Lupus Canada Advokit

Canada Pension Plan (CPP)

To apply for a monthly federal disability pension, an individual:

• must be considered disabled according to CPP legislation;
• must be between 18 and 65 years old;
• at the time that he or she became disabled, must have contributed to CPP in four of the last six years, unless there are extenuating circumstances;3

(If you have contributed to both CPP and QPP, your contributions will be combined. Applicants who reside in Quebec at the time of applying for benefits will apply to QPP: all applicants from other provinces apply to CPP-Disability.)

You should apply in writing for benefits when you believe that your disability prevents you from working regularly at any job. The application must be in writing. If you are unable to apply on your own, another person can apply for you. For an application kit, you can call free of charge to (English) or (French); TDD/TDY: . The kit contains the information and instructions you will need to apply and tells you what documents you need, such as proof of birth. The kit also contains:

• A basic application form for you and your dependent children to complete, including name, address and other vital statistics.
• A questionnaire about your health, education and work history.
• A consent form to be signed by you, allowing CPP staff to contact other sources to support your application.
• A medical report to be completed by your doctor. If you have more than one doctor, choose the one who knows the most about your main medical problems. Along with this will be an envelope for your physician to return the medical directly should they wish.
• Documentation to verify your legal status in Canada.

When the application is received, it will be reviewed to make sure it meets the criteria for contribution and the definition of disability. Sometimes CPP asks individuals to have a medical examination by a physician it chooses, in order to verify medical findings and limitations. This will be paid for by CPP.

Payments generally begin about four months after CPP determines you to be disabled, so it is important not to delay making an application. The amount an individual receives is calculated on the amount contributed and the number of years of contribution. As previously noted, you must have contributed in four of the last six years, unless there are extenuating circumstances noted on the previous page. The maximum CPP-Disability benefit in 2005 is $1010.23 per month. Each January this is reviewed and adjusted if there is an increase in the Canadian cost of living index. Cheques are sent/deposited within the last three banking days of each month.

CPP-Disability does not pay for medication or transportation nor does it subsidize rental costs. If your health improves and you are able to return to work on a regular basis, CPP may offer you a three-month trial work period. During this time you will continue to receive CPP benefits. If you are able to continue work beyond the three months, your CPP-Disability benefits will be discontinued. If you are working but not on a regular basis, you can earn up to $4100.00 in a calendar year without informing CPP and losing your benefits. You must inform CPP if your earnings are more than $4100.00. They will want to talk with you about your personal circumstances, medical situation, work capacity and pattern.

Other benefits that CPP-Disability offers include a monthly benefit for children of a disabled parent, a survivor benefit including a lump sum death benefit for funeral expenses and a pension for surviving spouses and children.

Definitions of Disability
It is important to realize that "disability" is defined differently for various entitlements. For the Canadian Pension Plan, an applicant must prove that:

1. The disability is severe: because of the disability, the person must be incapable of regularly carrying out any paid work.
   
   
2. The disability is prolonged: likely to continue for a long and indefinite period or likely to result in death.

The definition used by CPP-Disability is different from that used by many other government programs. It may be more difficult to satisfy the narrowly defined criteria of "severe", "prolonged" and the inability to perform any gainful occupation. Decision-makers consider the individual's personal circumstances in deciding whether the disability meets the above criteria. For that reason, it is important that the application and any future correspondence refer to the person's work history, age, gender, education, etc.

If approved, you will receive a Notice of Entitlement letter indicating the date the benefits will start, the monthly entitlement, any retroactive payments you are eligible to receive as well as your rights and responsibilities. Retroactive payments can be paid to a maximum of 12 months. Generally the first payment is received within 30 days of approval. It will take approximately four to six months for your application to be processed and approved.

Some people have their eligibility to continue to receive CPP-Disability benefits re-assessed. To continue to qualify for benefits under this program you must be under 65 years of age, and your disability must be considered severe and prolonged. CPP-Disability will periodically review your file to verify that you have not regained the capacity to return to work. You may appeal a decision you do not agree with. If an application for CPP disability benefits is refused, it may be because decision-makers felt that criteria of a severe and prolonged disability were not met or that you have made insufficient contributions to the Plan. You will receive a letter explaining the decision. A denial of benefits can be appealed. You have 90 days to request, in writing, a review of your application. A doctor's letter should accompany each appeal. While there is no required form for a doctor's letter in support of an appeal, the format suggested here could be effective.

