When clients call my office I ask them why they have been denied CPP disability benefits. Believe me I get a wide range of answers - some I would not repeat, but mostly people do not know why they have been denied. They say to me, I have a disability, I have paid in to CPP disability - so why don't I qualify? I am writing this blog post because I think it might be helpful for people out there to understand the CPP disability language.
As you know you have to meet three criteria in order to qualify for CPP disability benefits; your disability has to be severe, it has to be prolonged, and you have to have made sufficient contributions in a particular number of years.
CPP Disability is assessed using an ADJUDICATION FRAMEWORK - this document (you can find it online just google) outlines the policies used to determine medical eligibility of applicants for the CPP Disability benefit. It became effective in May, 2004. Now in my opinion this document is not followed very carefully by CPP Disability adjudicators - but it is out there for people to review and can be helpful when putting together your submissions.
The DATE OF APPLICATION is the date that CPP disability application is received by the Feds. This is important as when there is eligibility for retroactive payments the amount is calculated from this date. DATE OF ONSET is the date a person is determined to be disabled for CPP disability purposes. This date can be no more than 15 months prior to the receipt of the application. Payment begins from the fourth month following this date.
In order to qualify you must be under age 65. If you have applied for your early retirment at age 60 - there are another set of rules that you may fall under - I have blogged about this previously.
Your disability has to be SEVERE - which means you must have a mental or physical disability that regularly stops you from doing any type of work (full-time, part-time, or seasonal), not just the work you usually do. The formal definition can be found under Section 42(2)(a) of the CPP legislation. As well your disability has to be PROLONGED - which is long-continued and of indefinite duration.
There is an ALLOWABLE EARNINGS which is a client's total earnings from all work in a calendar year that is equal to or less than the Disability Basic Exemption. A CPP disability beneficiary is allowed to earn around $5000 per year without a requirement to report earnings from employment and without being reassessed on earnings from employment alone. (check with CPP to find out the exact amount).
BENEVOLENT EMPLOYER is someone who will vary the conditions of the job and modify their expectations of the employee, in keeping with his or her limitations. The demands of the jobs may vary, the main difference being that the performance, output or product expected from the client are considerably less than the usual performace from other employees. If you read some of my prior blog posts you will see clients that I have worked with who had benevolent employers.
CPP Disability are not supposed to rely on medical diagnoses alone but rather the assessment of FUNCTIONAL LIMITATIONS. A functional limitation is an impairment that leads to a less than normal performance for an individual. The focus of CPP disability is only on those functional limitations that affect the capacity to work. Question 22 of the CPP disability application is where you would list your functional limitations - think about these carefully - they are very important - on the website is an application guide, review for helpful tips.
In applying for CPP disability, the applicant has the ONUS OF PROOF. This means that the person or representative acting on behalf of the person, must provide the necessary documentation to satisfy the Feds that he or she meets the "severe" and "prolonged" criteria.
The PRIME INDICATOR when determining eligibility for CPP Disability is the medical condition. This determination is based on the nature of the medical condition, functional limitations, impact of treatment, and medical statements from your health practitioners.
The CPP disability medical adjudicators must be REASONABLY SATISFIED that is - is it more likely than not this person's disability makes him/her incapable of regularly pursuing any substantially gainful occupation? If the standard of reasonably satisfied is met -than the application or appeal should be granted.
SOCIO-ECONOMIC CONDITIONS - the availability of certain types of jobs in a particular location, lack of child care or elder care, family responsibilities, or preferred working hours, factors that exist in society which are outside the context of an individual with a disability are not considered when determining severe and prolonged.
SUBSTANTIALLY GAINFUL OCCUPATION is an occupation where the remuneration for the work performed reaches a certain benchmark for earnings that likely indicates whether a person is showing regular capacity for work. The SGO is the maximum monthly CPP retirement pension x 12 months.
Most people are denied because CPP disability will argue that they have the capacity to perform some type of work suitable to your limitations - but remember these definitions - and it will help you answer questions when the CPP adjudicators do their EARLY CLIENT CONTACT calls. These are telephone calls made by CPP departmental representatives at the initial application and reconsideration stages. No less than two attempts to contact the client are to be made for a rapport and decision call. The rapport call is to inform the client of the process and the required documentation. The decision call is to explain the reasons for the decision and the appeal rights. I find that these calls can be very manipulative - if a client does not know the CPP language then often times the adjudicators can manipulate answers of clients which then go on to be used as a reason to deny. I am not saying someone should fabricate the truth here - but you have to watch what you say. The adjucators in my opinion (although very nice people) have a job to do - and in my experience - that is to deny benefits.
Understanding the CPP disability language is important - especially now with the CPP SOCIAL SECURITY TRIBUNAL looming in the future - do yourself a favour and get educated on the process and procedures. Or contact our office and we can help advise you on the lay of the land.