Lawyers for Canada Pension Plan Disability Benefits_.

The Canada Pension Plan (CPP) includes disability benefits, created by the Canadian Government, to partially replace the income of eligible contributors under 65 who are dealing with a severe and prolonged disability. These benefits are different from what private insurance plans offer.

Applying for CPP disability benefits can be complex. If your application is denied, our lawyers are here to guide you through the process.

The steps to apply for CPP disability benefits may change based on individual situations. To help you navigate the application and appeals process, we’ve created a simple chart. Should you face a denial at any point, our lawyers are ready to offer the support you need.

CPPD Eligibility

Who is eligible for disability benefits?

The Canada Pension Plan disability benefits offer income replacement to individuals who meet the following criteria:

1. They are below the age of 65.
2. They have fulfilled the minimum CPP contribution requirement.
3. They have a severe mental or physical disability that prevents them from engaging in any substantially gainful work.
4. The disability is long-term and indefinite or is likely to result in death.

Substantially gainful work refers to a job that pays an amount equal to or greater than the maximum annual disability pension. In 2023, this amount is $18,508.36, before tax.

There are two types of CPP disability benefits available:

1. The disability pension: This is for individuals who have not yet retired or started receiving a pension.
2. The post-retirement disability benefit: This is for individuals who become disabled after retiring and commencing their retirement pension.

CPP disability benefits can supplement long-term disability (LTD) benefits provided by private insurance plans. However, most LTD plans reduce their payment by the amount received from CPP disability benefits.

If your medical condition is expected to be short-term, temporary, or does not meet the above requirements, you may be eligible for Employment Insurance sickness benefits instead.

What qualifies as a “disability” for CPP disability benefits?

The Canada Pension Plan (CPP) defines a “person deemed disabled” as someone with a “severe and prolonged mental or physical disability.” The CPP disability legislation specifies that a “severe” disability refers to any mental or physical impairment that prevents someone from engaging in substantially gainful work, including part-time work. “Prolonged” means a disability that is long-term and indefinite or is likely to result in death.

Under CPP disability rules, you can only receive benefits for up to 15 months before the date you apply. That means the most you can get in retroactive benefits is 15 months’ worth from your application date. If you apply and the decision takes six months, you could be eligible for up to 21 months of back pay, assuming there’s enough proof of your disability. If you’ve been disabled for five years but only apply today, you can only get benefits for the last 15 months.

However, there’s a catch: there’s a mandatory 4-month waiting period for retroactive payments, during which you receive no benefits. So, even though you might be owed 15 months of back pay, you’ll only receive 11 months of it.

Courts have interpreted the legislation in numerous cases, emphasizing that the definition of disability must be understood from a real-world perspective, including considering whether a real-world employer would hire a person given their disability.

In Villani v. Canada (A.G.), [2001] FCA 248, the Federal Court of Appeal determined that a “large and liberal” interpretation should be applied to the definition of severe disability, taking into account the legislative intention to apply the severity requirement in a “real-world” context. Factors like age, education level, language proficiency, and past work and life experience are all relevant considerations when evaluating eligibility for disability benefits.

In Inclima v. A.G. Canada, 2003 FCA 117, the court stated that an appeal for CPP disability benefits should be denied if the individual seeking benefits has not demonstrated sufficient effort to find and maintain employment. Additionally, the inability to work must be a result of the serious health condition.

The most important thing is to ensure you have medical evidence supporting your disability. A disability insurance lawyer can assist you in constructing the strongest possible case.

What contributions make someone eligible for CPPD?

In order to qualify for the Canada Pension Plan (CPP) disability benefit, you need to have made contributions to CPP for the Minimum Qualifying Period (MQP).

The MQP is typically four of the last six years, or three of the last six years if you have contributed to CPP for at least 25 years. The MQP is determined by a specific date, usually December 31st of the last year in which you met the MQP criteria.

The amount of your CPP disability benefit is based on your contributions. Your denial letter will indicate whether you have made sufficient contributions or not. You should provide this information when consulting with a lawyer so they can best evaluate your case.

Your disability must have been deemed severe and prolonged prior to the MQP date.

