What Should You Do If Denied Canadian Pension Plan Disability Benefits? - Diamond and Diamond Lawyers

What Should You Do If Denied Canadian Pension Plan Disability Benefits?


Your future can look bleak when the injuries suffered through an accident or illness make it impossible for you return to work and earn a living. The Canadian Pension Plan disability benefits offer hope with financial assistance for individuals who are disabled. The application process to obtain disability benefits can be a long one. The manner in which applications have been screened to determine eligibility has been the subject of news stories in recent years of otherwise eligible people being denied benefits appear to have had the effect of improving how claims are handled, but it is important to know what to you can do if your claim is denied.

Overview of the Canada Pension Plan

A person who is unable to engage in any type of work may apply for disability benefits under the Canadian Pension Plan. The amount of the monthly payment you receive under the CPP as a disability payment depends upon the amount of your past contributions to the CPP and the total number of years you made contributions.

The maximum CPP disability payment amount you could receive is $1,290.81 a month. This is based upon the base payment every eligible applicant receives of $471.43 plus an additional amount based upon your CPP contributions made when you were employed. Dependent children of a person receiving disability benefits could receive $237.69 each month as a children’s benefit.

A child must be under 18 years of age to receive children’s benefits. Children who are between 18 and 25 years of age may receive benefits if they are full-time students at a school or university.

Eligibility for CPP disability benefits

The first requirement for eligibility for CPP disability benefits is having contributed to the CPP for four of six years preceding your application for benefits or three of the past six years if you made contributions for at least 25 years. If your earnings were too low to make contributions because you were the primary caregiver for your children, you might qualify for benefits under a special child-rearing provision of the CPP.

Assuming you meet the contribution requirements, you must suffer from a severe and prolonged disability and not have reached 65 years of age. Individuals with a terminal illness may be eligible for benefits under a terminal illness application.

It can take several months before a decision is made on your application for benefits. Individuals with a terminal illness have their applications processed on an expedited basis with a decision rendered within five days.

What happens if my claim is denied?

Medical adjudicators determine if your medical condition meets the severe and prolonged standard to receive benefits. Someone suffering from a medical condition that is temporary in nature would not be eligible to receive benefits. Among the factors considered by the medical adjudicator in evaluating your claim for disability benefits are the following:

  • Nature and severity of your medical condition
  • Effect of your medical condition on your ability to work
  • Prognosis for recovery
  • Your age, education and work history
  • Your work performance, earnings and productivity

You may request a review of your application in the event your claim for benefits is denied. The request for reconsideration must be made within 90 days. If reconsideration does not result in a reversal of the denial, you can appeal to the Social Security Tribunal, but it might be in your best interest to speak with a lawyer to learn how to protect your rights during the appeal process.

Personal injury lawyers in Ontario

The personal injury lawyers at Diamond & Diamond have years of experience pursuing compensation and benefit claims for the victims of accidents and injuries. If you have a claim for benefits and need assistance, call our 24/7 personal injury hotline at 1-800-567-HURT or visit our website to speak to one of our team members. We have offices throughout Ontario to offer free consultations and case evaluations.

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