Your CPP Disability Hearing

If you have applied for CPP disability benefits and have been refused, you will be notified by letter. You will be advised that you can appeal the refusal by writing a further letter requesting a review of this decision.

You should talk to your doctor and get a stronger medical letter from him or her, describing your disabilities in greater detail, and enclose it with your appeal application. If you have new medical information from other doctors, consider including that documentation. Make sure that you respond within the time limit that they specify or your claim will be cancelled. Follow their instructions carefully.

When they receive your request for a review, the CPP authorities will have your application and the additional information reviewed by an appeal officer, who will go over your file to see if the original rejection should be reversed.

You will be notified of this decision in due course. If your application is still rejected you have the right to a further appeal hearing before an appeal panel of three persons in a large community where or near where you live. These panels are put together fairly frequently and they hear several appeals in a one- or two-day hearing session.

To start the process for your appeal hearing, you must follow the CPP's officer's instructions and send a letter stating that you want to appear before an appeal panel. The CPP authorities will then schedule a hearing for you and advise you of the time and place. Contact your doctor (who might be your star witness) immediately, to see if he or she would be available. Regardless of whether or not your doctor is willing to attend the hearing, the doctor's letter will be an important document in your appeal.

With the letter advising you of the hearing, you will receive a package of materials, which the CPP officer intends to rely upon to reject your application. It will contain the medical reports that you had sent them and a report of the officer who rejected your claim stating his reasons for the rejection. Read this report carefully as you must counter-act its comments.

The best way to counteract the CPP's rejection is to have your doctor state in writing that in his or her opinion you are severely disabled and you will be so for a prolonged period of time. If your doctor is not able to come to this conclusion you will not win.

The review panel consists of three persons (members of the community appointed by the government) who schedule the hearing in a local hotel or other room. The atmosphere is very informal but your presentation will not be informal. The hearing starts with an introduction and welcome by the panel chairperson who then asks you to present your case. You should then:

1.   Make a brief introductory statement explaining who you are and what you want - a disability pension as a result of your severe disability, which will last for a prolonged period of time. You won't have to go through all the paperwork; they will have read the materials that the CPP officer sent to you. Tell the panel who will be your witnesses. This will give them an idea of what to expect and allow them to prepare to take notes.

2.  Call your doctor as your first witness if he or she is able/willing to attend. Give the panel three copies of his resume. Ask the doctor to review his or her resume so that he or she can inform the panel of his or her training and experience. Then ask the doctor to review all your medical records to describe your condition to the panel. Finish by asking him or her to give an expert opinion as to what your disabilities are, when they became totally disabling, how bad they are, and how long they are expected to last. Your doctor will have been a courtroom expert witness in the past so he or she will be quite comfortable with this process. Make sure that the doctor gives a date when the disability became severe as that is the date that the disability payments will commence. At the conclusion of the doctor's evidence, the panel may ask him or her questions.
If your doctor does not attend, refer the panel to the summary statement describing your condition on your medical report and point out how your doctor has stated it meets the criteria of a severe and prolonged condition.

3.   Call family members (one or two) as witnesses. A father, mother, spouse, older child or friend, can describe the details of your life and the difficulties that you have. Describe the ordinary activities that are difficult or impossible, such as getting dressed in the morning, preparing meals, taking care of children, traveling about, looking after your family. This is to give a concrete and graphic picture of your disabilities to the panel.

4.   Give evidence yourself. Explain what your problems are. Describe the difficulties you have doing everyday activities. Describe in detail what you cannot do and why. Then answer any questions the panel may have.

5.   The CPP officer will read their report and state why your claim should be denied. Argue against this. Give reasons why the officer is wrong.

After this, the chairperson will thank you for coming and state that will you get their decision directly from Ottawa in a few weeks. Be patient. This will take some time.

REMEMBER...the most important information is the medical information provided by your doctor. If he or she is not prepared to say that you are severely disabled for a prolonged period of time, you will probably lose. Ensure that you have given your doctor enough details concerning your condition so that he or she can form this opinion.

If the Tribunal denies your appeal, the Pension Appeals Board (which is independent of HRDC) is your final opportunity for appeal under CPP. It is important to note that both you and the Minister of Human Resources Development can appeal a Review Tribunal decision to the Pension Appeals Board. Permission to appeal (called "leave to appeal" must be requested in writing from the Pension Appeals Board within 90 days of receiving the letter of denial from the Review Tribunal. The letter should go to:

The Pension Appeals Board has a handout on how to apply for leave to appeal. Before applying you should obtain a copy of this from the address above.