Yesterday I worked with a client - her name is Heather.  Heather worked for 28 years as a cook in a retirement village.  She was a great cook, and was well liked by her co-workers and the residents of the nursing home.  At "happy-hour" time, Heather would work the bar and enjoyed catching up with her customers at the village.

Heather always struggled with her knees.  She had been on her feet for years and her knees were becoming more problematic.  Her employer tried to accommodate her as best as they could, but the kitchen and the bar are physical and eventually she could no longer continue.  In 2008, she was advised that she needed total knee replacements.  She had both knees replaced in 2008 and 2009.  The pain that she had in her hips and back were thought to have been radiating from her knees, was expected to resolve once she had the knee replacements and she was anxious to have the surgeries in order to get her life back. She was a golfer, enjoyed darts, and was a new grandmother. 

It was clear after the 54 physiotherapy visits after the surgeries, and the acupuncture, and the exercise and weight loss, and the medication, and her beloved Dr. Ho that she was not going to get back to her old job as a cook.  She was restricted by her physicians to 2-3 hours of work - 2 days a week.  She went back to her employer but they couldn't accommodate such a limited capacity to work.  She was broken-hearted and soon became depressed.  This lead to a number of other issues raising their head - more pain - more stress eating - more depression - limited sleep - the never-ending self-recrimination that she was unable to provide an income for her family.  She could not retrain, cooking was all she knew, and she had chosen that profession as in her words "book work never stuck with me"

She applied to Canada Pension Plan three times and was repeatedly denied.  She gave up after each denial as she was told she would get no where with the government.  She went on to have her hip replaced - and her back has serious degeneration due to arthritis.  She fights depression constantly and seeks mental health counselling.  She took injections in her back to see if that would help her pain.  She is on medication and she needs help to sleep.  And yet she continued to be denied.

A medical adjudicator from Canada Pension Plan called Heather and told her because the doctor said that she could work 2-3 hours, 2 days a week that she was indeed capable of working and that she did not qualify for a disability benefit. When Heather said that she could not work at the same level as  I am quoting directly from the file here the medical adjudicator who works for CPP says "Canada Pension Plan disability does not look at the level of earnings she could make, just whether or not she is able to work some type of job."

This statement is in fact misinformation and this case-manager knows that.  The reason why I know that, is because I have been doing this work for twenty years and I recognize the medical adjudicator on file.  The adjudication guidelines talk about what a substantially gainful occupation is - actually there is a policy outlining it - and there are the allowable earnings provision which reflects the fact that some people only have the capacity to work in a limited way - as was the case with Heather.  So this medical adjudicator ignored the guidelines to deny a claim. This misinformation was included in the denial letter, and made up part of the Minister's submission that they included to defend their position to continue to deny this claim right to the hearing date.

Sadly this is not an isolated incident.

Heather and her husband appeared at the Social Security Tribunal hearing and were able to explain how Heather's medical condition has severely impacted their life.  Because Heather could no longer work, her husband was working two jobs in his early seventies to make ends meet.  When Heather was asked by the Tribunal Member if she had anything to say in closing - Heather spoke about how she was misled by the government, how she had paid in to the program for 28 years, how she was reduced to tears by the medical adjudicator who spouted the misinformation, how this decision prevented her from enjoying her life, how she had to scrape by to get Christmas gifts for her grandchildren, how she had always contributed to her family, how she has to use all of her RRSPs in order to survive and now she is left with no retirement funds.  She spoke about the pain that she was experiencing, the fact that she had done everything she could to regain her ability to work, but that she was quite simply disabled.  She said that she finally felt validated that she had the opportunity to speak her piece to the Tribunal Member.

One of the recommendations that I have heard in my work on the CPP Disability Roundtable is that the government is suggesting that there be early intervention in that medical adjudicators contact appellants to speak to clients prior to making a decision.  I am opposed - the reason being - is for the type of situation that actually occurred in this file. Further, these calls are out of the blue, and most people find speaking with the government to be very stressful.  Heather explained she was on the back foot during this call - and was confused and stressed, and as noted "client weepy" by the medical adjudicator.  How about some compassion lady?

