Reasons CPP Disability Applications Are Denied

Before starting your CPP Disability appeal process, it is crucial that you fully understand the reasons why your initial CPP Disability application was denied.

To notify you of their decision, Service Canada will send you a denial letter as well as an information sheet entitled “How to Ask Canada Pension Plan (CPP) Disability to Reconsider Its Decision”

We highly recommend that you read your denial letter and the information sheet carefully as it will usually refer to the medical reports, doctor’s notes, and other documents that Service Canada has reviewed and will usually state what information it has used to arrive at the denial decision.

Disability Credit Canada has helped many Canadians with their CPP Disability application and/or their CPP Disability appeal process. Although each CPP Disability application is unique, we have seen a few common mistakes as follows:

• Your Disability Is Not Considered “severe and prolonged” under CPP Regulations
• Late CPP Disability Application
• Not having enough information on medical conditions and employability
• Not enough financial contributions to CPP
• Not fully understand CPP Disability terms and regulations

Your Disability Is Not Considered “severe and prolonged” under CPP Regulations

The most common reason Canadians are denied CPP Disability is that Service Canada does not accept that the applicant’s disability is sufficiently severe and prolonged.

The standard CPP Disability denial letter will indicate the reason as:

“You do not have a disability that is both severe and prolonged as defined under the CPP legislation”

Following we have explained what Service Canada determines as “severe” and “prolonged”

Severe: The CPP Disability definition says a person’s disability is severe when the person is “regularly incapable of pursuing any substantially gainful employment.”

In other words, you must prove that your medical condition is so severe that you cannot work at any job regularly enough to earn a living.

Keep in mind that Service Canada emphasizes greatly the importance of what your doctor says about your medical conditions and limitations, and on any medical reports that are submitted.

It is important that your doctors’ reports explain your condition and why it prevents you from working. When there is little medical evidence that clearly shows your impairment, Service Canada may assume you can do some sort of work and may deny your eligibility.

At Disability Credit Canada, we have helped hundreds of second-attempt applicants work with their medical practitioners to fully certify and explain his/her conditions, and how they have severely affected his/her ability to work at all.

Prolong Service Canada can sometimes deny one’s CPP Disability application if they see that his/her condition is not prolonged. For example, someone applies for CPP Disability, but is scheduled to undergo surgery for her condition, and that surgery may result in a recovery of her condition, which Service Canada understands as the condition will be treated and will no longer affect her ability to work. Service Canada will also likely decide that an applicant’s condition is neither long-term nor of unknown duration (prolonged) if there is medical evidence suggesting that a full recovery is expected by a certain date.

Late CPP Disability application

You may also be denied if you do not apply for CPP Disability soon enough after you become disabled. For example, if you take too long to apply, you may not meet the four out of six-year criteria. This is the rule that says you must have contributed to CPP for four out of the six years immediately before you apply for CPP Disability.

In these situations, we highly suggest that you utilize the Late Applicant Provision. This allows an applicant to have a Minimum Qualifying Period closer to the onset of her or his disability. Late applicants have to prove that their health has stopped them from working ever since their Minimum Qualifying Period (MQP) which, because they applied for CPP Disability late, maybe a considerable time in the past.

Late Applicant Provision

This may be used by people who did not apply for CPP Disability as soon as they became disabled. When people wait too long to apply, the four out of six year rule may mean they are ineligible for benefits.

When someone applying for CPP Disability has not paid enough into CPP under the current contribution requirements, Service Canada automatically looks at one’s contributions to see when they last paid enough into CPP to qualify for benefits.

Under CPP Disability’s Late Applicant Provision, an applicant must prove they were disabled by the MQP date and prove that the disability has been continuous from that date until the present day.

Minimum Qualifying Period (MQP)

The MQP is the minimum period of time that you must have worked and contributed to CPP in the years immediately before you became disabled (as defined in the CPP legislation) in order to be eligible for CPP Disability benefits.

For example:

• If you have only worked for four years, then you must have made valid contributions to CPP each of those four years in order to be eligible for CPP Disability.
• The “four out of six-year rule” applies to those who became disabled from January 1^st, 1998 onward. If you have worked for more than four years, then in most cases, it is necessary that you have made valid contributions for four out of the last six years before you became disabled.

