Canada: Long-Term Disability Series: CPP Disability Benefits – Should I Apply?

Last Updated: June 15 2017
Article by Brad Moscato

When you see the words Canada Pension Plan, or its familiar acronym CPP, your mind probably turns to happy thoughts of retirement. The CPP deductions on your pay stub are a regular reminder that once you reach retirement age you'll have a dependable source of income based on your years of work.

But CPP also provides benefits for people who have not yet reached age 65 and find themselves unable to work at any job as the result of a severe and prolonged disability. In this blog post I review who may qualify for CPP disability benefits, whether a person should apply, and what to do if you feel you've been unfairly denied access to these benefits.

A "Severe" and "Prolonged" Disability

To qualify for CPP benefits, you must have a "severe" mental or physical disability that prevents you from doing any type of substantially gainful work on a regular basis. This disability must also be "prolonged," in the sense that it is a long-term/indefinite disability or one likely to result in death.

You must also be under the age of 65, and have paid into the CPP program for at least four of the last six years in contributory period, or three of the last six years if you have made valid contributions for at least 25 years (although there are some exceptions to the contribution requirements).

While the disability must be both "severe" and "prolonged," there is no standard definition of disability in Canada.

Should I Apply for CPP?

You or your doctor may have determined that your disability is both "severe" and "prolonged" enough to make sustaining gainful employment impossible, but will the CPP disability benefit application adjudicators agree?

While some medical conditions leave little doubt that a person is clearly incapable of sustaining regular employment, other disabilities may progress more gradually or be subject to more discretionary medical opinion. In these cases, it is extremely important to be in regular contact with your family doctor and to ensure you have their full support before making an application.

If your doctor is not prepared to support your application, proceeding with a request for CPP disability is much less likely to result in success. Sometimes a doctor may not be familiar enough with your condition/illness to appreciate the extent of your disability. Other times they may not believe you have exhausted all options in terms of therapies and accommodations to justify CPP disability benefits and are therefore reluctant to support your application. You may be in the unfortunate situation of having a family doctor who may be predisposed to deny any request for support.

Since medical support is essential for successful applications, you may consider consulting an experienced disability benefits lawyer prior to filing an application. In reviewing your case, these lawyers can often suggest steps to take to demonstrate to your doctor the severity of your illness.

Should I Consider Early Retirement?

People close to retirement age (above 60) who have a "severe" and "prolonged" disability may think they should simply apply for an early pension rather than disability benefits. However, CPP disability benefits may pay out more than full retirement pensions. Even if you won't be able to draw CPP disability benefits for very long before you reach the standard retirement age, you will receive more money for that period and receive a full pension upon conversion. An early retirement pension will remain at the reduced rate for the duration of your life.

What If I Already Have LTD Benefits Through An Insurance Plan – Should I Still Apply for CPP Disability Insurance?

It depends.

  • If you are unable to work and your prognosis is guarded you should consider applying.
  • In addition, LTD insurance plans often make applying for the CPP disability benefit mandatory after a certain period of time. If you do not make an effort to obtain this benefit in good faith, some policies may even claw back your LTD benefits anyway.
  • Drawing the CPP benefit decreases the odds your LTD insurance provider will seek to terminate their payments (it reduces the LTD insurers' financial obligation to you, but being declared to have a "severe" and "prolonged" disability by CPP makes it more difficult for the insurer to justify ending your payments).
  • While receiving the CPP disability benefit you are not required to contribute to the main CPP program. If you don't apply and no longer pay into the CPP program, your retirement pension will be lower.

Applied But Denied CPP Benefits

While there are many advantages to applying for the CPP disability benefit, denials of legitimate claims do happen. Consulting a lawyer with expertise in handling disability benefits cases in advance of filing may help you to create an application with a greater likelihood of success. If you've applied on your own and have been denied this benefit, a second set of experienced eyes may find ways to improve your chances of a reversal of this decision on appeal. Time is of the essence. Often, the appeal period is 90 days from receipt of the denial letter.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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