Know what is involved when applying for CPP disability benefits

By Paul Russell, LegalMatters Staff • People suffering from a disability that prevents them from working may be entitled to receive Canada Pension Plan Disability Benefits, with their likelihood for approval increasing dramatically if they follow the right steps, says Toronto paralegal Joyann Oliver.

“The process of proving eligibility for the benefits can be overwhelming, so anyone can call us for advice before they start,” says Oliver, co-founder of JNR Legal Services.

“Or if people want to try to do it themselves, but are then denied benefits, we will be happy to provide guidance so that they are in a better position at the reconsideration stage,” she tells LegalMattersCanada.ca.

In order to be entitled to CPP disability benefits, Oliver says applicants must:

• be under the age of 65,
• have contributed to CPP for four of the last six years prior to becoming disabled, and
• suffer from a severe and prolonged disability that prevents them from returning to work or obtaining a job that they are reasonably qualified for by way of education and/or training.

“If they don’t meet these criteria, the application will be rejected,” says Oliver, adding the disability can be either physical or psychological.

The first step is to apply directly to Service Canada, she says, by completing an application form accompanied by a medical report from a doctor.

Be cautious with your wording

“As you complete the application form, be careful not to use certain words, such as ‘can’t’ or ‘unable to,’” Oliver says. “Those words seem to imply that you are completely incapacitated.”

Instead, she advises using terms such as “performed with difficulty” or “requires assistance” in their place.

“For example, instead of saying, ‘I can’t walk up a flight of stairs,’ say ‘I find it difficult to climb stairs,’ or “I need rest after climbing stairs,’” Oliver says.

If applicants claim they can’t do something, but later it is found out that they can perform the task, that inconsistency will be noted when an adjudicator is making a decision on their claim, she says.

Providing the appropriate medical records is also important, Oliver says.

“Include only documentation that is relevant to your disability,” she says. “Unless a lab test or the blood work supports your claim for disability benefits, don’t burden Service Canada with those records.”

When requesting a medical report from a physician, she says it is essential the document covers these eight points:

• What is your prognosis?
• What is the doctor’s diagnosis?
• What are your limitations and restrictions?
• How are those limitations and restrictions related to your diagnosis?
• How do these limitations prevent you from obtaining or maintaining any form of gainful employment?
• Is your disability severe and prolonged?
• What treatment was prescribed?
• Have any of these treatments provided any benefit for you?

If you are suffering from chronic pain, it is important the medical documentation does not come from your family doctor, but instead from a chronic pain specialist, Oliver says.

 “A report issued by an expert at a chronic pain clinic will provide more detail and will carry more credibility than a report from a family doctor,” she says.

If the initial application is rejected, Oliver says applicants have 90 days to seek a reconsideration, again with Service Canada.

“Do not resubmit the same medical documentation,” she says. “Instead, ask your doctor for a fresh medical report, or ask your physician to refer you to a specialist, who can provide that report.”

Detail how your life has changed

Oliver says it is beneficial to provide Service Canada with a letter stating how your life has changed because of the disability.

“What were you doing before, in terms of sports, going to the gym, social activities, or community involvement, etc.,” she says. “Also list what activities you can still do, but with difficulty. Show how your life has changed.”

Oliver says Service Canada will review the documentation and make a decision on your eligibility.

The initial denial letter from Service Canada provides a Minimum Qualifying Period (MQP) date, she says, and it is important that applicants prove they are disabled from that date forward.

“When you get an updated medical report, the doctor should state something along the lines of, ‘In my opinion, this patient has been disabled as of (the MQP date), and has been unable to engage in employment since that date,’” Oliver says. “It is very important that your doctor recognizes that MQP date and states you were disabled either before or as of that day.”

If disability funding is denied a second time, applicants have 90 days to appeal that decision to the Social Security Tribunal of Canada, she says.

Those receiving long-term disability payments will likely be told by their insurance companies they must apply for CPP disability payments since that will reduce the monthly amounts the insurance firm pays out, Oliver says.

Similarly, those applying to the Ontario Disability Support Program should also request CPP disability benefits, she says.

Oliver invites anyone with questions to contact her for a consultation.