Some Statistics

I submitted a Freedom of Information Request to find out what is happening with CPP disability applications and appeals - in 2010 - 2011 there were 73,179 applications for CPP disability - up 3965 applications from 2009 - 2010.

 

Of the 73,179 applications 39, 160 of them were denied.

 

The AVERAGE annual decision through put time of initial applications was:

National Region 104 days

Atlantic Region 94 days

Ontario Region 101 days

West Region 111 days

 

The AVERAGE annual decsion through put time of reconsiderations was:

National Region 105 days

Atlantic Region 114 days

Ontario Region 94 days

West Region 119 days

 

 

Another concern

Okay so you have been reading about my concerns and I have just thought of another thing.

Many individuals who go to the appeals - have witnesses - support people - and sometimes doctors or professional people attend the hearing to give evidence on their behalf. Sometimes, when there is say a stroke or a brain injury and there is cognitive issues - a professional or a spouse will give evidence to the Panel to highlight the changes that they have seen in the appellant's functioning. One of the ways to quantify cognitive decline is with a neuropsychological assessment but these are extremely expensive - so my question is how are people now going to be able to give evidence - how are the single members going to be able to hear all the aspects of the case?

Is everything going to have to be in writing?

Also how is the average person going to be able to afford the cost of the medical reports to support their appeal? I am able to finance medical reports for my clients - but it is very expensive - and is the average person going to be able to secure the evidence that they need in order to win their appeal - I also have the expertise to get the information that is required from a doctor to substantiate an appeal - writing that their patient is "severe and prolonged" on a prescription pad is not going to cut it.

In what format is a spouse or partner going to be able to give evidence? The Feds mantra about no "objective medical evidence" they often use in order to deny a claim - but how is an single member going to assess a person's credibility and experience when they are talking about subjective evidence like pain or mood? How is that going to be assessed on paper?

How is a person with mental illness or brain injured going to be able to coordinate all the information they require in order to have a comprehenive appeal?

So many questions - and so far no one will give me any answers - at least not from Human Resources Development Canada.

 

Canada Pension Plan disability Social Security Tribunal

If you have been following my recent blog entries, you will be aware, that included in the Haper Government's massive Bill C38 the Budget Implementation Act 2012, it outlines what is going to happen in terms of this new appeals system that is going to be put in to place for people who are denied Canada Pension Plan disability benefits as well as Employment Insurance benefits. These changes to the CPP disability appeals system have been overshadowed by so many other changes that the government is implementing, that there has been little in fact almost zero discussion amongst Canadians.

I would like to perhaps enlighten the masses what it is like for someone who finds themselves in the position of having to apply for disability under the Canada Pension Plan system. Firstly, unless a disability is catastrophic and immediate it can take a long time before a person ulitimately decides that they can no longer work. This decision is difficult to make - so much of our self esteem and dignity is tied in to what we do - where we work - how we make a living - and it often means giving up financial independence and putting a financial burden on yourself and your family. But you decide that you can no longer work, so you get the forms from Canada Pension Plan and you start to complete them. These forms can be quite onerous for an individual for numerous reasons, and then you have to get your medical doctor on board to complete the medical report required by CPP.

Some doctors are really great, the go above and beyond to help out their patient and support them fully in the application. Some however are very lukewarm, often because of the paper work and the extra time this takes, the small amount the Feds pay for their time, as well as the pervasive feeling among doctors that most of the claims are going to be denied anyway. Still an applicant perserveres and completes the application. Sometimes, they contact me and ask me questions about how best to succeed and try their very best to send in a complete and comprehensive application.

Then they wait............. and they wait............. and they wait ............... and they phone .......... and likely after six months they might get a phone call from the adjudicator responsible for making the decision. Some of the adjudicators are very nice people and very nicely explain what their decision is - some of them - well don't get me started on that - and yes finally you get a decision - DENIED - you are denied - because while we understand you have physical limitations you are able to do "some type" of work so you do not meet the legislative criteria.

