If you’re faced with a debilitating illness or you’ve been seriously injured in an accident, CPP disability benefits can provide you with the financial support you greatly need. So much rides on getting CPP disability claim approval. Waiting for answers and living with the unknowns can be unbelievably stressful.
Knowing what to expect can make the CPP disability assessment process less stressful. Let’s talk about how CPP disability claims are assessed and what you can anticipate throughout the process.
Eligibility criteria for CPP disability benefits
First, it’s important to note that eligibility is based on multiple factors, not just your medical diagnosis. To qualify for CPP disability benefits, you must meet each of these criteria:
You are under the age of 65;
You have made enough contributions to the Canada Pension Plan over your working life;
You have a mental or physical disability that regularly stops you from doing any type of substantially gainful work;
You have a disability that is long-term and of indefinite duration or is likely to result in death; and
You have tried all medical treatments available to you.
To apply for CPP disability benefits, you must submit an application package to Service Canada along with all the necessary medical evidence and documents to support your claim. It usually takes about 90-120 days for Service Canada to assess your application and make a decision.
The CPP disability assessment process
Upon receiving your application, the first thing Service Canada will check is that you made sufficient contributions to the Canada Pension Plan during your working years, and that you made contributions during the minimum qualifying period (unless you are relying on an exemption such as the late applicant provision).
If you pass that hurdle, a medical adjudicator employed by Service Canada will then review your application package and decide whether to approve or deny your claim. Medical adjudicators are health professionals (usually a registered nurse or nurse practitioner). The medical adjudicator’s job is to determine whether you are disabled as defined by CPP legislation: disability must be a physical and/or mental impairment(s) that is both severe and prolonged.
The legal test for CPP disability is one of both medical impairment and employability. The key question is whether you have a severe and prolonged disability that prevents you from working at any job. The adjudicator will look at many factors such as:
the combined impact of objective medical findings;
your functional limitations (as reported by you and your health care professional in their medical report);
your prognosis; and
your age, education and work experience.
The medical adjudicator will also consider whether you’ve followed medical advice and recommended treatment plan(s). If you’ve refused recommended treatment or stopped receiving treatment against your doctor’s orders, your claim is likely to be denied due to “failure to reasonably comply with medical advice.”
Lastly, the CPP adjudicator will look at whether you have any upcoming surgery, plans to attend a rehabilitation program, or other upcoming treatment that may improve your medical condition. You will only qualify for CPP disability benefits if your disability will impair you for the foreseeable future or the rest of your life. Temporary disabilities are not covered by the CPP disability program (if the latter applies to you, contact us to explore other possible sources of income replacement/disability benefits, including LTD qualifications).
What else might happen in the CPP disability assessment process?
There are a number of things that might happen in the time between submitting your CPP disability claim application and finding out whether your claim has been approved. For example:
You, your doctor, or your employer may be contacted to provide missing information or additional evidence.
The medical adjudicator may call you for a phone interview to ask questions about changes in your medical condition, plans for returning to work, etc. to help them make their decision.
Service Canada may seek information from specialists or obtain a second opinion from an independent medical examiner.
At the end of the CPP disability assessment process, you’ll either get a notification that your CPP disability benefit claim is approved and you will start receiving the payments soon, or you will get a denial letter notifying you that your claim has been denied. The denial letter should contain the reasons why your disability claim was denied (though the reasons are not always clear—a skilled CPP disability attorney can help you decipher the denial letter and devise a strategy to get your claim approved).
Dedicated CPP Disability Attorney Alberta and Saskatchewan
CPP disability attorney James Ludwar is here to help if you need support applying for CPP disability benefits. Mr. Ludwar can help you successfully navigate the CPP disability claim process or guide you through the appeal process if you’ve been met with an unjust CPP disability claim denial.
Check out our website to learn more about how we can help you with your CPP disability claim or other disability claims. Aside from being an experienced CPP disability law firm, we also provide other legal services for matters such as long-term disability claims to clients throughout Alberta and Saskatchewan.
If you’re ready to work with a professional CPP disability attorney, we welcome you to contact us. Your first consultation with our CPP and LTD attorney is free and can be done at your convenience whether you’re in Calgary, Edmonton, all of Alberta, Saskatoon, Regina, or all of Saskatchewan. Request your appointment today.
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