CPP Disability: The Ultimate Guide + Video

I wrote this guide for people who need to navigate the CPP disability program. The guide gives you the information you need to start your CPP disability journey — all in one place. So, you don’t have to search the internet for answers. 

I cover all of the main topics and issues you will face. And, I include links to articles that give you more detail if you want it.

We have pulled together all the forms and resources you will need to submit an application, do an appeal, or tackle other common issues.

If you have questions, call our toll free disability claim helpline at 888-732-0470.

You are on the right track. Educating yourself is the best way to maximize your chances of success. 

1. Overview of CPP Disability

Canada Pension Plan (CPP) disability is a government program. It pays disability benefits to eligible people. You must meet age, disability, and contribution requirements to qualify. Service Canada pays the benefitmonthly. You may also get a one-time lump sum payment.

To qualify, your disability must be “severe and prolonged.” This essentially means you have a condition that prevents you from doing any job on a regular basis.

There are three types of CPP disability benefits:

• Regular disability benefits
• Children’s benefit
• Post-retirement benefit

You can get regular CPP disability payments until age 65. Your children can get the CPP children’s benefit up to age 25. You can get the CPP post-retirement benefit if you are over age 60 and don’t qualify for regular benefits.

CPP disability works together with EI Sickness. EI Sickness is a short-term benefit. It’s paid over the first 17 weeks you are off work. On the other hand, CPP disability is a long-term benefit.  It starts after you have been off work for 17 weeks.

2. Eligibility for CPP Disability

You must meet three criteria to qualify for this benefit. Firstly, you must be under age 65. Then, you must have a “severe and prolonged” disability. And, you must meet the contribution requirements.

The disability and contribution requirements are the hardest. You meet the disability requirements if you can’t do any work on a regular basis. Contributions have to be recent. You must have valid contributions in 4 of 6 years leading up to the date of your disability. Or, you can have 3 out of 6 years, but this is only if you have paid for 25 years total. These are called your Minimum Qualifying Periods.

Most people pay into the Canada Pension Plan by working. However, there are other ways to get credits. For example, you can get credits from a former spouse. This is called credit splitting. Also, you can get credit for contributions when you leave the workforce to raise a child. This is called the child-rearing provision. Finally, you can transfer credits from other countries where you worked.

Still, you can qualify even if you don’t have contributions in 4 of the last 6 years. You may be able to backdate your application using the late application provision. This type of application is complicated, however. If you have to do a late application, then you should seek professional help.

3. CPP Disability Payments

Service Canada calculates CPP payments based on your contributions. The more you pay in, the more you get.

Everyone gets a fixed payment of $505.79, plus an amount based on their contributions. Therefore, each person’s payment is different. Service Canada calculates your payment using a formula. To learn more, see our article on calculating the CPP disability payments. 

CPP disability only pays a monthly benefit. In other words, it doesn’t cover medical or caregiver expenses. These types of expenses may be covered provincially. 

CPP disability payment amounts for 2020

Here are the CPP disability payment amounts for 2020:

• The maximum benefit is $1,387.66
• The average benefit is $1,010.57
• The post retirement benefit is $505.79
• The children’s benefit is $255.03 per child

The retroactive CPP disability payment

CPP disability is paid as a monthly benefit. However, you may also qualify for a one-time retroactive payment. This is also called a back payment. The back payment can be substantial, often valued at $15,000 or more. I have seen back payments as high as $70,000. In another article, we answer the top 7 questions about CPP retroactive payments.

CPP disability payment schedule for 2020

Service Canada pays CPP disability once per month. Here are the payment dates for 2020:

• January 29, 2020
• February 26, 2020
• March 27, 2020
• April 28, 2020
• May 27, 2020
• June 26, 2020
• July 29, 2020
• August 27, 2020
• September 28, 2020
• October 28, 2020
• November 26, 2020
• December 22, 2020

4. Disability

You must have a severe and prolonged disability to qualify for this benefit. The Canada Pension Plans defines it as follows:

• A disability is severe when it prevents a person from regularly doing any substantially gainful work

• A disability is prolonged when it is of long, continued, or indefinite duration; or is likely to result in death

Courts have interpreted the meaning of the “severe and prolonged” criteria. For example, here are some key principles from court decisions:

• Severe is focused on the capacity to work, not the medical condition
• The availability of work is not a factor for a severe disability
• A person’s employability in the “real world” is a factor for a severe disability
• To work “regularly” means being able to commit to a predictable work schedule
• Substantial gainful is defined by regulation to be the maximum CPP payment

What medical conditions qualify for CPP disability?