If someone has made enough contributions between 1987 and 1997 (but not after that date) then they will be considered qualified under the rules that were in place between 1987 and 1997.

The current rule is that one must have made qualifying contributions in four out of the last six years. In addition, effective since March 3, 2008, applicants who have made qualifying contributions in three of the last six years and valid CPP contributions for at least 25 years meet the contributory requirement.

Applicants don’t provide enough information on medical conditions

According to the CPP Disability regulations, the importance of proving your condition using medical reports, letters from your doctors, and other health professionals alongside details on your employability is of priority. Yet, not many applicants understand this and end up being unsuccessful. We have seen several cases where doctors and health professionals are not familiar with the eligibility criteria for CPP disability benefits, and were not able to help their patient’s case.

Additionally, CPP stresses on the importance of the severity of one’s condition and how it affects their ability to work at a job.

In this case, we strongly recommend applicants to communicate the importance of their condition, how it has affected their lives on a daily basis, and how it has prevented them from committing to any form of sustainable work.

Applicants don’t have enough financial contributions to CPP

There are circumstances where one may be eligible for CPP Disability, but they were not aware of this at the time they first applied.

These circumstances are:

1. You stopped working a long time ago

For example: You had been in the workforce from 1990 – 2009, and had made valid contributions to CPP. However, you became disabled in 2010 and had been unable to regularly commit to a sustainably gainful job, and had left the workforce since. You applied for the CPP Disability in 2015 (5 years after you had become disabled), you can still qualify for the CPP Disability by calculating your contribution accordingly to the MQP under the Late Applicant Provision. Read more on this Provision here.

If you’re eligible in every other way, except you stopped working a long time ago, you can still be eligible to receive CPP Disability benefits

To apply based on this, you must:

• Have had enough years of CPP contributions when your disability started
• Have had your disability continuously the whole time. For example, if you were able to work for some time during the period, you can’t use the “late applicant provision”.

You don’t need to apply separately for the late applicant provision. It will automatically be considered if you apply late for CPP Disability benefits.

2. You stayed at home to take care of your children, so you had no income or your income was low during those years

If this is the case, you can still qualify for CPP Disability under the Child-rearing Provision. Click here for more details on Child-Rearing Provisions pertaining to CPP Disability eligibility.

3. You are separated or divorced, whether you were married or living common-law

CPP also applies the Credit Splitting between divorced or separated applicants. The “Division of Pension Credits” will be applied and will affect both spouses’ CPP benefits. Read more on how credit splitting works here.

4. You were not able to apply due to a physical or mental problem

There are cases where applicants were significantly unable to file and apply for CPP Disability on their own due to restrictions from a physical or a mental problem. Protection is available for those individuals under the Incapacity Provision. Please obtain the “Certificate of Incapability” here to fill out and attach with your submission to CPP Disability.

5. You lived and worked in another country

Fortunately, Canada has agreements with many countries on the Pension Plan. That said, the credits you have accumulated while working in other countries can help you qualify for benefits from both Canada and the country you worked in.

To learn more about Pensions and Benefits for individuals who have lived and worked outside Canada, click here.

Applicant doesn’t fully understand CPP Disability terms and regulations

Although all the information about CPP Disability benefits, eligibility criteria, application process, and provisions are readily available on Canada’s website, they are often written in legal terms and may not be easy to understand.

Applicants can choose to apply for CPP Disability on their own, but they may risk an otherwise winnable case due to not having an extensive understanding of CPP Disability. From our experience, stating that one has a qualifying disability and has made a valid contribution to the CPP is not enough, this information and facts need to be presented in a clear and convincing manner, in order to win CPP Disability benefits.

At Disability Credit Canada, we take pride in helping disabled Canadians claim the CPP Disability tax credit. Check out our other Resources

1. Long-Term Disability Coverage through the Canada Pension Plan 
2. CPP Disability Benefits Application Guide
3. CPP Disability Denial and Appeal Overview
4. CPP Disability Request For Reconsideration
5. CPP Disability Appeal to Social Security Tribunal – General Division
6. CPP Disability Appeal to Social Security Tribunal – Appeal Division
7. CPP Disability Appeal Letter Sample