After a person reads this denial, I typically find a number of things will happen. One person may become enraged and immediately appeal, some might become discouraged and believe that the decision rendered is correct so they quit. Other appellant's may be heartbroken that their family has struggled to keep things afloat only to be denied and hope begins to fade - some people even force themselves back to work to prove that the government is wrong.

Of the people who appeal, well they go back to their doctors for more information. They try and call Service Canada to get the answers to no avail. They are lost and they do not know what to do - but they do know the decision is incorrect. Sometimes they find my office.

I do not have much faith that the appeals are fairly adjudicated - most times in the files - I just see a reiteration of the same information that the Feds relied on to deny the claim the first time around - sometimes I see pages of information that are ignored - which again only supports my belief - that there is an amount of claims exposure the Feds expect to have - not proven of course - I can never find a way to do that - but I believe it is true - but anyway you still have to go through the reconsideration.

And so they wait ......... and they wait........... and they wait - and again likely after another six months - you are denied again. So approximately 12 months after you applied you are still without any financial support and you are still unable to work.

As I have mentioned in previous blog entries, I have felt confident that an appeal that was arm's length and independent was a good thing. The Panel members and judges were well trained, and there were three people involved that would make a decision on the appeal. They were able to meet the client in person and talk about the disability - not just rely upon written information.

Now the Harper government is changing all of that. They are also pushing for appeals that are going to be held using electronic means - phone or video conferencing - or even just paper appeals - and as I have said before - how is one - appointment by the government tribunal member - going to have all the necessary experience - medical, legal, etc, to adjudicate an appeal?

It is very unfortunate that Canadians are being denied this opportunity to an arm's length independent appeal - unfortunate and shameful. All the good people at the Review Tribunal and Pension Appeals Board have worked diligently to ensure appellants got fair and non adverserial hearings and now it is all being dismantled.

Readers may assume that I am self-interested because I am a private advocate who makes her living off successful appeals - but it is more than that - I am not concerned about putting together an application or appeal that would be successful and identifying the merits of an appeal - my real fear is the impartiality and that this new appeal will simply be another way to rubber-stamp another denial - closing options for legitimate good Canadian people who have paid in to CPP and who are disabled.

These changes are coming in to effect in April 2013. So please if you are in the appeals process it is critically important that you find someone who is experienced to help you either with the application or appeals process.

I will keep you posted.

 

A change is going to come - April 2013

When the Feds announced the budget in March included in the contents was this paragraph:

"The Minister will introduce legislative amendments to eliminate administrative duplication in appeals and tribunal services by replacing the current administrative tribunal system for major federal social security programs with a single-window decision body. The new Social Security Tribunal will continue to provide a fair, credible and accessible appeals process for Canadians."

This now means that the Office of the Commissioner of Review Tribunals as well as the Pension Appeals Board will cease to exist in its current format.

The Budget Implementation Act which came out April 26th, 2012 provided some information about what this new Social Security Tribunal would now look like.

The Social Security Tribunal will consist of the General Division and an Appeal Division.

The Tribunal will consist of no more than 74 full time members appointed by the Governer in Council.

The General Division can summararily dismiss an appeal if it is satisfied that it has no reasonable chance of success.

If you are denied at the General Division you can appeal to the Appeal Division and any appeal to this division may only be brought if leave to appeal is granted.

The only grounds for appeal are that

a) the General Dvision failed to observe a principle of natural justice or otherwise acted beyond or refused to exercise its jurisdiction;

b) the General Division erred in law in making its decision, whether or not the error appears on the face of the record; or

c) the General Division based its decision on an erroneous finding of fact that it made in a perverse or capricious manner or without regard for the material before it.

The head office of the Tribunal is in the National Capital Region or at any other place within Canada that may be designated by the Governor in Council.  I have also heard through that there is a push for electronic appeals - are the hearings going to be held in the location that the appellant resides in or are they going to be done just on paper alone?