Service Canada and the Social Security Tribunal view your medical condition as a prime indicator of the seriousness of your disability. This is part of the Medical Adjudication Framework for CPP Disability, which is used by Service Canada.

When assessing your medical condition, the medical adjudicator and tribunal judges will consider the following factors:

• The nature of your condition
• Functional limitations imposed by the condition
• Impact of treatment
• Medical opinions
• Interaction with other conditions
• Personal characteristics

Any medical condition can qualify a person for CPP disability. This is because benefits are paid based on the seriousness of a person’s symptoms and disability, rather than the seriousness of the medical condition in general.

Following is a partial list of medical conditions that can qualify you for benefits:

• Back Problems & Conditions
• Bipolar Mood Disorder
• Carpal Tunnel Syndrome
• Chronic Fatigue Syndrome
• Chronic Pain
• Complex Regional Pain Syndrome
• Crohn’s Disease
• Depression
• Fibromyalgia
• Heart Disease
• Headache and Migraine
• Irritable Bowel Syndrome (IBS)
• Knee Disorders
• Lupus
• Lyme Disease
• Multiple Sclerosis
• Neck and Cervical Disorders
• Psoriatic Arthritis
• Sleep Disorders
• Vestibular Disorders
• Visual Disorders

How to prove disability

It’s not easy to prove disability. So, Service Canada sometimes denies claims for people who should qualify. Unfortunately, it’s not enough to have a “severe and prolonged” disability. You have to be able to prove it. In a way that the Service Canada medical adjudicator or the Tribunal judge will accept.

Focus on the decision-maker (i.e., adjudicator or judge). What proof will they accept? How will you convince them? What do they expect to see? Will they have concerns about you? Do they see red flags when they review your case? How can you overcome those concerns? Failing to focus on the decision-maker is a common mistake.  

It is critical that you present your claim as a story. However, how you tell the story matters. You must present your story in a way that is persuasive to the decision-maker. You can’t just tell your story in a way that makes you feel good. In fact, that’s a common mistake.

Medical records and documents are the best proof of disability. On the other hand, your description of your problems is the worst proof. Your descriptions can work, but only when they are backed up by medical records.

5.CPP Disability Application

Before you apply, you must consider if it’s the right time. Make sure you’re eligible. You must also have your doctor’s support. You can’t win without support from your medical treatment providers. Also, be aware that Service Canada has changed its procedures in response to COVID-19.

Check out our Top 8 Tips for Applying for CPP Disability Benefits. If you plan to do your own application, read our article on 7 Mistakes you must avoid.

Sometimes your insurance company will force you to apply for CPP disability. They will ask you to sign forms that seem unfair. Read about the pros and cons of signing the Irrevocable Consent to Deduct and Pay and Insurer. You may have reservations applying for CPP disability, but there are good reasons to apply even though the insurance company gets all the money.

To get started, you have to submit a CPP disability application. At a minimum, your application must include two forms: an application form and a medical form. Service Canada considers your application complete once it gets both forms.

Firstly, you fill out the application and arrange for your doctor or nurse practitioner to fill out the Medical Report. Next, you mail the completed application to the right Service Canada office for your province. Your doctor will mail theirs. For more detailed instructions on how to fill out the application, see our online guide: How to Apply for CPP Disability Benefits [Practical Guide & Video].

Application timeline and status

It can take 4-6 months for Service Canada to process your application. In the meantime, you can check on the status of your application online. 

Sometimes there are delays. If Service Canada mishandles your application, then you can file a complaint. 

There’s no fee to apply, but you have to pay your doctor to fill out the Medical Report. Service Canada will reimburse you for up to $80. You would pay any charge above that.

You also need to pay to mail in the forms to Service Canada. It can’t be sent through email, fax, or couriers. Therefore, we recommend Canada Post Xpresspost.

6. CPP Disability Appeals

Once you send in your application, Service Canada will make a decision to approve or deny your claim. 

Whether your claim is approved or denied, you have the right to appeal any unfavourable decision. So, it’s obvious to appeal when your claim is denied. 

If you’re looking for more information to help you understand why your claim was denied, take a look at our article: 7 Common Reasons for CPP Disability Denial (and what you can do about them).

An appeal is a formal process to review the decision. The appeal is handled by a new decision-maker. They have the power to uphold or overturn the first decision.

If the appeal decision is also unfavourable, then you can appeal to the next level and seek a new decision.

There are three rounds of appeal, including:

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

Technically, you can also appeal to the Federal Court of Appeal; however, that’s rare.

Now, let’s look at each level of appeal in more detail. 

Reconsideration Appeal

The first level of appeal is the reconsideration. You do this appeal directly with Service Canada. There is a 90-day deadline to request the reconsideration appeal. You must request this appeal using the Request for Reconsideration of a CPP decision before the 90-day deadline. Also, you need to send in any new medical information or other documents in support of your appeal.

