Frequently Asked Questions

We thoroughly review all Canada Pension Plan cases before we agree to represent an appellant. Therefore, if Fortis Advocacy Partners agrees to take your case, you can be confident in the knowledge that we believe your appeal has merit.

Fortis Advocacy Partners is also a well recognized organization and the officials at the various levels of appeal are usually aware of our services, we have a good reputation.

Fortis Advocacy Partners is confident when they state that all efforts to win your claim will be undertaken, however, there are always unknown variables to any appeal. For the most partFortis Advocacy Partners has an excellent success rate.

Fortis Advocacy Partners does not charge money up front for their services. Instead, they charge a portion of the back payment that you will receive when your CPP disability benefits are approved. If Fortis Advocacy Partners is unsuccessful, there is no charge for the services.

Utilizing the services of an advocate can be incredibly beneficial. It is important to consider the value of your time, effort, and energy. Fortis Advocacy Partners will take away a lot of the stress associated with the appeals process due to their extensive knowledge and experience in assisting clients appeal their denial.

Additional fees may apply for disbursements. These are the out-of-pocket expenses incurred by Fortis Advocacy Partners in pursuing the appeal and may include the cost of medical reports, some travel expense etc. Any fees incurred by Fortis Advocacy Partners on your behalf are discussed with and explained to the client.

CPP has a Child Rearing Provision that may help you qualify for or receive a higher CPP benefit amount. Parents who have taken time out of work to raise their children may apply for this provision.

The amount of benefits paid under the Canada Pension Plan is based on how long and how much you have contributed to CPP while you were working. The years that a parent had little or no earnings can be excluded from the 4 out of 6 rule calculation. If you were not working or had low earnings while caring for a child under the age of seven, the Child Rearing Provision can be used to exclude these periods of time for the calculation of your benefit. This may help you qualify for benefits or increase the benefit amount you can receive.

To qualify for the Child Rearing Provision you must submit the appropriate forms enclosed in the CPP disability application.

You do not have to wait to apply for Canada Pension Plan disability benefits. Some individuals who have a critical incident that causes immediate disability apply right away. Some people who become disabled over years may wait until they have completed all their medical tests before applying.

There is no specific provision as to when you can apply for CPP disability but keep in mind that under the legislative criteria, a disability must be both “severe and prolonged”. Therefore, your disability application will likely be denied if there is an expectation that your disability will be short term.

Canada Pension Plan disability does not allow for closed-periods of disability. A disability cannot be prolonged unless it is determined to be of “indefinite duration”. The CPP is not used for short term compensation for temporarily disabled persons no matter how severe their disability is or how long their recovery period may be.

Each situation is unique – so please contact an advocate to discuss any questions about applying for CPP disability.

If your disability is both severe and prolonged you can apply for CPP disability benefits while still receiving sick leave from your employer.

Section 42(2) of the Canada Pension Plan defines disability. It says that:
(a) a person shall be considered to be disabled only if he is determined in prescribed manner to have a severe and prolonged mental or physical disability, and for the purposes of this paragraph,

  1. a disability is severe only if by reason thereof the person in respect of whom the determination is made is incapable regularly of pursuing any substantially gainful occupation, and
  2. a disability is prolonged only if it is determined in prescribed manner that the disability is likely to be long continued and of indefinite duration or is likely to result in death.

In order to qualify for CPP disability benefits you must show that your disability is both severe and prolonged.

There are several decisions from the Federal Court and the Pension Appeals Board that have interpreted the legislative criteria. Here are some examples:

This requires a realistic review of the “whole person” – the person in respect of whom the determination is made. This means that age, education level, past work, and life experience should be taken into consideration. It is also not a medical diagnosis of a condition that determines disability but its effect on the person.

Incapable means that as a result of the disability, an individual would not be able to work in any substantially gainful occupation. Incapable of work does not relate to profitability. It must be established that an individual’s disability directly affects his or her capacity to work.