Under the current system if you are denied at the Review Tribunal and you are granted Leave to Appeal to the Pension Appeals Board you get what is called a hearing "de nova" which means that the Pension Appeals Board will look at the appeal with 'fresh eyes" - you start from scratch and essentially the prior decision carries no weight on the decision making process.  However, under the new system the appeal division will only intervene if an appellant is able to establish the decision contained one of the above noted errors.  This concerns me - the average person will have no idea how to make these arguments.  How is a person with no education, or those who have language barriers, or those who are functionally illiterate, or who are sick ever going to be able to make a successful submission?

Every application to the Tribunal is to be heard before a SINGLE MEMBER.  Who are these members going to be? Are they going to understand the tenants of the CPP legislation? Are they going to have a medical background so they can understand the medical reports? The Feds at the Pension Appeals Board had a doctor who would explain the medical condition to the Board because they did not have medical expertise - the Review Tribunal have a medical member sitting on the Panel - are these new single members going to have the expertise of a lawyer or a medical person? Also, when the appeal is heard before three panel members I understand that they have the opportunity to deliberate among themselves and there is the opportunity to discuss all the points that have been made at the hearing - when there is an appeal before a single member - well I feel that that opportunity is lost - if the single member is having a bad day - who is going to hold that single member accountable? Where will the balance in the decision making be - it is no different from presenting the information at the initial application, and at the reconsideration - those decisions are made by a single member of the Federal Government - is that the same thing that is going to happen under the new system - only the single member is in a different location??

There is also a lot of discussion in this Bill about the Electronic Administration of the Canada Pension Plan.

 

So what does this mean? I am not a friend of the Federal Government - you have read my blog and likely noticed the disdain I have for the Feds. They state in their budget document that this new tribunal is going to "provide a fair, credible, and accessible appeals process for Canadians." - not likely. My first response to this was why would the Feds do this - the Tribunal and the Pension Appeals Board run well - the system has been in place for years. I believe and have stated many times that having a hearing before three independent arm's length community panel members is an excellent way for an individual to have his case and application for Canada Pension Plan disability fully explored.

An individual from Service Canada told me that the adjudication time frame for an initial application is running as high as 32 weeks - that is eight months. Then 60% approximately are denied - and then you are waiting at least another 20 - 25 weeks for a reconsideration. I am still waiting for the results of a Freedom of Information request I submitted to formalize these statistics but things are pretty grim out there - at least that is what I hear from the daily calls of desperation to my office. So in the past I was confident that an appellant would have a good hearing before the Review Tribunal especially if they were prepared well - and now the Feds have completely changed the system and from what I read - the Canada Pension Plan Act itself.

Now everyone is up in arms about changes to the environment but what about all of these subtle changes that affect Canadians - believe me no one seems to care - unless it happens to them - and you have read my discussion about how this process and procedure negatively and significantly impacts Canadians at some of their lowest times - how exactly is that fair and credible, oh and lets not forget accessible?

So I am working here to evolve the website as these changes come in to place - I will tell you one thing I believe for sure - get help with the application - get help with your appeals - make sure you find someone - use the resources on the website - anything you can do to make sure you get a successful result before these changes came in to place.

I intuitively believe that the Feds are doing this for one reason alone - and that is to save MONEY - and of course in my opinion their CLAIMS EXPOSURE which will ultimately mean they will save MONEY.

Please check back as I make changes to this website to help you with your applications and appeals.

Credible. Fair. Accessible. My a$$

 

Still learning after all this time.

This week marks my 14th year of running the clinic.

I was so vain as to think that I really understood the procedures and the CPP program well - and you know I do - but there appears situtations to me that I really do not have any idea how to answer people's questions.

I ask them have they phoned the 1-800 number - you know "Service Canada" - and they laugh at me. They tell me that they receive different information depending on the time they call - and then it is an insufferable amount of holding time before you are connected - well I suppose we cannot complain too much - I mean some of the 1-800 numbers I call are off shore and at least "Service Canada" remains in Canada - but any way I digress!

