CPP Kit
Download the CPP Kit in MS Word format.
Introduction
Dear CPP Disability Applicant:
Perhaps the most important thing we can tell you is this:
YOU ARE NOT ALONE!
All of the professionals and persons with disabilities we talked to have told us that this experience can be intimidating, frustrating, and stressful. If you have felt this way at all thus far, you are simply among the majority of others who have applied for CPP disability benefits!
We realize that this procedure can be difficult. Our goal is to provide enough information to make the process of applying for CPP Disability benefits easier and less stressful.
The plain truth is that most people do not receive benefits after their first application. Unfortunately, this is often because of problems related to the applications, not because the applicants are not actually in need. The most common problems are failing to apply or appeal on time, and not being able to convey how disabling a disability really is.
By explaining the application process and providing insights from those who have experienced common pitfalls, we hope to make the process less stressful for you, and hopefully lead to earlier success.
Table of Contents
| Introduction | . . . . 1 |
| Table of Contents | . . . . 2 |
| CPP Contacts and Checklist | . . . . 3 |
| Eligibility | . . . . 4-5 |
| Application Documents Explained | . . . . 6-8 |
| Tips | . . . . 9-10 |
| Appeal Process Explanation | . . . . 11-14 |
| Letter to Friend/Family Member | . . . . 15 |
| Letter to Physician | . . . . 16 |
How do I contact Service Canada?
By telephone:
English: 1-800-277-9914
French: 1-800-277-9915
By mail:
Service Canada
P.O. Box 1687
Postal Station M
Halifax, Nova Scotia
B3J 3J4, Canada
How Do I apply for CPP Disability Benefits?
You must fill out the following forms (see below for explanation):
Application- Questionnaire
- Medical Report Form (filled out by doctor)
- Consent Form
- Child Rearing Dropout Provision (where applicable)
Once completed, send all the forms in the same package. It is recommended you send it by registered mail, to:
Service Canada
P.O. Box 1687
Postal Station M
Halifax, Nova Scotia
B3J 3J4, Canada
Remember to sign everywhere required, and include your SIN (Social Insurance Number) on every page.
Am I Eligible for CPP Disability Benefits?
In order to be eligible for Canadian Pension Plan Disability Benefits, you must meet Preliminary Eligibility requirements (see below, "PART A"), and your disability must be a "severe and prolonged" mental or physical disability (see below, "PART B").
PART A: "Preliminary Eligibility"
Answer the following questions to determine if you meet the preliminary eligibility requirements.
1. Are you under 65 years of age? Yes/No
2. Did you stop working because of a medical condition? Yes/No
(In other words, were you unable to continue working because of a medical condition?)
3. When you were working, did you pay into the Canadian Pension Plan for at least 4 of the last 6 years? Yes/No
- To find out if you have made enough contributions to CPP, contact Service Canada to find out (by telephone: 1-800-277-9914).
- If you became disabled before January 1, 1998, you must have contributed to CPP in either 2 of 3 years or 5 of 10 years prior to the onset of your disability.
If you answered "yes" to all 3 questions, move on to "PART B" (see next page) to determine if your disability is eligible for CPP Disability Benefits.
If you answered "no" to any of the questions, see if you fall under any of following exceptions:
- Stayed at home to raise children
- See Child-Rearing Dropout Provision
- Applied too late
- Separated
- You were unable to apply because of your disability
PART B: "DISABILITY"
In order to be eligible for CPP pension benefits, you must meet the following two conditions.
Your disability, whether mental or physical, must be BOTH:
- Severe
- Prolonged
Is your disability "SEVERE"?
What does "severe" mean?
- CPP defines "severe" as: a disability that makes "a person incapable of regularly pursuing any substantially gainful occupation."
Are you incapable of regularly maintaining ANY job? Yes/No
In order for your disability to be classified as "severe", you have to be able to prove that you cannot work in any job, not just the job you held prior to your disability. This does not mean that you can't find a job, but rather than you couldn't perform most jobs because of your disability.
Is your disability "PROLONGED"?
What does "prolonged" mean?
- CPP defines "prolonged" as: "such severe disability as likely to be long continued and of indefinite duration."
