So, you just got the letter from Service Canada denying your application for CPP disability benefits. You’re here because you want to learn more about how to appeal that decision.
As part of our Ultimate Guide to CPP Disability, I am going to share a simple seven-step process you can use to do your CPP disability reconsideration appeal.
This seven-step appeal process is based on my experience helping hundreds of people with reconsideration appeals. I’ll start with a short review of how reconsideration appeals fit in with the larger CPP disability claim process. Then, I’ll go through the seven steps you can follow to do your appeal.
Let’s get to it.
What is a CPP disability reconsideration appeal?
If Service Canada denies your claim for CPP disability benefits, you’re entitled to four levels of appeal:
- Social Security Tribunal – General Division
- Social Security Tribunal – Appeal Division
- Federal Court of Appeal
This article focuses on the first level of appeal: the reconsideration. The reconsideration appeal is made directly with Service Canada. It is usually handled by the same medical adjudicator who made the decision to deny your application.
You do the reconsideration appeal by submitting a written request to do so. You then try to convince the decision-maker (i.e. medical adjudicator) to reverse their earlier decision by providing them with new information and documents.
A reconsideration appeal is an exercise in legal advocacy. It is important to understand that your appeal will not be decided based on the “truth” of your situation as you know it. Rather, the decision-maker will make a decision based on how well that truth is communicated in the documents presented in your appeal. It is not enough for you to present the truth; rather, you must present it in a way that will persuade the medical adjudicator.
It is beyond the scope of this guide to teach you everything about how to be persuasive, but I give a high-level overview in “The Best Story Wins: The Secret to Winning Your Disability Claim.”
What follows is a simple seven-step process you can use to do your reconsideration appeal.
Step 1: Verify that you’re at the reconsideration appeal stage
You have a lot on your plate, so it is possible to be mistaken about what level of appeal you’re at. It might seem silly, but we see this happen all the time. You don’t want to do a reconsideration appeal if you should really be doing an appeal to the Social Security Tribunal. This is a major mistake because appealing to the wrong agency can cause you to miss deadlines.
So, let’s first confirm that you’re actually at the reconsideration appeal step. You will need the denial letter you got in the mail from Service Canada to compare. There is an easy way to know for sure that you’re at the reconsideration appeal step. The first paragraph on the letter will have the heading “CPP disability decision,” and it will look exactly like this:
If the opening paragraph of your letter looks like this, then you know your next step is indeed the reconsideration appeal. Note that it references the date they received your application (blacked out in my example).
Now that you know for sure you’re at the reconsideration appeal, let’s move to Step 2.
Step 2: Identify your reconsideration appeal deadline
You have a deadline to request a reconsideration of the unfavourable decision. The deadline is always 90 days from the date you received the decision letter from Service Canada.
The first thing you need to do is figure out your deadline. For simplicity, and to avoid any arguments over when you got the letter, we recommend that you use the date on the letter to calculate your 90-day deadline.
The date on the letter included above is February 9, 2016. Even if you received the letter on February 11, you still want to use the date on the letter. You would then count forward 90 days from February 9, 2016, with the first day being February 10. In this case, the result is May 9, 2016. That would be the 90-day deadline to request your reconsideration appeal, if your application denial letter was February 9, 2016.
If you’re like me and aren’t totally confident in your counting abilities, you can use TimeAndDate.com’s online calculator to calculate the exact deadline. Just fill in the date of the letter, select “Add” and input 90 days’ time, and click “Calculate New Date.”
Step 3: Request the reconsideration appeal
Now that you know your deadline, it is critical that you request the reconsideration before that deadline. You can request the reconsideration appeal by writing a letter or by submitting Service Canada’s Form: Request for Reconsideration of a Canada Pension Plan Disability Decision SC-ISP 1145 (2018-10-09).
We recommend you use Service Canada’s form in order to ensure you provide them with all the required information. If you just write a letter, you may forget to give them necessary information and your appeal request could be rejected.
