Your doctor says you cannot work. Your long-term disability insurer says you have to apply for CPP disability anyway. A few months later, a letter from Service Canada says your disability is not “severe and prolonged.” You are not alone. Many first applications are refused, and many of those decisions are later reversed. But the deadlines to challenge them are short.
What CPP disability is
The Canada Pension Plan disability benefit is a monthly payment for people under 65 who have contributed to the CPP and cannot work because of a disability. It is separate from long-term disability insurance through an employer, from accident benefits after a car crash, and from WSIB. People can receive it alongside those benefits, although other payers usually reduce their payments by the CPP amount.
The test: severe and prolonged
Two words decide most claims:
- Severe means you are incapable regularly of pursuing any substantially gainful occupation. This is not about your own job. It asks whether you can do any job on a reliable, regular basis.
- Prolonged means the disability is likely to be long continued and of indefinite duration, or likely to result in death.
You must also have made enough CPP contributions in recent years, and the disability must have begun while you met that requirement. If you stopped working some time ago, the date your contributions last qualified you can become the central issue.
Why claims are denied
- “You can do lighter work.” Service Canada often finds that a person who cannot do their old job could do sedentary or part-time work.
- Medical evidence that names the diagnosis but not the limitations. A report saying “chronic pain” or “major depressive disorder” does little on its own. The evidence has to show what you cannot do, how often and for how long.
- Treatment gaps. Not following recommended treatment, or not being referred to specialists, is treated as a sign the condition is not as severe as described.
- Attempts to work. Short, failed returns to work can actually support a claim, but only if they are explained.
The appeal steps and deadlines
- Reconsideration. Ask Service Canada in writing to reconsider within 90 days of receiving the refusal letter. This is the first chance to add evidence and to answer the specific reasons for refusal.
- Social Security Tribunal, General Division. If reconsideration is refused, appeal within 90 days of receiving that decision. The Tribunal holds a hearing, often by phone or video, and decides the claim afresh.
- Social Security Tribunal, Appeal Division. A further appeal is possible only with permission, and only on limited grounds.
Late requests are possible in some cases but are harder to win. Do not let a deadline pass while you wait for a medical report.
How CPP disability interacts with other claims
- Long-term disability. Most group policies require you to apply for CPP disability and deduct it from your LTD benefit. Some insurers estimate the deduction even before CPP decides. Our posts on LTD denials and mental health LTD claims explain those policies.
- Accident benefits and lawsuits. After a car accident, CPP disability payments can affect income replacement benefits and the income loss you can claim in a lawsuit. Our post on accident benefits and tort claims explains how the pieces fit together.
Building a strong claim
- Describe your worst days and your typical days, not your best days.
- Ask your doctors to describe functional limits: sitting, standing, concentration, reliability and attendance.
- Keep a record of every attempt to work and why it ended.
- Follow treatment and keep appointments, or document why you could not.
How we can help
At Kabir & Alam, we help people apply for CPP disability, request reconsideration and appeal to the Social Security Tribunal, and we coordinate CPP with LTD and accident claims so that one does not undercut another. Read more about our disability benefits practice or book a consultation with us.
This post is general information about Canadian law and is not legal advice. Every case turns on its own facts. Speak with a lawyer about your situation before making decisions.