I have wanted to write this blog entry for a while.
Everyday I get calls from people who seem to believe information about CPP disability that I would consider to be completely inaccurate or a myth.
So I have decided to address these myths and provide alternative information. To illustrate the falsehood of the CPP disability myths I have used cases I have worked on.
MYTH 1: YOUR DOCTOR NEEDS TO STATE YOU ARE "SEVERE AND PROLONGED" IN A LETTER
I had this one the other day. A lady called me and said she had been denied CPP disability but she could not understand why as her doctor had written in a letter that her disability was "severe and prolonged" I asked if she had the doctor's letter and if she could read it to me. She proceeded to read and the letter might have been a paragraph long from the doctor stating that her disability was Rheumatoid Arthritis - that she had been unable to work for approximately 12 months and that her disability was "severe and prolonged". The lady was pleased because the doctor had used the "right" words, but in my opinion and experience - that type of letter would carry little weight. It is more helpful to have your doctor discuss why your disability is severe and prolonged - for example, what are your functional limitations - are you able to be dependable or reliable as a result of your medical condition; how does your medical condition impact your capacity to work. Severe and prolonged are just words and without explaining why your disability is severe and prolonged I do not think it will help much. The same goes for scrawling - "this patient has a severe and prolonged disability" on a prescription pad. I have seen that happen. I just think it is helpful to explain why you meet the severe and prolonged criteria. If you scroll down you will see more information on how to collect medical reports as well in the appeal guide there is a sample medical letter.
MYTH 2: YOUR DOCTOR SAYS YOU WILL NEVER QUALIFY
This happens quite frequently. Someone will phone me discouraged because their doctor is not being supportive either with a desire to apply for CPP disability - or if you are trying to appeal a CPP disability denial. The doctor will say you will never qualify. I can understand why they would likely feel this way as I have seen over many years of cases, doctors writing really strong letters of support indicating why someone is disabled only to have their patient be denied again despite what the doctors have said. If you are faced with this situation, I advise my clients to say, that they understand how frustrating it is for the doctor's opinions to be ignored but that you need the information and wish to continue on with the application or appeal. Most times I find that doctors work hard to help out but of course they are also very busy and hate paper work (perhaps that is a myth!).
MYTH 3: YOU HAVE TO BE DEAD, DYING, OR A COMPLETE INVALID TO QUALIFY FOR CPP DISABILITY BENEFITS
Not true. You have to have a disability that is severe and prolonged as defined in Section 42(2)(a) of the Canada Pension Plan Act. You must be found disabled according to these legislative provisions - you must be found incapable of regularly pursuing any substantially gainful occupation. As I have said numerous times this definition does not say you have to be dead, dying, or an invalid to qualify. Read through my blogs and you will find some helpful information about how this definition is interpreted.
MYTH 4: EVERYONE IS DENIED A CPP DISABILITY BENEFIT ON THE FIRST APPLICATION
Well not everyone but between 50 - 60 percent are denied on first application - and I really think the people that are approved are either terminal or have catastrophic disability. So this myth has some truth to it. I think chances increase if you have someone help you to audit your application - there is also an application guide on this website. Persistance does seem to pay off - you cannot give up if you have been found disabled and you know you should meet the criteria. Unfortunately there are legislative technicalities that you cannot avoid, like minimum qualifying period dates or the 15 month rule if you have been on CPP early retirement.
MYTH 5: CPP DISABILITY WILL GET ALL THE INFORMATION THEY NEED IN ORDER TO DETERMINE YOUR ELIGIBILITY
Not true. It is your responsibility or onus to establish that you meet the criteria of CPP disability. Sometimes the Fed's will develop the file and collect additional information, but not in all cases. So if you are applying for or appealing a denial, you need to ensure that all the information is submitted. This is even more important now with the creation of the CPP Social Security Tribunal. The only time the onus or responsibility is not the appellants is if it is a reassessment case. Then it is up to the Feds to prove you have regained your capacity to work. This myth also includes the fact that you can ask CPP doctors to examine you - or request an independent medical consult - this used to happen in limited cases at the higher level of appeals but not for applications or reconsiderations.
MYTH 6: THE 1-800 OR SERVICE CANADA STAFF KNOW WHAT THEY ARE TALKING ABOUT
Again not my intention to be rude to these staff but I have often found that these staff members do not give client's the correct information. Not in terms of general information, but the CPP Disability adjudication and appeals system is complex. If you have been given information by a 1-800 staff then I would search online and see what you can find. I had one lady who had breast cancer who was told by a Service Canada staff member that she would never qualify because her breast cancer could be cured. This simple answer does not provide all the information required in order to determine whether or not you could or would qualify.
MYTH 7: YOU CANNOT WORK AND/OR YOU CANNOT TRY TO WORK IF YOU ARE APPLYING FOR OR APPEALING A CPP DISABILITY
This is one of the myths that aggravates me the most. I see it all the time in letters of denial. Well you are working so you do not meet the requirements, or you tried to work so you do not meet the requirements, or how do you know you cannot work when you have not tried to work. All variations of the same myth. I have blogged extensively about this topic and if you want further clarification about this send me an email or call the office.
MYTH 8: ANYONE CAN ACT AS A REPRESENTATIVE IN A DISABILITY APPEAL
I have seen some individuals who have been successful in an appeal acting alone - and there are those who definitely have the capacity to do so. However, with this new CPP Social Security Tribunal and only one opportunity to have the case heard "de nova" (with fresh eyes) and reviewing all the information at the General Division- I think it is very important to make sure you have an experienced representative to support you. Understanding the CPP legislation can take many years and you gain experience from working in the trenches with the people who have been denied. Also understanding medical terminology and medical reports is critical in my opinion. If a representative does not have any understanding of what medical reports say and mean - how is that going to be helpful? Think of it this way. I might go to a fresh-out-of-school mechanic for an oil change but I would want to know what the experience level is if I was going for an engine rebuild! With the April 1, 2013 changes these appeals are now really significant and I think that is important to keep in mind. If you are experienced representative then you should be quite confident in presenting and identifying who you are and what you have done that will incite a person's confidence in your ability.
Okay these are all I can think off right now, but I am sure more will come to me.
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