This means that the limitations associated with a disability are persistent to the point of being continuous or uninterrupted. This means that you cannot commit yourself to a work schedule with reliability or predictability. Predictability is the essence of regularity.

Pursuing means to actually engage in an occupation. Pursuing is not used in the sense of seeking work. A person who is not looking for work may be capable of or work and, conversely, a person who is looking for work may, because of their disability, not be able to “pursue” work.

Substantially Gainful Occupation
A substantially gainful occupation means an occupation where the remuneration for the work performed and the services rendered was at a substantially gainful amount. The substantially gainful amount is a benchmark of earnings that likely indicates whether a person is showing regular capacity for work. This does not mean that you cannot work at your old job, but that you cannot work at any job – full or part time – for which you are or could become reasonably qualified.

Prolonged is only considered after the “severe” criterion is met; that is, only after it has been determined that a person has a severe disability. An applicant must demonstrate that both the “severe and prolonged” criteria are simultaneously met. This means that you do not expect to be able to return to work. if there is a reasonable expectation of recovery, you will not qualify.

The CPP disability benefit is a monthly payment. It is available to people who contributed to the Canada Pension Plan while they worked, and then become unable to work. Benefits for the child of a person receiving a CPP disability benefit is a monthly payment to a natural or adopted child or a person receiving CPP disability is entitled to a benefits up to age 18. A child between 18 and 25 may receive continued benefits if they are attending school full time at a recognized institution. For additional information on this benefit please contact Service Canada. CPP disability does not provide medical coverage for prescription drugs or treatments.

The Application for Disability Benefits is available online or contact Service Canada at 1-800-277-9914 to have a kit mailed to you. You can also go to your local Service Canada branch to obtain the application. For additional information, please review the HRSDC CPP Application Guide.

Service Canada information states that applicants who have a terminal illness will have their disability applications reviewed within 48 hours upon receipt of their application. Service Canada staff give these applications priority to determine eligibility quickly so that benefits can start as soon as possible.

No. You have contributed to Canada Pension Plan – the receipt of this benefit is not based on an asset test. It does not matter how much money you have in the bank.

Unless your disability is catastrophic there is no easy way for you to tell whether you will be found disabled by Canada Pension Plan. In the end, the decision of whether or not to apply should be yours. There is a common belief that CPP denies most applicants the first time they apply for disability benefits. In 2008- 2009 CPP received 66,350 applications for CPP disability. They denied 35,881 of these applications – this is about 54% nationally.

The medical adjudicators who review your claim are supposed to consider the combination of and cumulative effect of all of your medical conditions. Questions that the medical adjudicators should consider are- what is the nature of the medical condition? What are the limitations posed by this medical condition? How far has the person’s disease progressed? What are the impacts of medical treatment? How many mental and physical conditions are identified? So yes, the combination of health conditions should be considered by Canada Pension Plan disability.

The most common reason why CPP disability applications and appeals are denied is because HRSDC decides that a person’s disability is not severe. Your denial letter may state;

“While you may not be able to do your usual work, we have concluded that you should be able to some type of work” or

“We understand you have limitations. However, I concluded that the information shows that your limitations do not prevent you from doing some type of work.”

Another common reason is due to contribution issues. If a person does not apply for CPP disability soon after they become disabled, they may not meet the 4 out of 6 year rule. However, CPP disability may use the Late Applicant Provision. You may have a denial letter that says:

“We recognize that you are disabled now, however we have concluded that you should have been able to do some type of work in December 2003.”

Let’s imagine that a person in this case has Multiple Sclerosis and was diagnosed in June 2004. Yet for many years prior to actual diagnosis, the applicant had been doctoring and trying to find out what was medically wrong with them. They had not been working due to the symptoms of Multiple Sclerosis since 2001. It is important in this type of situation that all of the medical history be submitted to the Canada Pension Plan to substantiate disability at the date of the Minimum Qualifying Period December 2003.

