file an incomplete Notice of Appeal to the Social Security Tribunal. When you make these types of mistakes, your appeal can be denied on procedural grounds, regardless of whether you meet the age, contribution and disability requirements for disability benefits.

If the medical adjudicator denies your initial application, then you have 90 days to request a reconsideration appeal within Service Canada. You will get a reconsideration decision from Service Canada within 30 to 60 days. If the reconsideration decision is unfavorable to you, then you have 90 days to file a Notice of Appeal with the Social Security Tribunal.

Once your case is accepted for appeal with the SST, you have one year to send in all your documents and written submissions. You may request a tribunal hearing at any time, after you have sent all the necessary documents to support your claim. The SST will then assign a Judge and a hearing date for your case. At this point, the tribunal will no longer accept further documents. A common mistake is requesting a tribunal hearing before you have submitted all documents needed to prove your case. This happens when you do not understand what types of documents are needed to prove your case at a tribunal hearing. This is one of the dangers of waiting until the last minute to try and hire a disability lawyer for your tribunal hearing.

After the Social Security Tribunal schedules your hearing, you must show up on the day and time of the hearing. The Hearing is a 90-minute session where you present verbal testimony to a tribunal judge. You also make verbal arguments and submissions to the judge to say why he or she should rule in your favor. Tribunal hearings can be in person or by teleconference or video conference. It is most common for the hearings to be by teleconference and videoconference. Focusing verbal testimony on the wrong information during the hearing is a common mistake. For example, many people come prepared to speak about the here and now, rather than during the critical period which could be several years ago. After the hearing, the judge will send you a written decision within 30 to 90 days.

If you get an unfavorable decision from the tribunal judge, then you can apply to have the Social Security Tribunal (Appeal Division) review the decision. You do not have a right to have the Appeal Division review your case; rather, you only have a right to ask them to consider doing so.

If you receive an unfavorable decision from the SST Appeal Division, you can apply for leave to appeal to the Federal Court of Appeal. Again, you have no right to have the Federal Court review your case, you can only ask that they consider doing so.

Note: On March 21, 2019, the Government announced it was making structural changes to the appeals within the Social Security Tribunal. We will continue to update this section as more information is known. To learn more read: The 2019 Changes to CPP Disability & The Social Security Tribunal: What they Mean For you.

Time Extensions and New Applications

If you miss a deadline to appeal, then normally you have lost your chance to appeal and are stuck with the denial decision. However, if you act quickly, sometimes Service Canada or the Tribunal will forgive the missed deadline and allow your appeal to go forward.

You can request "forgiveness" for the missed deadline by requesting an "Extension of Time for Appeal." When considering whether to grant an extension of time, the medical adjudicator or judge must consider the following four factors about your situation: 1) Have you demonstrated a continuing desire to appeal; 2) Do you have a chance of success with the appeal; 3) Do you have a reasonable excuse for missing the deadline; and 4) Will the other side suffer no prejudice if the extension is granted.

If the medical adjudicator or judge denies your request for an extension, then you may have the right to start over by filing a new application. You will not have the right to file a new application if the tribunal judge has considered your case and issued a final decision. Consult a disability lawyer if you are not sure if a judge has issued a decision on your case. 

5. After CPP disability benefits are approved

Once your CPP disability claim is approved – either by Service Canada or by order of the Social Security Tribunal – then Service Canada will process your claim and you will normally start receiving benefits in 1 to 4 months. You will receive a one-time lump-sum payment for CPP disability retroactive payment going back up to 12 months from the date Service Canada received your application. In addition to the lump-sum payment, you will get a monthly disability payment. This will be deposited to your bank account each month on the same date.

If you are also receiving long-term disability benefits, then you likely must pay over most (or all) of the lump-sum payment to your insurance company. This is because receiving the retroactive payment creates an overpayment situation with your past long-term disability benefits. Overpayment problems with CPP disability and LTD insurance benefits is often a major source of stress. If it doesn’t receive the CPP lump sum payment from you, your insurance company can stop your long-term disability payments, sue you for the back-payment amount, or both.

You may also experience income tax headaches when paying the CPP lump-sum payment over to your insurance company. This happens when your LTD benefits were non-taxable, but the CPP disability benefits are taxable. This means you will be taxed on the lump-sum payment, but not have the money to pay the taxes, as it was paid over to the insurance company. There are steps you can take to minimize your tax burden in this situation, including having the lump-sum payment taxed over two or more years, applying for the Disability Tax Credit, and claiming a tax deduction for any legal fees you paid for your application and appeals.

