Have you been denied CPP disability benefits? Are you in the process of applying, but are curious about why people get denied and how you can avoid it?
Even if you are legitimately disabled, there are some red flags that arise in disability claims that will cause Service Canada to deny you pretty much immediately. Simply by knowing what these are and understanding the mindset of the people reviewing each claim, you will be better prepared to successfully complete your application or appeal your denial.
I have been a member of Resolute Legal’s support team for the past five years. During this time, I have had the opportunity to speak with hundreds of people who have been denied CPP disability benefits. As part of our Ultimate Guide to CPP Disability, I am sharing with you the seven most common reasons I have seen for denial and give some suggestions for dealing with each of them.
1. Your age
A person’s age, education, work experience, and transferable skills are key factors that must be considered when determining if a person is disabled from all gainful employment.
Service Canada usually won’t tell you this, but one of the most common reasons for denial is your age.
Most often, if you’re under the age of 55, they will evaluate your situation and your medical condition differently than if you were older.
If you’re 40 or younger, they’re going to place a lot of emphasis on your attempts at all sorts of possible alternative work. They will also evaluate if you’ve made valid attempts at all types of treatment. They see your age as your ability to seek out further treatment — and the younger you are, the higher the chance that you will be able to return to some type of work at some point in the foreseeable future.
What you can do about it
Well, you probably can’t change your age — but you still have some options. Focus on following through with all treatment recommendations. Make sure you have taken steps to try and stay at your job with accommodations, or have tried other, easier work. If you have tried everything you can to treat or work around your disability, you will seem much more credible — even if you’re young.
2. You haven’t tried accommodated work
This reason for CPP disability denial comes up no matter what age you are. Service Canada or the Social Security Tribunal will evaluate if you’ve tried any accommodations in your own role before being taken off or ceasing work yourself. They will also evaluate if you’ve made any attempts to return to work at another type of job that might be more suitable to your medical conditions — whether that is lighter duty, a different type of occupation, or a reduced amount of hours worked per week. Service Canada wants to see that you’ve sought out all avenues before deciding that you’re completely unable to work.
They can grow suspicious if your medical condition is one that typically doesn’t imply that you couldn’t try some sort of lighter duty work. If you are applying based on a mental health condition that resulted from stress in the workplace or have not made a serious attempt at trying another type of employment, they may deny you as well.
What you can do about it
Go back and try accommodations at your previous job, or try a different job altogether. Attempt some volunteer work to see how you handle it. It might help to keep a journal during this time so you can track your duties and how your disability hinders you while doing them.
If your doctor has taken you off work and said that you are no longer able to do any type of work due to the severity of your medical condition, Service Canada might not evaluate you so heavily on this point.
3. You took yourself off work — not your doctor
One big red flag when CPP evaluates your disability application is whether a medical professional took you off of work or whether you decided to cease work yourself. When you decide to take yourself off work without the support of a doctor, it will be nearly impossible to get a claim approved. A doctor’s support and agreement to take you off of work is key to getting approved, as it justifies your reasoning when applying for this disability claim.
In contrast, when you take yourself off work and a doctor is not in agreement that you couldn’t do any type of work, or is sending in reports to them that you could do some sort of lighter duty, it discredits you on paper because a medical professional is saying the complete opposite. Unfortunately, they do take the medical professional’s advice and professional opinion at a higher value than yours — regardless of what you may think and feel.
While there are some instances when taking yourself off work is certainly a good instinct and a necessary measure, you need to be sure that your doctor is in agreement that you should be off work.
What you can do about it
If you find yourself in a situation where you and your doctor are in complete disagreement, you may want to consider getting a second opinion from another medical professional. Your disability claim for any type of program is highly unlikely to get approved without having a medical professional’s opinion to back you up.
4. You left for pregnancy and never returned — now you’re claiming disability
A common reason for receiving a denial is in a situation when an individual has left work for maternity leave, has decided not to return, and is now attempting to claim disability. This is usually a red flag for Service Canada, but there are many scenarios in which these are valid claims. With the appropriate medical documentation submitted for the appropriate conditions, you would be able to secure a disability claim and confirm that you can’t do any type of work.
However, there are many conditions that are not severe and prolonged enough for a disability claim to be approved. There are many scenarios in which individuals have conditions that would not typically prevent them from doing some type of work — but in conjunction with caring for their newborn, they have decided it would be more difficult to return to work. Unfortunately, in these scenarios, it is highly unlikely for you to get approved. When Service Canada sees your claim, it looks as if you have decided that you do not want to return to work and that the medical findings aren’t supporting that. The doctor submitting your forms may have said in your file that you are able to do some type of work; that your condition has improved or cleared up; that you’re functioning on medication and treatment. They may say there are still further treatment options or that they do not agree that your disability is severe and prolonged.
What you can do about it
Get further clarification and gather the necessary reports from your doctor. You may have to attempt a return-to-work to prove you are unable to work.
5. No official diagnosis, or diagnosis in dispute
One surefire way to be denied by Service Canada or the Social Security Tribunal is to apply before receiving an official diagnosis. Service Canada has specific guidelines to evaluate claims based on certain medical conditions, and they have specific staff evaluating each case. They compare their guidelines with all of your medical documentation to determine if you have sought out and received enough treatment, and verify if your doctors are all agree that you are disabled and unable to work.
The issue with not having official diagnosis is there’s nothing for them to compare their documentation to. If there is no official diagnosis, there is no way for them to validate if you received proper treatment and if there is a chance of recovery.