Personal characteristics are considered as part of a comprehensive approach to adjudication of the claim. Personal characteristics are evaluated on a case by case basis, and in conjunction with the medical condition.

Age alone does not entitle a person to a CPP disability benefit. However, age, in terms of function, is an important consideration. With increasing age it can affect a person’s ability to recover from illness or injury and his or her ability to sustain work.

A lack of education alone does not establish entitlement to CPP disability. Generally speaking, the more education an individual has the more likely it is that the person will be able to do some form of work.

Work experience must be evaluated within the context of a disabling medical condition and how it affects that particular person’s regular capacity to pursue any substantially gainful occupation.

Saying that there are no jobs available in your town, is a poor argument to make. You are implying that the reason you cannot work is because you cannot find employment in your area. The language you speak, the place where you live, or unemployment rates are not considered in a CPP disability determination.

Similarly, factors such as the lack of child care of elder care, family responsibilities or preferred working hours are also not to be considered in a CPP disability determination.

Although these factors may be considered a barrier to work, they are not related to a person’s regular capacity for any work as a result of a “severe and prolonged” disability.

These are all Federal Court decisions that have helped to interpret Canada Pension Plan disability and are used frequently in the various appeal hearings pertinent to CPP disability.

The Villani decision provided direction on the legal test for the CPP definition of disability, the first time a federal court decision provided such direction. The decision confirmed that the medical condition is the primary factor in determining disability, and it also confirmed that personal factors should be taken into account when determining disability. The decision is consistent with the existing CPP Disability policy that requires age, education and work experience to be considered when assessing a person’s capacity to hold any job.

Some have interpreted the Villani decision as raising questions about the possible role of socio-economic factors in the determination of disability under CPP Disability. However, a federal court decision a short time later in January 2002 on the Rice case, brought some important clarifications to the Villani decision. In Rice, the court made clear that socio-economic factors, such as labour market conditions, or factors such as where applicants live, are not relevant to assessments of disability for the purposes of the CPP Disability program. Rice relied on the Villani decision, but limited the personal characteristics to be considered to those relating to the “capacity to be employed”. Examples of these characteristics include age, education level, language proficiency, and past work and life experience. The Rice decision also affirms that the CPP is national in scope and unlike, for instance, the Employment Insurance Act, is not subject to regional differences. Given the same functional limitations, regional differences in labour market conditions should not result in different determinations of eligibility for disability benefits.

There have been other federal court decisions since Villani and Rice which have helped to bring clarity to the administration of CPP disability. The 2003 Angheloni decision confirmed the Rice decision that socio-economic factors are not relevant in determining disability. Both Angheloni and the 2003 Inclima decision also clarified that, where there is evidence of residual work capacity, a person’s efforts or lack of effort to retrain or try light work are to be taken into account.

In most cases of appeal, the Tribunal or Panel members require evidence of mitigation efforts. This means an appellant must have shown efforts at reducing or lessening the severity of the disability.

Applicants for disability entitlement should demonstrate a “good faith” preparedness to follow appropriate medical advice and to make such efforts as to find alternative employment if evidence of work capacity exists.

For example, often clients will tell me about a return to work attempt – or perhaps they have tried to volunteer – these attempts can be favourable to an appeal if you attempt and fail due to the disability. Therefore, these are examples of mitigation efforts.

Another example of mitigation is following through on doctor’s recommendations and trying treatment options that are available to you.

Not really. Because most types of illnesses can vary from minor to severe, there is no one simple list that Canada Pension Plan considers to be disabling. The legislation states that CPP considers both physical and mental disability.

Contact Fortis Advocacy Partners if you have been denied your CPP disability benefits – or review the information found on this website to see if some of your questions can be answered. The more informed you are about the appeals process – the better your chances of success.

The website contains helpful application and appeal guides which you can utilize to help you be successful. Send us an email if you have a question or have us collect your file from Canada Pension Plan to review so we can help you understand why you have been denied.