Okay so I have some pretty good contacts within the department - well I thought I did - because I have sent several emails to CPP managers, as well as called CPP regional officers - only to be told to phone the 1-800 number! Yeah okay....

Anyway I am back to trying to wade through enormous amounts of procedures to find policy and answers to questions that half the time I think do not exist - or maybe they exist in one region but not another.

So my recourse is the Freedom Of Information Act, then I have things in black and white and concrete answers to my questions that do not forget relate to Canadians in the public - not cause I am out of a whim trying to find information for my own jollies.

Maybe the Feds are pissed at me cause I am "outing" them - and hello to all you bureaucrats who are reading the blog.

So yes there are clients that appear that have unique situations that I am very interested in finding out the answers - and I often get ideas for the blog from CPP recipients - so thanks and keep them coming. I will try and find out the answers to your questions the answers that you are advised to get from "Service Canada".

CPP and the dangling carrot.

I received a phone call this week from a clergyman - let's call him Cameron. Cameron had just turned 60. He could no longer work as a clergyman a position he had held for 30 years or more due to multiple disabilities both physical and mental. Cameron had applied for CPP disability at 59. He was denied because the Feds said whilst they recognise that he has limitations he was still suitable for some type of work. No surprise this is the standard denial vernacular.

So why I am calling this the dangling carrot......

The Feds go on to say and I am paraphrasing, well you cannot have your disability benefit but, because you will be turning 60 in whatever length of time that is - or if you are already 60 - we are delighted to advise you that you can collect you CPP early retirement benefits. Just sign here, withdraw the disability application, and there you have it we will put you on these benefits and just forget the CPP disability. We will even recognise the date of your appliation to CPP early retirement benefits as if that is the date you applied for early retirement benefits (note I am being a tad sarcastic).

This is the dangling carrot......

The CPP early retirement benefit payment is significantly lower that what you would collect on a CPP disability benefit - so the Feds have saved themselves a lot of money. It is my opinion that the Feds are also playing on people's emotions and desperation of the fear and financial implications of not having a monthly income. In Cameron's case I have seen the medical reports and the doctors have all supported that he is not capable of doing any work quite clearly.

I have seen this situation occur over and over again. Most people understand what the dangling carrot is - and the smart people of Canada are on to it.

I would also like to make note of one more thing. I have seen a lot of write ups lately from financial planners talking about taking early retirement from CPP. It is their perogative to give financial information but I get frustrated that not one of the financial planners mention that if you take early retirment one of the implications is the window of eligibility to access CPP disability benefits. I have talked at great length about this in previous blog entries.

I would like to thank everyone who contacts me about the blog. I am happy that the information it contains is helpful. Have a good week. Allison

Skype Appointments

I have set up the clinic to be able to conduct appointments via webcam using Skype.

I have found that this is an excellent way for people to consult with me from all over Canada.

If you are interested in talking wiith me via Skype please email me to set up a time and then send a friend request using Skype to the Disability Claims Advocacy Clinic.

Please note I will not respond to friend requests to people who have not identified themselves to me!

The Link between CPP and LTD Disability Insurance

I often receive phone calls from individuals who are applying for CPP disability at the request of their private insurance companies. The insurance companies usually require that their clients make application to CPP disability, as CPP is first payer on most disability insurance policies (also many WCB programs, Provincial disability programs, Auto insurance programs etc.) When these individuals are denied CPP, the insurance companies require that they appeal and often I get called because there is a level of fear that if the client is denied again, the insurance company will also deny them as well. Most insurance companies do not provide the resources their clients need to handle these appeals, and if I may be frank, many of the disability insurance adjudicators do not understand themselves the procedure a client has to go through when appealing the denial of CPP disability benefits.

So it is a no brainer that I get panicked calls from private insurance clients who are now facing CPP appeals and the added stress and worry that because CPP has denied them, that their insurance company may shortly do the same.