There are exceptions to the minimum requirements. For instance, individuals who were out of the workforce to raise children or those who were unable to apply due to physical or mental disability may still be eligible.

For further details regarding eligibility, you can refer to the Canada Pension Plan Disability Benefit – Eligibility section on the Government of Canada website.

CPPD Benefits

Why should I apply for CPP disability?

There are several benefits to applying for CPP disability benefits:

• Financial Assistance: CPP disability benefits provide financial support to individuals who are unable to work due to a severe and prolonged disability. These benefits can help cover essential expenses and medical costs during the period of disability.
• Long-Term Security: By applying for CPP disability benefits, you establish a stable and ongoing source of income, ensuring long-term financial stability while you are unable to work consistently.
• Enhanced Coverage: CPP disability benefits can supplement other disability coverage you may have, such as long-term disability insurance, providing additional financial protection and peace of mind.
• Support for Health and Rehabilitation: When you apply for CPP disability benefits, you gain access to resources and services aimed at supporting your health and rehabilitation. This can include medical treatments, vocational rehabilitation programs, and other forms of assistance to improve your well-being and potential for future employment, if applicable.
• Future Considerations: Applying for CPP disability benefits establishes a record of your disability, which can be valuable for potential future claims or eligibility for other programs and services related to disability support.

How much will I receive on CPP?

The Canada Pension Plan (CPP) disability benefit payment amounts vary based on individual circumstances. However, in 2023:

• The minimum monthly benefit payment is $558.74.
• The maximum monthly benefit payment is $1,538.67.
• The average monthly amount is $1,132.55.

The specific amount of your CPP disability benefit is determined by your contributions. For more detailed information regarding the potential benefit amount you may receive, please refer to the Canada Pension Plan Disability Benefit – How much could you receive section on the Government of Canada website.

Additionally, CPP disability benefits are subject to taxation. This means that the benefit is considered income for tax purposes.

CPPD Denial of Benefits

Why was my CPP application denied?

Some common reasons CPP disability benefit applications are denied include:

• Insufficient Medical Evidence: A lack of medical documentation to prove a severe and prolonged disability can lead to denial. Comprehensive medical reports, diagnoses, treatment records, and other relevant data are vital to the claim.
• Failure to Meet Eligibility Criteria: If you don’t satisfy specific criteria such as the minimum contribution period or the definition of a severe and prolonged disability, the application may be rejected.
• Incomplete Application: Missing information or documents can result in denial. Accuracy in completing all sections of the application and including all required documentation is crucial.
• Discrepancies or Inconsistencies: Inaccurate or inconsistent information can cast doubt on the validity of the claim, leading to rejection. Ensuring accuracy and consistency throughout the application is key.
• Failure to Cooperate: Unresponsiveness or failure to provide additional information during the review process can result in denial. Prompt and complete responses to any requests from the CPP authorities are essential.

If your CPP application has been denied, review the denial letter and seek professional advice from a lawyer who specializes in CPP disability claims. They can help evaluate your case, identify the reasons for the denial, and guide you through the appeal process if applicable.

What can I do if my CPP application was denied?

If your application for Canada Pension Plan (CPP) disability benefits is denied, you have the option to request a reconsideration. During this process, Service Canada staff members who were not involved in the initial benefits claim will carefully review your application, considering any new information or documentation you provide. If the reconsideration decision is also unfavorable, you can then proceed to appeal the decision to the Social Security Tribunal – General Division, which will involve a hearing. The next level of appeal is at the Social Security Trubunal – Appeal Division. In rare cases, if the application is still turned down by the Social Security Tribunal, denied applicants may have the opportunity to further appeal to the Federal Court or Federal Court of Appeal.

Common questions about CPP disability eligibility:

Am I eligible for disability benefits if I was working in another country?

If you have lived and worked in a foreign country, the contributions you made towards a retirement plan in that country may be considered when determining the minimum requirements for contributing to the Canada Pension Plan (CPP) for four of the last six years. The list of countries with which Canada has international social security agreements can be found on the Canada Revenue Agency website. For further information about these agreements and Canada’s international social security policies, you can refer to the following link.