A new CPP medical adjudicator will review everything. They will take what they already had along with the new information and make a decision. 

We have an article where we give a 7-step guide for your CPP reconsideration appeal. You can check it out here: How to do a CPP Reconsideration Appeal [Guide + Sample Letter]

And finally, if you are considering doing a reconsideration appeal, check out our article on 7 Mistakes to Avoid When Doing Your Own CPP Reconsideration Appeal.

Social Security Tribunal (General Division)

If Service Canada denies your reconsideration appeal, you have 90 days to request an appeal with the Social Security Tribunal. You do this by filling out and sending in a Notice of Appeal General Division (2020-05) Form. You also send new evidence to support your appeal. 

Once you send in all new documents, the Social Security Tribunal will schedule a hearing for your case. A hearing is a live meeting with the judge to review and discuss your case. It’s like a court trial, but more informal.

You attend the hearing to give verbal testimony. Also, you’ll answer any questions posed by the judge or hearing panel members. You can also present legal arguments for why the judge should approve your claim.

The tribunal hearing differs from the reconsideration appeal in a couple of ways. The judge is independent of Service Canada. And, you have the opportunity to give verbal testimony. 

Social Security Tribunal (Appeal Division)

If your claim is denied at the Social Security Tribunal (General Division), then you can request permission to appeal the decision. You have no automatic right to appeal. You have 90 days to fill out and send in an Application to the Appeal Division (Requesting Leave to Appeal). 

This appeal process starts asking for permission to appeal. If you are granted permission to appeal, then you are given more time to prepare any written explanation for why you believe the general division judge or hearing panel made a mistake in denying your claim.

Service Canada will also prepare written explanations for why they believe the general division judge or panel was correct in denying your claim.  The appeal judge will then make a decision on the written documents submitted, or will hold a hearing where you are given a chance to speak and answer questions.

If you are representing yourself at the Social Security Tribunal, we highly recommend reading our article: CPP Tribunal Hearing: 5 Mistakes to Avoid when Representing Yourself

To learn more about how to win your appeal, check out my article: Are You Making This Mistake With Your CPP Disability Appeal?

Late Appeals

If you have missed the deadline to submit your request for appeal, there may still be something you can do. To learn more, read our article How to request an extension of time to appeal a CPP disability denial.  

7. After Approval for CPP Disability

Being approved for CPP disability is great news. But, it can come with a new set of challenges. Here are some common challenges you may face: 

Getting payments started

Payments don’t start immediately. If Service Canada approves your claim, payments usually start in a month. However, if your claim was approved by the Tribunal, it may take up to four or five months for payments to start. Even worse, if your case goes to the Tribunal appeals division, you may have to do another hearing. Be prepared to wait for a few month. 

CPP Overpayments

CPP disability overpayments cause a lot of stress. Overpayments happen when you get approved for CPP disability while you also get disability benefits from another company or program. Those providers have a right to be paid back from the funds you get from CPP disability. You typically have to pay them your entire CPP retroactive payment. This seems unfair, but it is usually legal because it was included as a condition of the insurance policy or worker’s compensation regulations. To learn more check out our article on your options for long-term disability overpayments.

CPP Disability tax problems

I would not wish tax problems on my worst enemy. CPP disability benefits are taxable as income. Issues happen when you receive a large retroactive lump sum payment. Problems arise when Revenue Canada tries to tax this all in one year. Or, if you have to pay the lump sum over to an insurance company. But, you are still expected to pay taxes on it. We discuss these issues in an article on Paying Taxes on CPP disability Benefits. 

COVID-19 Emergency Benefits and CPP Disability

People receiving CPP disability as of July 1, 2020 qualify for a one-time payment of $600. The government is paying this through the Emergency Benefits Program. You don’t have to do anything to get this payment. They will automatically deposit it to your account in the fall of 2020.

Most people getting this benefit will not qualify for the Canadian Emergency Response Benefit (CERB). The CERB is only for people who stopped work because of COVID-19. People who get CPP and have a part-time job can qualify for CERB, in theory. This is because it’s very hard to meet the criteria. You need to have reported earnings of $5,000 in the 12 months leading up to March 15, 2020. Also, you must have lost that work because of COVID-19. This will not apply for people who do a small amount of work on the side, or who don’t report the income to Revenue Canada.

If you got the CERB in error, you will need to pay it back. This will happen when you file your taxes for 2020. Revenue Canada will be able to tell who got CPP disability but didn’t meet the income loss requirement. They will recover the money from you as if you owed taxes.