6. Representation

Authorized Representatives

Both Service Canada and the Social Security Tribunal allow a claimant to have an authorized representative. This representative helps you during your claim or appeal and can sign certain documents and forms for you. But don’t confuse an authorized representative with an authorized person, who can receive communications from Service Canada or the tribunal. An authorized person can’t act on your behalf or make decisions about your claim or appeal.

For your authorized representative, Service Canada allows a lawyer, guardian, curator, trustee, committee, executor, power of attorney, or any other legal representative. The representative must be appointed under the laws of Canada to manage your affairs, and you must submit legal documents confirming this appointment. These legal documents include a mandate, trusteeship, power of attorney documents, and letterhead from a lawyer confirming representation or an official CPP program form.

The SST defines a representative as anyone appointed to assist a claimant during the tribunal appeal process. You appoint a representative by submitting the official form provided by the SST. Any representative who assists you at the hearing and charges a fee must follow provincial rules governing the practice of law. Any representative who is not a lawyer or paralegal licensed in your province may be breaking the law and should not represent you at the hearing.

Negligent Representation

All authorized representatives must meet the same legal standard of competence regardless of licensing. If your representative makes a mistake that results in the denial of your claim or appeal, you can bring a malpractice claim against the representative to try to win back the money you would have received from the CPP disability program.

Negligent representation includes missing deadlines, poor case work, failure to submit key information, or even weak advocacy. Some of these items can be hard to prove, though.

You should also know that some representatives mean well but still provide poor service because they don’t know enough to represent people in CPP disability claims and appeals. This happens with both licensed and unlicensed representatives, but you take a greater risk with an unlicensed representative because they usually have no formal training, rules of ethics and professional responsibility, or malpractice insurance.

Licensed and Unlicensed Representatives

Licensed representatives include lawyers in all provinces and paralegals in provinces that license paralegals. Unlicensed representatives are often referred to as non-attorney advocates or non-lawyer advocates.

You need to know the differences between licensed and unlicensed representatives. Licensed representatives have formal credentials in the law, the legal process, and legal advocacy. They must follow a strict code of ethics and rules of professional responsibility. Licensed representatives must also carry malpractice insurance that would pay you if they make mistakes handling your claim or appeal.

Unlicensed representatives may have varying degrees of practical experience but no formal credentials in the law or advocacy. Unlicensed representatives don’t have official guidelines for their ethics and professional responsibility and probably don’t have malpractice insurance.

Of course, even a licensed representative may not know everything necessary for your claim, and many non-licensed advocates do great work with claims and appeals. However, the key difference is the accountability. You’re protected if a licensed representative makes a mistake, but you don’t know what you may wind up in if a non-licensed representative makes a mistake.

Paid and Unpaid Representatives

Obviously, paid representatives make their paycheques by representing people in claims and appeals. They can include both licensed and unlicensed individuals and businesses. You can negotiate the terms of payment to include a flat fee, fees based on time spent working on the claim or appeal, or some type of contingency fee, also known as a no-win, no-fee agreement. No-win no-fee means that the representative doesn’t get paid unless you do, so he or she has a vested interest in winning your claim.

Unpaid representatives include individuals, groups and non-profit organizations that provide advocacy and representation as part of their mandate. These organizations normally use non-licensed advocates to assist people with CPP disability claims, but some use licensed lawyers and paralegals. Many such groups and organizations provide good quality representation, although you have to keep in mind they don’t have to follow the legal codes of ethics and professional responsibility. It is possible the non-profit organization will have liability insurance that may cover them if their volunteer or employee doesn’t handle your appeal properly.

DO I NEED A REPRESENTATIVE

Let me be clear. You can lose a winnable claim if you make mistakes and don’t present the claim properly. Too many claimants believe the “truth of the situation” holds more power than it really does. Regardless of how disabled you have become, the decision-maker can only judge your situation by the documents and testimony you officially submit. If you don’t show the truth of your situation in your documents and testimony, you will lose your claim, no matter how much you deserve to win.

Many claims need you to take a strategic approach to gathering and presenting your evidence. For example, if you applied under the late applicant clause, then you need to obtain medical records that cover the past times in question. In such a case, relying on current medical records will result in a denial.

Winning lawyers know that the best story wins the case. Your case is a story, and you have to tell a good one, a believable one. A high-quality advocate has a lot more practice than you at telling the story a claim needs to win, so you should consider hiring this expert to tell your story.

If you need to stand before the SST, I strongly recommend a licensed representative with demonstrated competence in CPP disability appeals. The tribunal hearing is your last chance to provide evidence in support of your claim. If you lose because the tribunal didn’t see key evidence, you won’t get a second chance to submit the missing evidence.

If you handled your initial claim and reconsideration but received denials for both, then you need to ask yourself if you’re really able to win this without help. In both of my examples, my clients would have lost their hearings because their representatives didn’t submit critical information and a compelling story.

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