Should I apply for CPP disability if I am working, going to school, or volunteering?

Volunteering or pursuing educational activities, whether to obtain a degree or retrain, does not impact CPP disability benefits. If you engage in paid work and earn up to $6,600 (pre-tax) in 2023, your CPP disability benefits will not be reduced. However, if your earnings exceed the allowable amount, it is important to contact Service Canada to inform them accordingly.

If you have resumed work for a period, but your disability prevents you from continuing to work, the CPP disability benefit can be automatically reinstated without going through the typical application process.

Should I apply for CPP disability if I am pursuing long term disability?

Receiving CPP disability benefits while pursuing a long-term disability (LTD) claim with a private insurer offers several advantages:

1. CPP disability benefits can be supporting evidence of disability in your LTD claim. While not legally binding on the court or your LTD insurer, the fact that the federal government has acknowledged your disability can be compelling evidence in your favor.
2. CPP disability benefits provide income to help you manage your financial obligations while you navigate the LTD case through the court system. This financial support can assist you in paying bills and covering your day-to-day expenses.
3. Some LTD insurance policies require that applicants apply for CPP disability benefits.

It is important to consult with a lawyer to understand the specific implications of receiving CPP disability benefits alongside your LTD claim and to ensure that you meet all the necessary requirements and obligations outlined by your insurer.

Common questions about CPP disability benefits:

Are CPPD benefits retroactive?

CPP disability benefits may include payments for up to 15 months before your application date, depending on when Service Canada determines you were disabled. But there’s a 4-month waiting period, so the most retroactive benefits you can receive is 11 months. This makes it essential to apply for benefits right after becoming disabled.

In short, retroactive payments are calculated based on when you became disabled, when you applied, and how long it takes to process your application.

Are CPPD benefits taxed?

CPP disability benefits are subject to tax, but these taxes aren’t automatically taken out of your monthly payments. If you want federal income tax deductions, you’ll need to provide the correct tax forms.

Each year, you’ll get a tax slip—either a T4 (for Canadian residents) or an NR4 (for those outside Canada)—showing what you received in CPP disability benefits. You must include this slip when you file your taxes to report your benefits accurately and meet your tax obligations.

If you’ve received retroactive benefits, you can choose to tax them in the years they were due, not the year you received them. This can help reduce the tax impact.

Are CPP disability benefits deducted from your injury settlement?

Yes, if you’ve suffered a disabling injury in a car accident, your CPP disability benefits will be subtracted from any amount that you receive for missed time from work. Many long-term disability policies also offset CPP disability benefits from the amount owed under the LTD policy.

This rule is designed to ensure fair compensation without overpayment. After a car accident, you can apply for CPP disability benefits to replace income lost from not being able to work. The Supreme Court of Canada has emphasized that compensation should be adequate but not excessive.

The core issue is whether future CPP disability payments should be subtracted from future loss of income awards. If not, and you continue to receive both, you could end up being over-compensated.

Traditionally, CPP disability benefits were guided by the collateral benefits rule, meaning that insurance benefits shouldn’t be subtracted from civil claim remedies. This seemed logical for CPP disability benefits since you would have been paying the premiums and should benefit accordingly. But current law in Nova Scotia allows future CPP disability payments to be subtracted from awards for future loss of income following a car accident.

Common questions about CPP disability denials:

How to appeal a CPP disability denial?

When it comes to CPP disability benefits, there are multiple levels of appeal available to you. These appeal levels include:

• Reconsideration
• Social Security Tribunal – General Division
• Social Security Tribunal – Appeal Division
• Federal Court or Federal Court of Appeal

The initial stages of the CPP disability process is largely completing forms and getting the information you need to appeal on your own. Once you’ve completed this step, we can step in to help.

Reconsideration
At the reconsideration stage, those denied CPP Disability Benefits make their appeal directly to Service Canada.

Here’s what you need to know about appealing at the reconsideration stage.