8. CPP Disability Approval Rates

You may have heard that everyone gets denied for CPP disability. It is hard to get good information on the actual approval statistics. Service Canada doesn’t release the information to the public. However, we did get a sneak peek back in 2016.

The Auditor General of Canada did a review of the program. The report gave us our first look at the actual approval rates for 2014-2015. We put this information into the following infographic. We didn’t have the raw data, so we had to make some educated guesses.

For a full discussion, see our article on the Auditor General’s Report and CPP approval rates.

9. Appointing a Representative

You may choose to appoint a representative to help with your CPP disability application or appeal. Both Service Canada and the Social Security Tribunal will recognize and communicate with your designated representative.

For Service Canada, you can authorize a representative in your My Service Canada Account, or by signing a Consent to Communicate Information to an Authorized Person Form (ISP 1603 CPP).

The Consent to Communicate only allows communication and does not allow the person to make changes to your account, sign documents or accept payments on your behalf.

You need to have a Power of Attorney document, and give a copy to Service Canada, to enable another person to sign documents or make changes to your account.

For the Social Security Tribunal, you can authorize another person by signing the Appointment of a Representative and Authorization to Disclose Form (SST-ATD 2018-05 E).

10. What are the rules that apply to CPP disability?

The rules for the CPP disability program come from laws, regulations and published judicial decisions.

So, to understand the rules, you must understand how the courts have interpreted and applied the laws and regulations in past cases. 

Below are the laws that form the baseline of the rules for CPP disability benefits. I also include links to search engines that have the judicial decisions that have interpreted the laws.

Lawyers use both the laws and the judicial decision to understand how the rules will apply in each unique situation.

Statutes

• Canada Pension Plan Act (CPP Act)
• Part 5 of the Department of Employment and Social Development Act (DESDA)

Regulations

• Canada Pension Plan Regulations
• Social Security Tribunal Regulations

Policies

• Service Canada’s CPP Disability Adjudication Framework

Case Law

• Social Security Tribunal Case Law Database (CanLII)
• Tribunal and Court Decisions (Organized by Subject)

11. Answers to Frequently Asked Questions about CPP Disability

12. CPP Disability Resources

CPP Disability Offices by Province and Territory

Service Canada has designated offices that specifically handle these claims. While you can pick up an application Kit in any Service Canada office, you must mail your completed paper application to the designated processing centre for your province or territory.

The phone number for CPP disability is 1-800-277-9914. You use that number no matter what province you live in. There are no direct lines for the offices below.

Following is a list of the Service Canada offices that handle claims for each provinces and territories:

Newfoundland and Labrador, Service Canada, PO Box 9430 Station A, St. John’s, NL A1A 2Y5 

Nova Scotia and Prince Edward Island, Service Canada, PO Box 1687 Station Central, Halifax, NS B3J 3J4 

New Brunswick and Quebec, Service Canada, PO Box 250, Fredericton, NB E3B 4Z6 

Ontario, Service Canada, PO Box 2020 Station Main, Chatham, ON N7M 6B2

Manitoba and Saskatchewan, Service Canada, PO Box 818 Station Main, Winnipeg, MB R3C 2N4 

Alberta, Northwest Territories and Nunavut, Service Canada, PO Box 2710 Station Main, Edmonton, AB T5J 2G4

British Columbia and Yukon, Service Canada, PO box 1177 Station CSC Victoria, BC V8W 2V2

List of all forms needed for CPP disability

Following is a list of all the forms you may need for your claim or appeal. Please note that the government makes unannounced updates to these forms from time to time.

Service Canada Forms

• CPP Benefits Application ISP 1151 (2019-12-17)
• Medical Report for CPP Disability Benefit ISP-2519 (2018-10-03)
• Terminal Illness Application for CPP Disability Benefits ISP-2530-A (2019-12-17)
• Terminal Illness Medical Attestation for CPP Disability Benefit ISP-2530-B (2018-09-17)
• Consent to Communicate Information to an Authorized Person ISP- 1603 (2013-11-12)
• How to Certify Copies of Documents CPP ISP-1730 (2018-09-28)
• Certificate of Incapability ISP-3505 (2015-07-03)
• Request for Voluntary Federal Income Tax Deduction CPP ISP-3520 (2016-05-09)

Social Security Tribunal

• Notice of Appeal (General Division) 2020-05
• Application to the Appeal Division for Leave to Appeal SST-LTA (2019-02) E
• Appointment of a Representative and Authorization to Disclose SST-ATD (2018-05) E

Next Steps

If you still have questions about the CPP disability program, or about how it could apply to your personal situation, please call our support team toll free at 1-888-732-0470. Also, don’t forget to download a copy of this guide to take with you.