Will you be unable to return to work in the next 12 months? Yes/No
OR, is your disability likely to result in your death? Yes/No
Don't forget:
- Your application needs to be supported by a Medical Report from a doctor, who will have to confirm that in their opinion your disability is "severe and prolonged". You can have either your General Practitioner (GP) or a Specialist write the Medical Report.
If it is determined that your disability does not meet the requirements for BOTH "severe" and "prolonged" according to CPP standards, your claim will be denied - so it is very important that you and your doctor are able to establish these requirements through your application!
The Application Documents
1) Application Form
This form will ask some basic information to identify you and any children who financially rely on you (they may also qualify for benefits).
It is key that you fill out ALL information on this application as it is all mandatory.
You must also provide your original birth certificate, as well as the original birth certificates of your children. These will be returned. Or, you may send clear photocopies that are signed by a verifier (certified copies), such as your lawyer, dentist, doctor, or a police officer.
Don't forget to sign the form, and include your SIN number everywhere it is required!
2) Questionnaire
This is the most important form you will fill out - it is how the evaluator will determine if your disabilities are "severe and prolonged"
Be very thorough! Simply naming your diagnosis will NOT be enough to convince the evaluators. You must describe how your disability limits your ability to carry out day-to-day activities, hence making you unable to work.
Try not to feel crammed into the format of the questionnaire, and do your best to express the combined effects of your disability. For example, you may be able to stand up for a certain amount of time - but could you stand up for that much time after getting ready and traveling to work?
Remember that this is not confined to physical limits - try to explain how the pain you are going through affects your ability to focus and concentrate. These considerations will not be obvious or evident to evaluators, so you need to point them out, using them to your advantage.
While it is always good to keep a positive outlook, try not to 'camouflage' your disabilities. Avoid describing what you can do 'on a good day' and focus on your limitations during an average day.
We suggest having a friend or family member who knows you well to look over the form and ask them: "does this sound like me"? Preferably, ask someone who lives with you or knows the full impact of your disability.
3) Medical Report Form
Note: you may wish to give our included 'Letter to Physician' to your doctor to assist them with providing adequate information for your applications success.
Have your family doctor (or the doctor who knows your disability the best) fill out this form. You may also ask specialists to provide other documentation to help support your application.
Make an appointment specifically to discuss CPP disability benefits. It is a good idea to give the doctor specific examples of how your day-to-day life is limited. The information the doctor gives, needs to convey the same limitations as you have detailed in the questionnaire. So it is very important that your doctor understands how your disability affects your ability to work. The Medical Report is essential to the success of your application.
The doctor has the option of giving the form to you, or sending it in on their own. If the doctor decides to send it directly, it is recommended that you ask to have a copy made for your records.
Other documentation may be valuable to convincing CPP evaluators of your limitations. Ask your doctor what tests, reports, and so on, are relevant. Make sure your SIN is on each page of everything submitted.
4) Authorization to Disclose Information/Consent for Medical Evaluation Form
This form allows the CPP administration to collect personal information about you from various sources.
It also allows the CPP administration to require you to undergo a medical evaluation by a physician of their choice. During this process the questionnaire tips still apply.
5) Child Rearing Dropout Provision Form (where applicable)
This applies if you were caring for children under the age of seven during the time used to calculate if you have contributed enough to CPP to claim benefits (usually the six years before you stopped working). If so, you may eliminate the time you were providing care which will provide an advantage in the calculations.
Tips
- Try and keep on track of the progress of your application. While the process will be stressful, one of the most common pitfalls is the failure to respond within the required time! It is good to call for regular updates.
- A valuable tip is to keep a journal - record dates and subjects of phone calls, documents mailed, and so on.
Documents:
It is important to keep thorough records and copies of all documents you send and receive. It is a good idea to register your mail, especially to CPP (sometimes you can't afford not to).
You have a legal right to a copy of all your medical information even though you can't take it away with you. The doctor is allowed to charge a fee for copies.
Keep a photocopy of all the forms you send into CPP for your own records.
Dealing with people:
Remember that you catch more flies with honey than vinegar! While this is definitely a frustrating experience, others are going to be more willing to help you if you are considerate.
While remaining polite is necessary of course, it is wise to avoid being overly nice. For example, if someone from CPP asks you: "How are you feeling today?" you should avoid responding with a simple "Fine, thank you." This may suggest to an evaluator that you really are "fine." If they believe this is really the case, they will likely think you are perfectly capable of going back to work.
