I am on a roll today - must just be because it is in the last day of the year - and I am reflecting - or perhaps because I have had some time off from the office - and I have a lot to say!
There have been clients who have contacted me, who are appealing their Canada Pension Plan disability benefits and who are also clients of a disability insurance company. They may have disability coverage through work or they may have purchased it themselves - and if you read my blog you will know that Canada Pension Plan is typically first payer on any disability benefits. When clients contact me who need the help and they are insurance clients - I ask them if the insurance company has been forthright in giving them the medical information in their files in order to help them support their appeal. If they have not - I typically contact the insurance company to help facilitate this request.
Now most insurance companies are helpful - and why wouldn't they be? After all they have a very important stake in the outcome of an appeal - because all the back pay goes back to the insurance company (most times) and then the benefit they pay, is reduced by the CPP disability benefit. Some times insurance companies want to charge for photocopying - which I find a little cheeky.
Most insurance companies say that they have a "good working relationship" with HRSDC and CPP disability and that they have a good success rate in terms of getting benefits approved. I think the reason why is because insurance companies have the resources to fully explore a disability file - by that I mean they have the resources to send people to rehabs, to chronic pain clinics, for independent medicals, for functional capacity evaluations - all the typical medical and functional consults that establish whether disability exists. However, insurance companies still put the responsibility for applying for and appealing the denial on their client - I do not think most insurance companies are aware of the process and the challenges of making these applications - especially for brain-injured or clients who have problems with literacy as well as the added stress of dealing with this application with very little resources in terms of information about the process. In my opinion, the declining levels of service from the Feds due to cut backs is also making this process more challenging.
Then I got to thinking, you know what about those people who cannot afford to pay for these assessments - again another uneven playing field and another example of how lopsided this process is for average Canadians.
At DCAC I try as many ways as I can to get the necessary assessments to support a disability claim through as many resources as I can - but when a doctor in BC wants to charge $900 for a medical report - there are challenges for both me and my clients. When I am requesting medical evidence to support an appeal - I ask the doctor to advise me of the approximate cost of a report - and that helps me negotiate fees - however, doctors spend a lot of time doing paper work and need compensations - so it is a delicate line to walk. I also discuss any fees for medical reports with my clients so they are aware of the costs.
The CPP Adjudication guidelines state that an adjudicator must be "reasonably satisfied" that the disability exists - I explain that as any reasonable person who reads the information on file would agree that the appellant meets the legislative criteria. The Onus or Responsibility to establish disability rests with the applicant on balance - which means more likely than not - the appeal should succeed - it is not "beyond a reasonable doubt" which is what I think CPP requires.
Anyway, it is yet to be seen what is going to happen with the Social Security Tribunal as now more than ever information on paper is going to be critical in the appeals process. So being able to negotiate information from various sources and presenting them to the appeals body is going to be paramount.
In the new year I have a lot of things to do in terms of preparing for this new system - I am committed to ensuring that this website and my office become a resource for Canada Pension Plan applications and appeals - if you chose to use DCAC services or not - at least here you will find the information you need to help with your case and if you are denied CPP Disability benefits.
I am always available to answer questions - so send me an email or call.
As always, hang in there - and do not give up. Happy New Year.