Many people wrongly believe that they can only request the reconsideration once they have all the appeal documents ready to send in. This is not true. In part 3 of the Form, you can indicate that you are going to send in more information later.
Service Canada’s form has five sections. Take care to fill them out properly:
Section 1: Applicant information
Make sure to include your full, correct contact information.
Section 2: Information about the decision
Fill in the date of your decision letter regarding your application denial. I reviewed this above, in Step 2. Check the box to say you’re sending the form before the end of the 90-day reconsideration period. If you’re past the 90-day period, then you will need to provide reasons for the delay where indicated.
Section 3: Information you want us to consider
Check the box that best describes your situation. If you’re still intending to send more information that you haven’t received yet, then you need to check box 3. There is space for you to list the documents you’re waiting on and to give dates you anticipate receiving the documents. You should fill this out whenever possible.
Section 4: Reason for reconsideration
In this box you need to give the reason(s) why you want the Medical Adjudicator to reconsider their decision.
Section 5: Declaration and signature
Assuming you’re able to sign your own signature, there are three things you need to do here:
- Check the box under the “Declaration” heading
- Sign where indicated, and
- Fill in date where indicated.
Also, you need to sign this in ink. Service Canada will not accept electronic signatures, or faxed or emailed copies of signed documents. You need to send them the original ink-signed document. Make sure you save a copy for your records.
Medical adjudicators will allow reasonable time for you to get the rest of your documents in to them. They understand there can be delays in receiving records from doctors or other third parties; however, you have to show that you’re trying to get them. If you’re procrastinating on getting the records, the medical adjudicator will eventually make a decision based on the information you have already provided. Obviously, this is not ideal.
The final step is to send your reconsideration request to the correct Service Canada address. Make sure you send it to the same address as the denial letter you received from Service Canada. Each province has its own designated Service Canada office for processing CPP disability claims. If you need to check for the address you will be sending it to, we have these listed on our Ultimate Guide to CPP Disability page under the heading “CPP Disability Offices by Province and Territory.”
Second, be aware that you cannot fax, email or courier any documents to Service Canada. They will only accept paper documents by mail.
We recommend you use Canada Post Xpresspost as we have found that it always gets delivered. You also receive a confirmation number to prove that you mailed the request for reconsideration within the 90-day deadline.
Step 4: Identify what documents or information you need to support your appeal
Now that you have requested the reconsideration, you need to get to work putting together the documents for your appeal. Generally speaking, you will need to provide new documents or information to have a successful appeal.
Remember, you’re asking the medical adjudicator to reverse their own decision to deny your claim. Unless you give them a good reason to change their mind, they are going to stick with their original decision.
So how do you know which documents or information to send? This is the hardest part of doing any appeal — including reconsideration appeals.
The short answer is that you need to get the information and documents necessary to support a winning narrative for your appeal. I discuss this in a previous article called “The Best Story Wins: The Secret to Winning Disability Benefits.”
Crafting a winning narrative is not easy. I recommend you use what I call the “reasons for denial” matrix. This might sound complicated, but it’s really just a chart to help you sort everything out.
To create this matrix, you will need the original application denial letter you received from Service Canada. Then, go through the letter to underline the medical adjudicator’s reasons for denial and information or clarifications requested of you.
In the following CPP denial letter I have underlined and numbered the medical adjudicator’s three reasons for denial.
You can now take these three reasons and put them into the “reasons for denial” matrix. Then, for each reason for denial and information request, you will identify what you need to provide in order to refute the reason for denial.
When you focus on refuting the reasons for denial, you give yourself the best chance of convincing the medical adjudicator to change their mind.
Step 5: Write your appeal letter
Once you have gathered the information and documents you identified in your appeal matrix, the next step is to write your appeal letter.