Doctors:
During the application process, it is best to stick to one doctor, preferably your family physician. This will be the doctor that knows you best, and will allow your claim to be the most consistent. That being said, we all know that all doctors are not always encouraging. So, if your doctor is absolutely unwilling to support your claim, it may be necessary to change physicians as a last resort.
Hiring a Lawyer:
You do not require a lawyer in order to be successful in your application. That being said, lawyers who are experienced with CPP claims are often well equipped to know how to make a claim 'sound good.' Having a lawyer also adds a degree of legitimacy to your claim.
Although the earlier-the-better, the most practical point at which to use a lawyer is after you have been denied and are having the decision reviewed.
If you decide to hire a lawyer, ensure it is someone who has experience with CPP claims.
Timing:
Rule of thumb: when in doubt, act as soon as possible! Failing to apply for reviews, or appeals, is one of the number one reasons for unsuccessful of CPP benefit applicants.
How do I appeal a decision?
- If your application for CPP disability benefits was denied then you might want to consider appealing your decision.
- Before you decide to appeal, make sure you understand the reasons why Social Development Canada (SDC) denied your application for CPP benefits.
- A common reason why people are denied benefits is because they did not make enough recent contributions to the CPP. Check to see if you made the minimum amount of CPP contributions required in order to qualify for a benefit.
- If you were denied because you did not contribute enough to CPP:
- Were there times when you did not work or worked less in order to raise your young children (while they were under the age of 7)?
- Did you live in a country other than Canada? If you did not make enough contributions into the CPP, and if Canada has a social security agreement with the country where you worked, international credits may help you qualify for a CPP benefit.
- Did you apply to split pension credits with your common-law partner or spouse when you were divorced or legally separated?
- Another major reason why people are denied benefits are because their disabilities are not severe and prolonged enough that they cannot work at their jobs or ANY other job regularly over an extended period of time. Note: if you do not meet both of these two criteria, you will probably not succeed on an appeal.
- If you were denied because your disability is not severe enough:
- Was any important medical information not submitted in relation to your application?
- Is your condition worse now compared to when you sent in your application for a CPP benefit?
- You can help by providing as much information as possible throughout the process.
Important things to keep in mind throughout the appeal process:
- There are 3 levels of appeals. You must start with the first level of appeal.
- At each level of appeal, you must appeal in WRITING.
- There are specific TIME LIMITS for making an appeal at each level.
- You are responsible for ALL INFORMATION to support your case.
- You can provide this information AFTER you send the letter regarding your decision to appeal.
- You can request a review of ANY decision made on your application.
- Make sure to send any new information to support your case to the Social Development Canada (SDC) or Office of the Commissioner of Review Tribunals (OCRT) (depending on what stage of the appeal process you are at), as the new information might result in the SDC reversing its decision.
STEP BY STEP GUIDE TO HELP YOU LAUNCH AN APPEAL
APPEAL PROCESS
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Step 1 - Request a reconsideration from Social Development Canada (SDC)
- Time limit to request a reconsideration from a decision of SDC: 90 days from the date you received the decision from SDC
- Form for your application: write a letter to SDC requesting a reconsideration of your application
- Contents of your application - Include the following:
- your name, current address and social insurance number;
- an explanation of why you want to have your application reviewed;
- any new medical or other new information that could affect the decision, today's date and your signature.
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Step 2 - Appeal to the Office of the Commissioner of Review Tribunals (OCRT)
- If you are unhappy with your reconsideration by the SDC, you may appeal to the OCRT.
- If your appeal is accepted, you will be given a "Hearing", which is your opportunity to present your case before a three-member Review Tribunal panel.
- Time limit to appeal reconsideration: 90 days from date of receipt of reconsideration letter from the SDC.
- Form for your application: write a letter to the OCRT or use the NOTICE OF APPEAL Form from the ORTC website (http://www.ocrt-bctr.gc.ca/forms/notapp_e.html) to prepare your letter.
- Once your appeal is accepted, staff from the ORTC will contact you with details on what you must prepare for the hearing, as well as where and when the hearing will take place.
