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Why CPP Disability Claims Are Denied And What To Do Next

May 23, 2019

Why CPP Disability Claims Are Denied And What To Do Next

Why CPP Disability Claims Are Denied And What To Do Next

From Visually.

The Canadian government has many programs designed to assist citizens who suffer from severe injuries or disabilities. Among these programs is the Canadian Pension Plan, or CPP, which provides financial assistance to Canadians who are unable to make a gainful living. If you think you need the monetary support offered by CPP, here are some details that you should know:

What Is The Canadian Pension Plan?

The Canadian Pension Plan protects its contributors and their family members by providing them with income replacement for when they retire, become disabled, or pass away. Except for those who are in Quebec, most people who work in Canada are contributors to the CPP. Contributors are generally entitled to the following benefits:

  • Children’s benefits – If the contributor becomes severely disabled or pass away, the CPP children’s benefit would provide monthly allowances to their dependent children.
  • Disability benefits – If you are both under 65 years old and are suffering disabilities that disallow you from making a gainful living, you may receive monthly benefits from the CPP.
  • Retirement benefits – As a CPP contributor, you will receive your full CPP retirement pension when you hit 65 years of age. You can opt to receive your pension when you reach the age of 60, but with a permanent payment deduction, or at age 70, with a permanent payment increase.
  • Post-retirement benefits – If you are receiving your CPP retirement pension, are under the age of 70, and are continuing to work, you can still contribute to the CPP. These contributions will go toward a post-retirement benefits plan, which will increase your benefits when you fully retire.
  • Death benefits – If you are a CPP contributor and you pass away, your contributions will provide a one-time payment to or on behalf of your estate.
  • Survivor’s pensions – When you pass away, your common-law partner or spouse will receive a pension.

In addition to the benefits enumerated above, there are other provisions included in the CPP to maximize your benefit:

  • Child-rearing provisions – If you become unemployed or have insufficient income while raising your children, you may take advantage of the CPP’s child-rearing provisions to increase your benefits.
  • Pension sharing – Your spouse or common-law partner may also enjoy the retirement pension that you receive from the CPP.
  • Credit splitting for separated or divorced couples – If you and your spouse or common-law partner share contributions during the time you were together, these can be divided equally after a divorce or separation.

Contributors who become disabled while receiving their retirement pension may benefit from the CPP post-retirement disability pension

What Disability Benefits Are Covered Under The CPP?

The CPP disability pension is a monthly allowance provided by the CPP to people who are unable to work due to a disability or injury. This is designed to provide partial income replacement to eligible contributors to the CPP.

There are two disability benefits that CPP contributors may be entitled to:

  • The disability pension is for contributors who meet the eligibility criteria and are not yet receiving a retirement pension under the CPP.
  • The post-retirement disability benefit is given to contributors who become disabled or injured after they begin receiving their retirement pension.

Furthermore, the dependent children of the contributor who has become disabled or severely injured may be eligible to receive a certain amount monthly, until they reach the age of 18 (or 25 if they are full-time students).

Who Is Eligible For CPP Disability Benefits?

Solely being an injured contributor does not immediately make you eligible for disability benefits under the CPP. To qualify, the following additional conditions must be met:

  • Qualified contributions – The applicant must have been making contributions to the Canadian Pension Plan for at least four of the last six years (with minimum levels of earnings in each of those four years) or at least three of the previous six years, if the applicant has at least 25 years of contributions to the CPP.
  • Eligibility – The applicant must be able to demonstrate that they are unable to make a living or earn a livable income due to their physical or mental disability.

Your disability must be significant and prolonged to qualify

Additionally, you can only claim CPP disability pension if your injuries are severe and prolonged. These are defined as follows:

  • Severe – means that your mental or physical disability stops you from performing any productive work that can provide you with an income or from “pursuing any substantially gainful occupation.”
  • Prolonged – means that the disability is long-term and curing it may be an impossibility, or it is likely to result in death.

The “severe” and “prolonged” criteria must both be simultaneously present at the time you apply for disability benefits. Note that qualifying for other disability benefits under other government programs or from private insurance providers is not an assurance that your application for CPP disability benefits will be granted.

About 60 percent of CPP disability claims are initially denied

Common Reasons for Denial of Disability Benefits Claims

About 60 percent of the claimants for CPP disability benefits are initially rejected, mainly due to insufficient paperwork and proof of unemployability and the lack of medical information of the applicant. Other reasons that many qualified Canadians are not enjoying their CPP benefits are:

  • Missing the deadline for appeal – You only have 90 days after you receive the decision for your application to contest a denied CPP disability benefits claim. Although late appeals are sometimes permitted, you must have a good reason for missing the deadline.
  • The applicant is unable to explain their disability – Many applicants are not able to sufficiently explain their limitations and how their disability prevents them from working by either under-reporting or over-reporting.
  • The claimant gives up after their application is denied – Many CPP disability claims are initially denied. Unless the reason behind the rejection of your application is technical, such as insufficient contributions, it is advisable that you appeal the decision.

Appeals must be made in writing

What To Do If Your Claim Is Denied

If you are a contributor to the Canadian Pension Plan and are disabled as defined by the CPP but your disability benefits claim has been denied, you have the right to appeal the decision. Note that all appeals must be made in writing. Here are the steps to be taken to appeal a denied claim:

  1. Once you receive the letter of rejection of your CPP disability benefits from Service Canada, request for reconsideration within 90 days from the time you receive the decision. Submit your appeal to the Minister of Employment and Social Development Canada (ESDC). If your request is approved, a different ESDC staff will assess your case for eligibility.
  2. If your request for reconsideration is denied or if you are unsatisfied with the decision made by ESDC, you may appeal to the General Division of the Social Security Tribunal. The tribunal has two divisions: the General Division, which handles CPP appeals, and the Appeal Division, which handles appeals of the decisions made by the General Division.

If you are requesting that a denied CPP benefits claim be reconsidered, here are what you can do for a successful appeal:

  • Stay in contact with the CPP – Be sure to keep the CPP updated and make sure they have your correct contact information like your phone number, email, and mailing address. If you’re waiting for medical results and reports from your doctor, inform the CPP.
  • Supply all missing documents and information – If the reason for the denial of your initial application is that there are missing information or documents, be sure to supply them all. Also, correct all errors flagged in your initial application.
  • Meticulously keep a paper trail of all communications with the CPP – Keep a copy of all communications between you and the CPP as well as copies of all reports that you submit to them in connection with your CPP disability benefits claim. Keep a record of the date and time that you talk to them via the phone.

If you are having difficulty with your claim, get help from an expert

When dealing with the CPP, the slightest error in the information you give them can lead to the rejection of your claim. To avoid this, have someone familiar with the process review your applications and the documents you submit.

If you are having a challenging time with your CPP disability benefits application, call a personal injury lawyer for assistance. Michelle Linka Law is a Whitby personal injury lawyer who is highly experienced in fighting for those who have been injured and disabled in accidents. Call us at (416) 477-7288 to make an appointment.

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