What is the CPP disability eligibility criteria? If you’re beginning your application, you may be wondering what the requirements are and who can qualify for the benefit.
In this article, I explain how to know if you’re eligible for CPP disability payments. Not everyone is eligible — even if you’re legitimately disabled. There are specific criteria you must meet. I explain these criteria in detail below to help you assess your own situation and determine if you might fit the requirements. I also discuss how to tell when the time is right to apply for CPP disability benefits.
This article is part of CPP Disability: A Simple (But Complete) Guide for 2021.
CPP disability eligibility criteria
There are three main criteria you must meet to be eligible for CPP disability payments:
- Age. You must be between the age of eighteen and sixty-five.
- CPP contributions. You must meet certain contribution requirements.
- Severe and prolonged disability. You must be able to prove you have a “severe and prolonged” disability as defined by Service Canada.
Below, I will explain all of these in more detail.
You must be between the ages of 18-64 to be eligible to apply for CPP disability payments.
If you’re over 60, you must not be receiving CPP early retirement payments. This is because you cannot collect both disability and retirement pensions at the same time. If you are receiving monthly CPP retirement payments, then you have a very short window of time to convert those over to CPP disability payments.
For more information about doing this, see our post Converting CPP Retirement to CPP Disability: What you need to know.
CPP disability benefits are only available to people who have made recent and sufficient contributions to the Canada Pension Plan. This means that you are only eligible for CPP disability if you were making recent contributions to the CPP at the time you stopped work due to disability.
There are two main scenarios. You must have contributed for either:
- 4 of 6 years leading up to the date you could no longer work due to disability; or
- 3 of 6 years leading up to the date you could no longer work due to disability, if you have 25 years or more contributions.
If you don’t meet the above criteria at first glance, there are other possible ways to increase your contributions. These include credit splitting with a spouse, or being out of the workforce for an extended period to raise children. These are more complicated situations, however. If you aren’t sure where you land, then you should seek professional advice.
For more information about contribution requirements and determining your minimum qualifying period, see our article: CPP Disability Minimum Qualifying Period Explained.
Severe and Prolonged Disability Requirement
If you meet the age and contribution eligibility criteria, you can still only be eligible for CPP disability if you can prove you have a “severe and prolonged” disability. The words “severe and prolonged” have a very specific legal meaning when it comes to CPP disability benefits.
Severe is defined as “incapable of regularly pursuing any substantially gainful occupation.”
This definition is extremely nuanced; the courts have interpreted each of the words to have a certain meaning. Therefore, you can’t just rely on a common understanding of the words incapable, regularly, substantially, or gainful.
Prolonged is defined as “likely to be long, continued, and of indefinite duration, or is likely to result in death.”
You should seek advice from a disability law firm to determine if your disability meets this definition. Unfortunately, many well-meaning people — including doctors, general practice lawyers, and others — are misinformed about what it means to have a severe and prolonged disability.
When is the right time to apply for CPP disability?
Before you apply for CPP disability benefits, there are 5 main things you should consider:
1. Do I meet the CPP disability eligibility criteria?
Only apply if there’s a chance to get approved. In other words, you must meet the eligibility criteria as described in the first part of this article.
2. Does my doctor support me?
To put it bluntly, there’s no way you can win a disability claim if your doctor doesn’t support you. There are basically two situations you might find yourself in:
- Doctor needs convincing. If this is the case, you’ll really need to work with your doctor. Do everything they ask, follow their treatment plans and recommendations, and try everything you can to stay at work to prove that you really can’t handle it.
- Doctor is biased. This is rare, but we’ve encountered doctors who simply don’t believe or approve of disability benefits programs. Sometimes a doctor will say that you aren’t “disabled enough.” If this is the case, you might want to look for another doctor.
3. Is my medical condition well-documented in my medical records?
If you don’t have good medical documentation to back up your condition, symptoms, and treatment, it gets harder to approve your claim. Your condition must be well-documented. The further back the records go, the better.
If you haven’t already been doing so, you’ll want to speak with your doctor about your condition every time that you see them. A history of your struggle with disability and employment is essential. It needs to show that you’ve been complying with treatment as well as the results of the treatments you’ve tried.
You can’t win these cases based on your opinions and anecdotes alone.
4. Have I exhausted all work options?
Lots of legitimate claims get denied because the person can’t prove that they have exhausted all work options. Before you apply for disability benefits, you need to go out of your way to try everything you can — and have it documented! Many judges will be reluctant to approve a CPP case unless the applicant makes multiple efforts to keep working. These can include:
- Working part-time at your own job
- Working at your own job with reduced duties or workplace accommodations
- Trying an “easier” job, or attempting volunteer work that would be equivalent to working
If you haven’t made these efforts, then now is not the right time to apply.
5. Can I do the application myself?
You have to be equipped to complete the application — both physically and mentally. You also have to have a high level of self-awareness to be able to put together an application that is truly compelling and tells the best story. People can certainly have success doing CPP disability applications and appeals on their own. But, sometimes it’s best to have an advocate or lawyer to help prepare your appeal or application. They will be able to look at your case objectively — spotting weaknesses or red flags in your narrative that you might not have been able to spot yourself.
Learn the secrets for winning CPP disability
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