What Should You Do if Denied Canadian Pension Plan Disability Benefits?

Adjusting to life after an accident or illness can be difficult, especially after years of working for a living. If a disability has left you unable to work, you may be concerned about your ability to continue providing for yourself and your family. Fortunately, the Canadian Pension Plan (CPP) provides disability benefits for citizens who become disabled and no longer can maintain steady employment. Citizens of Ontario may be eligible for additional disability benefits through the province’s Ontario Disability Support Program (ODSP).

Applying for CPP disability benefits can be a long and frustrating process. If you have been denied CPP disability benefits, don’t give up hope! You may be able to appeal your denial, or you may qualify for your province’s specific disability program, like the Ontario Disability Support Program.

What are the Canadian Pension Plan Disability Benefits?

The CPP provides disability benefits in the form of monthly payments to citizens eligible for the program. This money is intended to replace the income lost after sustaining a disability.

CPP disability benefits do not include stipends or additional assistance for purchasing medications or medical treatments. If you need financial help to pay for your medical treatment, you may be eligible for supplementary benefits through Ontario’s Disability Support Program.

Who is eligible for CPP disability benefits?

A person may qualify for CPP disability benefits if he or she:

• Has a severe and prolonged disability
• Is younger than age 65
• Has contributed the required amount to the CPP program

In order to be eligible for CPP disability benefits, you first must have contributed the required amount to the CPP program during your working career. This generally requires that you have worked for at least four of the past six years, or three of the past six years if you have contributed to the CPP for more than 25 years. If you have not contributed the required amount, you will not receive benefits, regardless of your level of disability.

If you have contributed the required amount to the CPP, medical adjudicators will review your application to determine if your disability qualifies for CPP disability benefits. In order for your disability to be considered severe and prolonged, your injury or disease must be expected to last longer than a year or result in death. You also must be incapable of working at any job on a regular basis. The medical adjudicators are trained nurses who will analyze your medical records and consider factors such as your age, the nature of your condition and your work history when making their decisions.

How much money will I receive in disability benefits?

Persons who are eligible for disability benefits are guaranteed a minimum base payment of $471.53 per month, in addition to a supplementary payment determined by the amount you contributed to the CPP system while you were working. In 2016, the average monthly CPP disability payment was $933.82 per month, while the maximum payment was $1,290.81.

The amount you have contributed to the CPP will be documented on your Statement of Contributions. This statement is available for your review at your request, and you can challenge any errors you might find. The additional payment above the base payment of $471.53 will be calculated from the figures shown on your Statement of Contributions.

I’ve Been Denied Benefits. Now What?

There are three criteria that must be fulfilled in order to be eligible for CPP’s disability benefits, and therefore, three reasons why your application may have been denied.

First, you must be younger than age 65. If you are not, then you cannot receive the CPP’s disability benefits. However, you may be eligible for Old Age Security, which is provided to most Canadian residents older than 65.

Second, you must have contributed a certain amount of money to CPP while you worked. If you have not met the required contribution amount, you will not be able to receive CPP benefits.

Third, you must have a severe and prolonged disability. A medical adjudicator will review your application and medical evidence and will make a determination about the severity of your disability and your ability to work. Failing this criterion is a common reason applications for CPP disability benefits are denied.

CPP Disability Reconsideration

If you disagree with the medical adjudicator’s decision regarding your disability, you may request a reconsideration of that decision. A new employee will review your claim, as well as any additional information you provide, and will render a new decision. You must make a written request for a reconsideration within 90 days of receiving your CPP disability decision. Your request should include your contact information, your reasons for requesting a reconsideration and any new information that might be relevant to your claim.

Appeal to the Social Security Tribunal

If you have requested a reconsideration and do not agree with the new decision regarding your disability claim, you may appeal the reconsidered decision to the Social Security Tribunal (SST). There are two levels of the SST: the General Level and the Appeals Level.

The General Level is the first level of the SST. Your appeal to the General Level of the SST must be in writing and must be received within 90 days of the date of your reconsideration decision. There is a form on the SST’s website you can use to appeal, or you may write a letter explaining your appeal to the SST. You may have an lawyer represent you in your appeal.

The second level, or Appeals Level, of the SST hears appeals from decisions made at the General Level. Access to this level of the SST is not automatic; you first must request permission to appear in front of the Appeals Level, and the Appeals Level tribunal must agree to hear your case. As with the other levels, you may represent yourself in front of the tribunal or an lawyer or other representative may represent you.

Contact Our CPP Disability Lawyers Today

The calculations involved in determining your disability payment can be complicated, and mistakes can be made. Entitlements are also frequently denied.

If your CPP benefits have been denied, contact a lawyer in order to preserve your rights to appeal any negative decision. The Preszler Injury Lawyers is experienced with handling all levels of appeals and can guide you through the process of getting the benefits you deserve. Call 1-800-JUSTICE® today to set up a free consultation with one of the lawyers in our Ontario office.