What you need to know if you’re claiming CPP Disability Benefits

If you are ill or injured, and are not able to work at any job on a regular basis, you may be eligible to claim disability benefits under the Canada Pension Plan (CPP).  The CPP disability benefit is a form of income replacement and payment is calculated using a minimum fixed amount plus an amount based on your total lifetime contributions, up to a maximum.  In 2018, the maximum monthly CPP disability payment was $1,335.83.

Eligibility requirements for CPP disability benefits are not necessarily the same as the requirements under private insurance plans or employer-provided plans.  In order to qualify for Canada Pension Plan disability benefits, you must meet the following criteria.

1. You must have made sufficient contributions to the CPP (as indicated below);
2. You must be under 65 years of age; and
3. Your disability must be both ‘severe’ and ‘prolonged’ at the time of your application.

• To be considered ‘severe’, whether the disability is physical, mental or psychological disability, your disability must regularly prevent you from doing any kind of substantially gainful work.
• To be considered ‘prolonged’, your disability must be “long-term and of indefinite duration” or “likely to result in death”.

To meet the contribution requirements for CPP disability benefits, you must either have:

• contributed to CPP in four out of the last six years; or
• contributed to CPP in three out of the last six years, and have contributed for at least 25 years.

Note that there are circumstances in which the above contribution requirements might be waived, for example, if you earned very little or no income while raising your children, or if you became continuously disabled after meeting the contribution criteria at some time in the past.  You can learn more about exceptional provisions for CPP disability benefit eligibility at the Government of Canada’s CPP disability benefits website.

Any application for CPP disability benefits must be accompanied by supporting documentation, including your doctor’s assessment of your condition, treatments you have been following, and medical tests to substantiate your condition.  Based on your documentation, a CPP medical adjudicator will determine whether your disability is prolonged and severe.  Key information that the adjudicator will consider is the severity of your condition, how your condition specifically effects your ability to work, personal information such as age and education, and your prognosis for recovery.

If you meet the criteria for CPP disability benefits and your application is approved, you will receive either the CPP disability pension or the CPP post-retirement pension. Both are paid monthly.  If you qualify for one of these disability pensions and have dependent children, you may also be eligible for a monthly children’s benefit.  To be considered ‘dependents’, your children must be under 18 years of age, or enrolled in school full-time and between the ages of 18 and 25.

You may be paid CPP disability benefits even if you are already receiving disability benefits under a private insurance policy or another plan.  However, in such a case, you need to inform your insurer that you are receiving CPP benefits and they will reduce your insurance disability benefits accordingly. 

What happens if your CPP disability claim is denied?

Applications for CPP disability benefits are denied more often than you might think, including when the claimant is legitimately disabled and actually meets the CPP’s eligibility criteria.  If this happens to you and you disagree with the reason for denial of benefits, you may make a written request to have the decision reconsidered.   Your request must be submitted within 90 days of the date you received the adjudicator’s decision and should include any documents and information that may support your claim.

A different staff member will review your request for reconsideration, and if they also deny your claim, you may appeal the reconsidered decision with the Social Security Tribunal.  This requires that you submit a written appeal within 90 days to the Social Security Tribunal at the General Level, and you may be represented by a lawyer during this appeal.   Finally, if this appeal is not successful, you may request permission to argue your case to an Appeal Level tribunal; however, this level of appeal is not automatic and the Appeal Level must agree to hear the claim. 

Don’t give up if your CPP disability claim is denied.  Many disability claims are successfully appealed with the Social Security Tribunal, particularly with the help of an experienced disability claims lawyer.   At Dietrich Law, we have helped many clients get the CPP disability benefits they were owed and we well understand the financial burden and stress suffered by persons who are unable to work for a prolonged period.  If your CPP disability claim was denied, we invite you to call Dietrich Law and talk to a Kitchener Waterloo disability claim lawyer to find out what steps can be taken in having your CPP disability claim application approved.