- At least one month prior to your hearing, the OCRT will send you a SDC's document called the "Explanation of the Decision". This will provide you with detailed information related to your case, as well as the reasons your application and reconsideration were denied. This document will help you prepare for your hearing.
- Note: you can provide new information to support your appeal to the OCRT at any time before your hearing. Make sure to mail this new information in to the OCRT as soon as possible. The OCRT will send all new information received from you to the SDC. If SDC agrees that your new information supports your eligibility for a disability benefit, SDC can reverse its original decision. Depending when such information is received and investigated, a hearing may not have to take place.
- Also note that if the hearing location is far from your home, the OCRT will reimburse you for reasonable travel and accommodation costs.
- After your hearing, the OCRT will send a registered letter to you and SDC explaining the Review Tribunal's decision and the reasons for it.
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Step 3 - Appeal to the Pension Appeals Board (PAB)
- You must apply in writing requesting an appeal of the OCRT's decision within 90 days of receiving the OCRT decision letter.
- At this level of appeal, a PAB judge will review your request for an appeal and will decide whether to give you permission to present your case before the PAB.
- If the PAB judge decides not to hear the appeal, you and SDC will be notified by mail. This means that the decision made by the Review Tribunal is final and your appeal ends. However, you may request judicial review of the PAB's decision not to hear your case (see below, "Requesting Judicial Review").
- If the PAB judge decides that there are grounds to hear your appeal, you and SDC will be notified in writing. The PAB will then schedule a hearing date in your province at the next available opportunity.
- This is the final level of appeal, so the PAB's decision on your application will be final. You may however request judicial review of the PAB's decision.
Requesting Judicial Review
- You may request judicial review from the Federal Court of Canada. This must be done within 30 days of receiving notice of PAB's decision.
- The Federal Court of Canada will review how a decision was made by PAB, and whether PAB properly exercised its powers and applied the law correctly in its decision. If it decides that PAB did not, it will refer the decision back to PAB, ordering the case to be heard by different judges.
Letter to Friends or Family Members:
As a provider of moral support for your friend or loved one, it is important to remember not only the physical aspects of chronic pain, but the mental and emotional ones as well. On top of physical pain, a person with a long-term disability is also mourning the loss of a career and/or a way of life, along with the mental fatigue and depression of a physical disability.
In regards to CPP Disability benefit applications, your role may extend beyond moral support, such as helping keep correspondence logs.
Another valuable favour is to read over the application (especially the questionnaire) to ensure it reflects the actual limitations of the applicant. While it is good to be encouraging, being frank at this stage is key to a successful application. Do the descriptions really 'sound' like they match the extent of the applicant's limitations? A common problem is people describing what they can do 'on a good day,' which may, in the eyes of the CPP evaluators, be enough to sustain a job.
Describing the experience of limitations on paper is a difficult process. Your input could be extremely helpful in accomplishing this successfully.
If your friend or family member is UNABLE to complete the application by themselves, you may be able to complete the application for them. Contact Service Canada (1-800-277-9914) for further information.
Letter to Physician
Dear Physician:
In order to assist you in contributing to a successful CPP Disability Benefits application, we offer the following suggestions and tips.
Firstly, we would like to extend a respectful reminder that patients have a legal right to a copy of any medical document or file, for which you may charge a reasonable fee.
In order to be successful, a candidate must demonstrate a "severe and prolonged" disability that prevents him/her from maintaining any gainful employment. Therefore listing a diagnosis will be insufficient, as more descriptive details, which speak to the actual limitations, are required. In order to gain particulars of such requirements, please consult the recently amended guide for physicians. This is available from Service Canada by calling 1-800 277-9914, or online at www.hrdc-drhc.gc.ca/isp/pub/physguide_e.shtml.
If you feel another doctor (ie: your patient's family doctor or specialist) is better able to describe the limitations the patient experiences as a result of the disability, it is best to have the other physician fill out the Medical Report Form. However, this does not in any way, limit you from providing supporting documentation, reports, etc.
Finally, a warning on niceities. While being encouraging is undoubtingly helpful to your patient, including seemingly harmless phrases such as "on the right track" may raise detrimental doubts among the CPP evaluators, as to the necessity of the application.
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This project was made possible with the generous support of The Law Foundation of Nova Scotia.
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