I received a call yesterday - from a client who has massive anxiety and panic attacks, PTSD, etc. This client was contacted by CPP out of the Chatham region (this is for the folk who are reading this blog from Gatineau).  When the client sad that she could not speak to the medical adjudicator without her advocate present - the case-manager demanded that she talk to her - and eventually the client hung up.  She phoned my office in a full blown panic attack - had to call her psychiatrist after the call.  I am still getting the details to share as she does not remember the name of who it was that called her - but I will get there and share this information.

Anyway, it is Friday - and happy weekend to you all.  Please if you need help, contact the office as we are here to help.  Our expertise gets results.



Social Security Tribunal Appeal Time Lines

If you are denied at reconsideration and you find yourself appealing to the General Division of the Social Security Tribunal you are going to be in for a lengthy wait before your appeal is heard.

The average throughput time for an appeal hinges on a variety of contributing factors including the complexity of the appeal - but the majority of the clients will wait 517 DAYS

That is almost seventeen months which is outrageous in my opinion.  Can you imagine that you have made an application to CPP disability - it takes 4 months for a decision - you are denied - then you request an appeal and it takes another 6 months - so you could be waiting over two years before a final decision is rendered.

DCAC has close to 90 percent success rate.  CPP disability denies over 50% of initial applications.  This statistics identify why it is important to get help as soon as you can in the application process to avoid these types of delay and to have a much greater chance of being successful.


Review of the Social Security Tribunal

It has been a busy six months with a lot of work to be done here at DCAC Inc.  We continue to be the premier service for individuals who have been denied their CPP disability benefits or who need help with the application process.  We now have 12 staff members across Canada and we continue to grow.

Early this year the KMPG report was released.  This report was commissioned by Minister Duclos in order to review the SST's processes to ensure it met the needs and expectations of Canadians, as well as to assess its fairness and transparency.   The comprehensive report highlighted a number of facts which I will present over the next months, to inform Canadians about what is new and evolving in the Canada Pension Plan disability forum.

I have included several newspaper articles on the DCAC Facebook feed as this is more timely than my ability to blog sometimes!  If you have not liked the DCAC page - you will find a link to it on the website.

I would like to start with a summary of the Key Findings - overall the review found that:

  • The SST was born out of the previous government's initiative to save $25 million dollars and was announced in the Federal Budget without the benefit of any stakeholder engagement.  The SST inherited a large backlog of appeal cases before they had staff, systems, or processes in place.
  • The total cost of the SST is lower than the cost of the four legacy tribunals that were combined.
  • Timelines for appeals are longer than the previous system and the average person waits over 500 days for their appeal to be heard.
  • Examination of the appeal structure and the enabling legislation and regulations that were designed to expedite appeals have had the unintended consequence of slowing down the process and frustrating clients.
  • The public consultations undertaken in order to produce the KPMG report - consistently identified dissatisfaction with the accountability of the SST and more is required to support a transparent, accountable tribunal.
  • The government recognizes that social programs must be designed and delivered with a focus on the client - and the SST currently does not incorporate many of the leading practices of a client-centric organization.

There was unanimous agreement that the goal of the SST appeal system should be to serve vulnerable Canadians through a far, objective, and responsive appeals process and that achieving this goal will require a "resetting of the SST" shifting from a primary orientation to the law - towards a greater orientation to the client.

What does this mean?  Well the findings have illustrated that there needs to be changes to the appeal system - and as I blog over the next while I will share with you my experiences with the SST, with the reconsideration appeal process, and with the application process.  I will provide information about the recommendations of this report and highlight individual cases and how they fit in to the recommendation for changes that have been presented to Minister Duclos.

At this time, there has not been a response from the Minister on this report - and we do not know what recommendations will be followed.  I do have several issues with the current SST appeal system specifically concerning access to justice issues.  A right to appeal is meaningless if an appellant cannot navigate the appeal process - and I will talk about this moving forward.

If you are denied CPP disability and you need help appealing please get in touch with our office.  We will be able to guide you and in most cases achieve a successful result on your behalf.  I am very proud of the work that we do here - so much so - that DCAC has been nominated for two business excellence awards in the customer service category and business of the year for 2018.  As well, March marks DCAC's 20th anniversary so it has been great to be acknowledged.