Step 1: Confirm that you are at the reconsideration stage

Step 2: Identify your reconsideration deadline and notify Service Canada

You must notify Service Canada in writing within 90 days of receiving your denial letter. State that you intend to appeal and will be sending supporting information. You can also fill out a request form on the Government of Canada website.

Step 3: Identify relevant documents

Provide new evidence to support your claim, such as information from your doctor, therapy notes, etc. The required evidence depends on your unique situation, so make sure to address each denial reason with specific proof.

Step 4: Write your appeal letter

Start with a sentence stating what you are appealing. List the documents you’re attaching and include their names and dates. Discuss any new information that may be relevant to your case, such as new treatments or diagnoses. Directly respond to each denial reason, explaining why it is no longer valid.

Step 5: Send your appeal letter and co-operate with Service Canada

After sending your letter, be prepared to cooperate with Service Canada, providing any additional documents or information as needed.

Remember, each appeal is unique, so tailor your approach to your situation. Keep your communication clear and focused to ensure the best chance of success.

**Important note: The Minimum Qualifying Period

The Minimum Qualifying Period (MQP) is a crucial part of CPP eligibility that you might see on a denial letter. It’s the minimum time you need to have paid into the Canada Pension Plan to qualify for disability benefits. Your denial letter will tell you whether you’ve met this requirement. Knowing this information can be essential when talking to a lawyer about your case, as it can significantly impact the outcome.

Why is MQP important? You must meet the disability criteria by the end of your MQP. For instance, if your MQP was December 31, 2018, your disability must be considered severe and prolonged by that date. If it only became so on March 15, 2020, you would not be eligible for CPP disability benefits. Understanding the MQP is key to assessing the strength of your case.

What are the deadlines for appealing CPP disability benefits denials?

If you’ve been denied CPP disability benefits at the initial level, reconsideration, or at the General Division of the Social Security Tribunal you have 90 days to appeal from the date you received their CPP denial letter.

Appeals filed after the 90-day deadline may be accepted by the tribunal if they are filed less than one year after the reconsideration letter was received and adequate reasons for the delay are provided.

Your Notice of Appeal must address the following:

1. Is there a reasonable explanation as to why you delayed filing your appeal?
2. Can you show that you always intended to file an appeal?
3. Is there an arguable case in support of your appeal?
4. Will the delay adversely affect anyone involved in the proceeding?

You have 30 days to apply to have your decision reviewed by the Federal Court or Federal court of Appeal.

How does a reconsideration appeal work?

During reconsideration, a different medical adjudicator will review the application and may seek additional information from you. It is your responsibility to provide any requested supplementary information. In some cases, the medical adjudicator may ask you to undergo an examination by another doctor. If this occurs, CPP will cover the expenses for the doctor’s fees and any necessary travel costs you incur.

How to proceed after a CPP disability reconsideration denial?

If your CPP disability benefits are denied at the reconsideration stage, you can appeal to the Social Security Tribunal. Here’s how the process generally works:

1. Submit a Notice of Appeal: You have 90 days after receiving the denial to complete and send a “Notice of Appeal.”
2. Get an Appeal Number: Once you send your notice, you’ll receive an appeal number for easy reference.
3. Send Additional Documents: You have a year from receiving the appeal number to submit any extra documents that support your claim. A skilled CPP disability lawyer can assist you in gathering the necessary medical evidence to strengthen your appeal.
4. Send a Notice of Readiness: At some point, your lawyer may suggest sending a “Notice of Readiness.” This means you’re ready for your hearing, and you won’t be able to submit any more documents. It must be done with caution and after thorough discussion with your lawyer. It will include your medical evidence and possibly a brief written by your lawyer.

Note: A brief is a legal document that explains your case, the issues involved, and why you should receive compensation.

The Hearing
Typically, a hearing for a CPP disability appeal will include you, your lawyer, and the judge, who is an independent member of the tribunal. It’s rare for the lawyer representing the denial side (known as a Minister) to be there.

About two months before the one-year deadline, the Tribunal will send you a “Hearing Information Form.” Both you and Service Canada must submit this form. Then you’ll get a “Notice of Hearing” that tells you if a hearing is scheduled.