I am not trying to malign insurance companies here, as getting their clients CPP disability saves them a large amount of money over the life span of a claim, so they are entirely motivated to get their clients on CPP disability. I recently made a presentation to the disability adjudicators at a large insurance company and at the end of the presentation it was clear to me that the adjudicators now had a better appreciation and understanding of the complexity of the CPP disability program. Although the adjudicators had received "outreach services" from the Feds - I believe sorry to say - their presentations may not accurately portray what is really going on in the trenches!

As I have said previously, CPP disability benefit is viewed as the "first payer" by most private insurance plans. This means that most insurance plans take CPP disability benefits into account when calculating a claimant's entitlement to disability benefits. Most private long-term disability plans require a claimant to apply for CPP disability and to appeal a denial. Many agreements also indicate that noncompliance with these terms can result in withholding or reduction of long term disability benefits by the estimated amount of the CPP disability benefit. This is standard practice and part of standard form agreements of most private insurance policies.

If you have been denied a CPP disability benefit and you have been asked to appeal by the insurance company, then make sure you follow their recommendations. I believe most insurance companies are aware that CPP disability has a fairly measurable denial rate and so they may expect that you will denied on application. Do not be fearful of the denial from CPP disability. Next make sure you send in for your reconsideration within the 90 day appeal period and ask your adjudicator if the insurance company has some resources available that can help with your appeal. Also ask the insurance company if they can provide you with the medical information that is on your file - that way you do not have to pay for photocopying charges from your doctor's office. Most insurance companies have collected medical evidence on you in order to support your LTD claim - so as collecting CPP disability is in their best interests - I really think they should help you out by providing you with this information. If there is an issue with this I would ask for a supervisor and explain your motivation for wanting to collect this information.

Also, if there are insurance company staff who read this blog - I would like to ask them to consider having someone who works in the trenches, explain to them and their disability adjudicators the reality of managing a CPP disability appeal so they can help their clients secure the benefits that will offset their bottom lines.

Often I am asked by someone who has to appeal the denial of a CPP disability benefit who is receiving LTD private insurance what is the point to receiving CPP disability?

Although the income received from a CPP disability benefit is taxable and reduces your non-taxable long-term disability benefit, there are advantages to receiving a CPP disability pension:

· it places a freeze on your financial earnings as of the date of disability. This prevents CPP from establishing a record of zero of nil earnings to average into your future retirement or disability income calculation for the period you are disabled from working and not contributing to the CPP fund. Without this earning freeze your future entitlement to CPP benefits, including retirement benefits could be adversely affected.

· there is a federal tax credit available when a individual completes and submits the Disability Tax Credit Certificate (Form T2201) with their income tax.

· if you are in receipt of CPP disability benefits at the time of your death, CPP survivor benefits will be paid at the full level as though you have been working until the date of your death.

· CPP benefits provide a cost of living allowance every year. Any COLA increases will not be deducted from long-term disability benefits.

· if you have children they may be eligible for a children's benefit as long as you are receiving a CPP disability benefit. CPP pays benefits for children if they are:

a. under 18 years of age. These benefits are paid to the individual who has the care and custody of the children; or,

b. between the ages of 18 and 25 years old and attending school on a full-time basis. This benefit is paid directly to the child

 

 

 

 

MQP - The Magic Date

Hello Everyone,

Yes I am still working here at the Clinic. It has been some time since I have been able to blog. Many things have happened and I have case managed a lot of files in the last six months that have been interesting to say the least!

My reason for blogging today?

Well in the mail today I received two files that were sent to me for review - and unfortunately both of these cases were rightly denied based on what are late MQPs.

A MQP or Minimum Qualifying Period date - is what I like to call THE MAGIC DATE. It is critically important to the adjudication of a CPP disability claim.

You know you have to be found "severe and prolonged" - but you also have to be found severe and prolonged at the time of the MQP.