While you may be off work during this period of investigation, you’re usually better off applying for EI sickness — and hopefully while you’re off on EI, you will receive an official diagnosis. However, there are many individuals who are not lucky enough to receive an official diagnosis in such a short time; this is one of those messy areas within the system. Your doctors must provide very convincing evidence of your current limitations and why they would render you unable to do any type of work for at least a year, if not indefinitely. Most medical professionals will not go on record to say this unless you’re being hospitalized or treated at a care facility while there are ongoing investigations. Otherwise, Service Canada will view your case as presenting no concrete evidence as to how long your limitation period will be extended — and therefore they will deny the claim because they have reason to.
In some cases, you might have a diagnosis but your condition is not recognized as “severe and prolonged” based on Canadian medical professionals in the health system. There are many conditions you can receive approval for after specialists in numerous capacities and having tests that confirm diagnoses; however, there are still conditions that are areas of contention. Not all medical professionals are in agreement that certain conditions exist. There are arguments whether or not there is enough research to understand to what degree certain conditions will affect individuals, or what type of treatment will help resolve them. These are conditions like Fibromyalgia, Lyme disease, and other invisible diseases that do not show up on medical scans that normally confirm diagnoses.
Disability benefits are never approved or denied based on diagnosis alone. Someone could have a serious diagnosis like Multiple Sclerosis and still not technically meet the criteria for CPP. Disability benefits are always determined based on the limitations and impairment caused by the disability. Unfortunately, simply having a diagnosis is not enough.
What you can do about it
Have your doctor focus on describing and documenting your symptoms and limitations, even if they can’t give a firm diagnosis. Have your doctors confirm all the things they have done to rule out possible conditions or diagnoses, and the plan going forward for diagnostic testing. A medical diagnosis is not technically required for approval of benefits, but for practical reasons it is hard to be approved without it.
6. Not complying with treatment or fighting with doctors
There are certain guidelines Canada Pension Plan disability uses to evaluate whether or not your disability is severe and prolonged.
One of the main ways they will evaluate whether or not you should be approved is if you are refusing potential treatment options. Another is if it has been noted that you have decided to take yourself off of certain treatments that are recommended for your recovery. Sometimes individuals find themselves in situations where they have to stop certain treatments due to financial strain and the inability to pay for treatments like massage therapy, psychotherapy, and certain medications. However, on paper, it will appear to Service Canada that you still have the potential to recover from your condition with the prescribed treatments that you have chosen to quit or no longer receive.
If your doctor or specialist has noted that you refuse to receive specific medications and/or surgeries that they believe would result in your recovery from your condition, no matter what reasoning has brought you to that decision, Service Canada will see it as your unwillingness to comply. They will believe that you still have the ability to recover, but by your own choice you refused treatment. In their eyes, this makes you ineligible for approval.
You may have decided to forgo regulated medical professional treatment in favour of naturopathic treatment. If this is the case, they will most likely deny your claim. While naturopathic doctors have vast knowledge and can provide you with natural treatments that might make you feel like you’re receiving better results than pharmaceutical treatments, Service Canada will say that you are not seeking a regulated medical professional within their guidelines and they’re allowed to deny your claim. We are not saying that we are in agreement with this; however, within Service Canada’s own legislation and guidelines for approval, they have the right to deny your claim.
Because Service Canada highly values the opinions of medical professionals, another big red flag is a documented history of you being argumentative, uncooperative or harassing towards your treating doctors. This makes you look bad — not only for getting your claim approved, but for receiving treatment and help from any medical professional moving forward. If there are notations in your file that reveal that you were fighting with your doctors or generally refusing to comply, they will proceed to investigate the rest of your medical documentation to see if this was a clash with one doctor, or if it is becoming a trend.
Medical professionals reserve the right to “fire” you as a patient for several reasons: if you do not comply with treatment; if you continue to resist and fight their findings; if you are harassing them or their staff for specific diagnosis or a written report in a timeframe of your own choosing that does not comply with their ability to do so. While sometimes doctors and patients just aren’t a match, there are certain patients who continue to exhibit this type of behaviour throughout all of their visits with several treatment providers. This usually indicates that the patient values their own opinion as more important than the professionals. When you actively butt heads with your doctor, not only can you ruin your ability to receive treatment, but your Canada Pension Plan disability claim will likely be denied as well.
What you can do about it
You need to demonstrate a good working relationship with your doctors. Ideally, you will be able to fix your relationship with your current doctors. If this is not possible, you will have to find new doctors that you can work with, although this is not always easy or possible to do.
Admit your mistakes, and go back and try the treatments that you haven’t tried. You will be more likely to get approved for disability benefits if you have made a good-faith attempt to get better.
7. Refusing to return to work
When a doctor confirms, based on your current symptoms, treatment, and condition, that you do indeed have the ability to attempt some sort of work or return to your role completely and you outright refuse, Service Canada will take the medical professional’s opinion over yours — every single time. If there is nothing on paper saying that you cannot return to work — the medical professionals are saying you can and you’re the only one deciding you cannot — they will deny your claim. They will always take the opinion of the individual with education and experience over yours.
While you may decide to not return to work for your own reasons, the Canada Pension Plan disability does not appeal claims and approve individuals that make those decisions on their own. While there may be valid reasons that you cannot return to the work that you were previously doing, they might believe that you could return to some other type of work elsewhere. Without a medical professional backing your refusal to return to work, Service Canada will assume that you can work somewhere and deny your claim.
What you can do about it
If you are absolutely refusing to return to work, you need to get thorough medical documentation to support your choice. If this means finding a new doctor because your family doctor thinks you can still work, then you will have to take steps to do that.
Need to appeal your claim? Download our checklist to see the exact steps we take when appealing a CPP disability denial.