During the hearing, the judge will ask you questions about your disability and its effects on your life. Though your lawyer will be with you, the answers and evidence must come directly from you.

You’ll usually get a decision within 20 business days of the hearing. It’s all or nothing: you’ll either be approved or denied.

In some cases, if your evidence is particularly strong, your appeal might be approved without a hearing.

Approaching the hearing
The hearing is a crucial part of the CPP disability process, allowing you to explain your limitations face-to-face.

Here are some guidelines for the hearing:

1. Be Detailed: Clearly and thoroughly explain your limitations. If something is relevant to your case, don’t leave it out.
2. Stay Focused: Follow the Tribunal’s direction and only discuss the matter at hand. You’re being judged on specific eligibility criteria for CPP disability benefits, not on a compassionate basis. Your task is to show the Judge why you meet these criteria.
3. Stay Calm and Respectful: Treat everyone at the hearing with respect. Keep emotions in check. If the Judge asks about weak areas in your medical evidence, understand that it’s not a personal attack. They’re simply trying to fully comprehend your situation to make a fair decision on your eligibility.

Approaching the hearing with clarity, focus, and respect can help you present your case effectively.

Why do I need a lawyer for my CPPD appeal?

A lawyer can be critical with CPP disability because in these cases back and forth settlement negotiations do not happen. You either end up with your CPP disability benefits or you end up with nothing. An experienced CPP disability lawyer can help guide you in terms of documentation that may be required to help overturn your denial and support you throughout the appeal process. Furthermore, the lawyer will help you prepare for the hearing, which for many can be a stressful process. After all, you want to ensure you have the best possible chance at success moving forward.

How does the Canada Pension Plan disability Social Security Tribunal work?

If you’re unhappy with the reconsideration decision for your Canada Pension Plan disability claim, you can appeal to the General Division of the Social Security Tribunal of Canada. Here’s how the process generally works:

1. File an Appeal: You must submit your appeal within 90 days of receiving the denial decision.
2. Submit Documentation: The Tribunal will send a letter with a deadline for you and the CPP to provide all relevant documents. It’s vital to include everything that supports your disability claim, such as medical reports or new information not previously submitted.
3. Review by the Tribunal: If the Tribunal feels the appeal has “no reasonable chance of success,” it can be denied without a hearing. If there is merit, a hearing will be scheduled.
4. Further Appeal Options: If you’re still dissatisfied with the decision made at the hearing or before, you have the right to appeal further to the Appeal Division of the Tribunal.

The process emphasizes timelines and the importance of submitting complete and relevant information to make your case. It may be beneficial to seek legal or professional guidance to navigate these steps effectively.

What kind of evidence helps with winning a CPP disability appeal?

Winning a CPP disability appeal relies on presenting strong evidence that showcases the severity of your disability and its effects on your life. Here’s what can make your case:

1. Medical Conditions: Evidence should illustrate the serious impairments, limitations, or restrictions caused by your medical condition, preventing part-time or full-time employment.
2. No Recovery Expected: Proof that additional treatments or specialist referrals won’t improve your condition to the point where returning to work is possible.
3. Supporting Documents: These can include:
   • Doctors’ reports
   • Physiotherapist evaluations
   • Receipts or notes from those assisting you due to your disability
   • Evidence of attempts to find employment despite your disability
   • Any other evidence showing your efforts to improve your situation.

Your lawyer, working with you, will gather this evidence to build the best case possible. Providing comprehensive and relevant information is key to a successful appeal.

Speak to a CPP disability lawyer

Hiring a CPP disability lawyer from MacGillivray Law can greatly benefit your claim. Our experienced lawyers have in-depth knowledge of CPP disability procedures, increasing the chances of approval. We will assess your case, gather necessary evidence, and handle all legal aspects, saving you time and stress. In the event of denials or appeals, we will navigate the process, enhancing your chances of success while protecting your rights. Our CPP disability lawyers provide expertise, advocacy, and support to ensure you receive the maximum benefits you deserve. Whether you’re located in Halifax, Moncton, New Glasgow, St. John’s or anywhere else in Atlantic Canada, contact our team today for your free consultation.