Losing the ability to work as a result of disability can have a devastating impact on you and your family. It’s even more devastating if you don’t have access to disability benefits through your employment or private contract. Fortunately, the federal government has in place a disability regime designed to ensure those who are unable to work are still able to provide for themselves and their families. This regime is called Canada Pension Plan Disability (CPP-D).
Who is eligible for the benefit?
Canada Pension Plan Disability (CPP-D) Benefits are available for those who, as a result of disability, suffer a severe and prolonged inability to work. This is the disability test that an applicant must meet. Practically speaking, the disability must be one that prevents you from working long term or, worse, likely to result in death.
In addition to the disability test one must meet in order to receive CPP-D benefits, you must have also made the required financial contributions to Canada Pension Plan.
If you meet both parts of the test, you can make an application for CPP-D benefits.
What Happens if my application is denied?
If your initial application for CPP-D benefits is denied, not all is lost.
The first step you must take is to request a reconsideration of your denial. The request is made directly to CPP-D. The initial denial letter you received will indicate a timeline in which a reconsideration request must be made.
The request must be in writing and supported by additional medical documentation or other evidence that supports a severe and prolonged disability. The request for reconsideration is made directly to CPP-D and they will render a decision after reviewing any new evidence in support of your claim.
After reconsideration is completed, you will receive a letter with the decision.
What happens if my reconsideration request is denied?
If CPP-D continues to maintain the denial, the next step is to make an application to the Social Security Tribunal (SST).
The SST is an independent administrative tribunal that makes decisions on appeals for, among other things, denial of CPP-D benefits.
The process for applying for an appeal through the SST must be made within 90 days of the date you received the reconsideration decision from Service Canada.
The first document that you must submit to the SST is a Notice of Appeal. In addition, you will be required to provide supporting documentation including any medical reports, specialists’ reports, and evaluations.
From there, the SST will decide whether to proceed with the appeal in person, in writing, or over the phone. You can also make a request for the mode of hearing.
If the appeal proceeds in person, the hearing will proceed like a “mini trial”. The applicant files reports, presents oral evidence and makes submissions as to why they believe they meet the test for severe and prolonged disability. You have the right to bring a lawyer and it’s generally recommended you do so.
If the hearing proceeds in writing, the applicant simply makes written submissions to the tribunal. The decision maker will review the submissions along with the medical evidence and come to a decision.
If the hearing proceeds orally, it will take place over the phone and will run similar to an in-person hearing.
Once the hearing is completed, the decision maker will determine whether the applicant is entitled to CPP D benefits.
If the Tribunal finds that the applicant qualifies for CPP-D, the decision must be honoured.
Interactions with Long Term Disability (LTD) Benefits
It is commonplace for employees to have access to Long Term Disability benefits through work. LTD is similar to CPP Disability in that it is designed to provide an income for those unable to work as a result of disability.
Many LTD policies require a recipient of LTD to also make an application for CPP Disability Benefits.
If an applicant is approved for CPP-D benefits, the LTD insurer simply reduces what they are paying for monthly benefits by any monthly amount being paid by CPP-D benefits. In the end, the applicant receives the same amount but from two different sources.
Interactions between CPP-D and Accident Benefits
If you are injured in a motor vehicle accident, you are entitled to accident benefits through your auto insurer. Accident benefits include treatment costs, prescription medication costs, attendant care and other things.
In addition, if you are unable to work as a result of a car accident, your auto insurer will pay you 70% of your pre-accident income to a maximum of $400 per week.
If your injuries are more severe and likely to be prolonged, you may also be able to receive CPP-D benefits. If that happens, your auto insurer will adjust your income replacement benefit amount in order to avoid “double recovery”.
About the Author
Casey Dorey is an associate lawyer at Bergeron Clifford LLP. He works primarily in Kingston but travels across Eastern Ontario.
Casey obtained his LL.B from the University of Leicester, United Kingdom, with First Class Honours. While in law school, Casey was a Moot Court champion and represented the school externally in London, England. He was also awarded the Canadian Spring Scholarship.
He has appeared before the Ontario Superior Court of Justice, Small Claims Court, Criminal Injuries Compensation Board, and the Social Security Tribunal.