Always appeal refusal of CPP disability benefits

If CPP turns down your application for disability benefits, don’t give up. Over 60 per cent of appeals to the Office of the Commissioner of Review Tribunals are successful.

 The CPP disability benefit is a monthly benefit available to people who paid into CPP and then became unable to work at any job because of a disability. There are also benefits for children (paid to full time students until age 25) if at least one parent qualifies for the CPP disability benefit.

The CPP definition of disability is more stringent than private (individual or group)  long-term disability programs which generally specify you must be unable to work at your own occupation. Private insurers will typically require you to apply for CPP disability benefits and deduct any CPP benefits from your LTD cheque.

 If your application for CPP disability benefits is turned down, there is a three stage appeal process.

1.   A request to Service Canada for reconsideration.

2.   An appeal to the Office of the Commissioner of Review Tribunals (OCRT).

3.   An appeal to the Pension Appeals Board.

 At each level you have 90 calendar days to send in a letter appealing the earlier decision.

Mike Moreland is a former CPP staffer who has  represented several hundred disability claimants at all levels of appeal. Data he obtained as a result of a Freedom of Information request reveals that in 2006/07 only one-third of requests for reconsideration were granted, but 63 per cent of OCRT appeals were successful. He believes little has changed since then.

Why are so many people successful on second level appeals?

 Additional more complete medical documentation typically turns the tide when an applicant goes before the appeal panel, says Moreland. Many OCRT appeals are also  successful because for the first time, applicants come face-to-face with the people considering their claim and can fully explain their situation. 

For example, the onus is on the disabled person to do everything he can to return to health. But the panel may accept that the claimant had no insurance coverage for physiotherapy and simply couldn’t afford to pay for treatment.

CPP disability benefits are paid until age 65, and then the regular CPP retirement pension kicks in. Because maximum CPP disability benefits ($1,153) are higher than the maximum monthly CPP retirement pension ($960), if you becomes disabled before age 65  you will be better off if you can collect CPP disability benefits than if you apply for a reduced, early CPP  pension. In addition, once a disability benefit begins the CPP contribution period stops, which protects the value of your CPP retirement benefits at age 65

CPP will not pay more than 11 months of retroactive disability benefits from the date of an initial application, so it is important to apply as soon as possible. Additional supporting medical reports can be sent in within three months.

Service Canada has an application kit for CPP disability benefits and the appeal process is explained here.