The error most people make is putting too much information into the appeal letter. An effective appeal letter will give an opening sentence identifying the decision you’re appealing:
I am writing to appeal the decision dated January 30, 2019. I have already provided you with my request for reconsideration of a CPP disability decision.
You will want to indicate the documents you’re attaching in a bulleted list. For each document, give the name and date obtained. For medical records, indicate the time period covered by the records.
In support of my appeal, I am attaching the following documents:
- Updated Clinical File of Dr. Smith from September 2, 2018 to June 5, 2019
- Medical consultation report of Dr. B. Honeydew (Psychiatrist) dated May 24, 2019
- Medical report of Dr. Smith dated June 5, 2019
- Shoppers Drug Mart prescription medication printout from January 1, 2017 to June 5, 2019
- MRI report dated May 9, 2019
Then you would move on to discuss any new developments that Service Canada should be aware of. This could be a new diagnosis, a treatment that was just started, new failed work attempts, etc.
There is new medical information since the date of your decision on January 30, 2019. I have attended my family doctor for three visits. I have attached the updated clinical notes describing these visits. I have attended a consultation with a psychiatrist, Dr. B. Honeydew. His consultation report is attached. I also underwent an MRI of my spine on June 5, 2019. The MRI report is attached. I have an appointment with the pain clinic coming up on August 21, 2019.
Then move on to the most important part of the appeal letter. List each reason for denial and then explain why this reason is no longer valid. Discuss the information that refutes the reason and reference where they can find this information in the new documents attached.
In the letter dated January 30, 2019, you gave the following reasons for denial:
- “there is no evidence of disc herniation or compression on the nerve.”
- “You are still waiting for additional investigations and depending on the results, possible treatments.”
- “You are waiting to be seen by another anesthesiologist at the pain clinic and by a psychiatrist… we cannot conclude that all treatment options have been exhausted.”
Based on recent developments, I can confirm that these reasons for denial are no longer applicable for the following reasons:
- I underwent an MRI on June 5, 2019, which confirmed the presence of a disc herniation at L5-S1
- My family doctor has confirmed in the attached letter dated June 5, 2019 that we have completed all investigations and tests.
- I have now been seen by a psychiatrist who confirms that I suffer from severe depression. He confirms that I am currently not able to work due to depression. He discusses that I am currently taking new antidepressant medication that is being monitored and adjusted by my family doctor. He states that until my depression is under control, I am incapable of any employment.
- My appointment with the pain clinic and new anesthesiologist is upcoming on August 21, 2019; however, my family doctor has confirmed that the purpose of attending the pain clinic is to improve my quality of life. He confirms there is no expectation by him or the pain clinic that I would be able to return to work. My doctor clarifies this in his letter dated June 5, 2015, which is attached.
You then politely end the appeal letter by asking that the reconsideration be allowed and your benefits approved, based on this new information.
Step 6: Send your appeal letter and supporting documents to Service Canada
Follow the same process I outlined in Step 3 to send the reconsideration request to Service Canada. Remember you must send your appeal documents to the correct address. This will always be the address on the denial letter you received from them. Also, remember that you can’t use a courier to send the documents. Couriers will get returned as Service Canada always uses a post office box. Once again, we recommend you use Canada Post Xpresspost because it will give you a confirmation number and will get delivered to a post office box.
Step 7: Cooperate with any further requests from Service Canada
After receiving your appeal letter and documents, it is common for the CPP disability medical adjudicators to contact you to clarify things or to ask your assistance in getting more information. One common request is having you sign an authorization form so the medical adjudicator can request information from your employer, doctor or other medical providers.
You don’t need to treat these requests with suspicion. More often than not, the information the adjudicator is seeking will be helpful in your claim. In our experience, most medical adjudicators are acting in good faith to seek information that could support your claim. They are not always trying to build a case against you.
Need to appeal a CPP disability denial? Download a copy of our CPP Disability Appeal Checklist to see the exact tasks we do when representing someone in a reconsideration appeal.