If you have a late MQP your denial letter may say something like this -

"Unfortunately, you do not have enough earnings and contributions. However, Canada Pension Plan has a late application provision that allows us to consider if you had a disabilty that was both severe and prolonged and has been continuous since you made enough contributions to the CPP to qualify. In your case, you had made enough contributions to qualify until December of a given year"

Okay like I said this is a magic date and the decision makers have to find the applicant disabled as of that time and continuously to present - the lady whose file I reviewed this morning had an MQP of December 1997. This means she has to be found disabled from December 1997 until present. This is tough because it would require 14 years of continuous medical evidence to support this claim - sometimes this is easy to do - there may have been an accident or medical condition that has been clearly related to that time period - but most times I will say with a late MQP like that, is a challenge to establish disability.

Sometimes, there is a late MQP, and then a person tries to work after that MQP, and the feds deny because they say there is evidence of work capacity after the MQP.

This happened recently with a lady called Cindy. Cindy is very young 29 years - but she had been chronically sick with chrons since she was 19 years old - and I mean sick - surgeries, infections, abdominal pain, fatigue, malnutrition -the medical evidence was pretty conclusive - but the problem in Cindy's file was that she continued to try and work, and try to go to school, and try to do all those things that a young woman wants to do.

Cindy had earnings after her MQP - the Feds denied her because of this - they realized she was disabled now - but she was not disabled at the time of her MQP. Well her earnings were substantially gainful but she only lasted a short period of time - six months - before her chrons kicked up and she was hospitalized again - not to mention that throughout her work she repeatedly had to decline work shifts and often had to leave work because she was so sick - I really admired Cindy cause she continually tried to work and she felt so guilty because her parents were continually having to support her financially. I do not know what the results of the appeal will be but I will let you all know.

So you can see here how important the MQP is - it really is a magic date - it is like when your coverage expires like an insurance policy.

The calculation of the MQP is very complicated and there are so many different ways the Feds calculate the MQP - all different requirements and legislative tenants go into the calculation of the MQP. But I just wanted to get it out there that the MQP is critical in the adjudication of a claim.

In the files that I reviewed this morning - the applicant went through the hearings without any understanding of the MQP - bad move.

If you have a hearing or your are appealing the denial of a CPP disability benefit - then make sure you know the MQP. If you have any questions about this send me an email. One thing I will tell you - if you have an MQP say December 2006 and you have only submitted medical evidence from 2009 forward then you have not met your responsibility to establish your disability at the time of your MQP. So that means you will need to submit medical information from December 2006 in order to establish that you were disabled at this time.

Hopefully this has all made sense to you!

For those of you who want further reading on this subject - the Office of the Commissioner of Review Tribunals has a good explanation of the MQP calculation rules and the link for that is

www.ocrt-bctr.gc.ca/hwt-cmm/cpp-rpc/req-cond-eng.html#more_MQP

 

 

 

 

How long will it take to get a decision?

I get a lot of calls at the office asking me how long it will take before CPP decides on either the application or the request for reconsideration.

I have been able to make some calls and I have found out the approximate processing times.

British Columbia Region - Initial Appliation - 25 weeks processing time - Reconsideration - 20 weeks processing time.

Manitoba and Saskatchewan - Initial Application - 20 weeks processing time - Reconsideration - 14 weeks processing time.

Alberta - Initial Application - 26 weeks processing time - Reconsideration - 16-18 weeks processing time.

Ontatio - Intial Appication - 120 days processing time - Reconsideration - 120 days processing time.

I am sorry I do not know the Atlantic Regions.

Also these time spans are averages - they fluctuate according to work loads and whether or not CPP is developing your file by collecting additional information.  Note if CPP is developing your file that is a good thing - as it is an applicant's responsibility to establish disabiity - so if the feds are looking into it is not just a straight out denial.

Finally back in the office for three straight weeks - looking forward to catching up and returning calls. Wishing it was spring already.