Why CPP Disability Benefits may be denied

Posted by Stevenson Whelton LLP
July 02, 2019

Eligibility Requirements for Canada Pension Plan Disability Benefit

Canadians who become disabled due to an injury or illness may be eligible for income replacement benefits through the Canada Pension Plan (CPP).  In order to qualify for benefits, an applicant must meet the following criteria:

  • A severe and prolonged disability.    This requires that:
    1. You have a physical or mental disability that regularly prevents you from doing any type of substantially gainful employment; and
    2. The disability is long-term or will continue indefinitely or is likely to be fatal.   For the purposes of CPP, a terminal or fatal medical condition is a condition that “cannot be cured or adequately treated and is reasonably expected to result in death within six (6) months”.
  • Must be less than 65 years of age.
  • Must meet the CPP contribution requirements.   
    • Almost everyone who works in Canada (excluding Quebec), is under 18 years of age and earns more than $3500, contributes to the Canada Pension Plan. Contributions to the CPP are based on a person's income up to a current maximum of $57,400, which was the average wage in 2019.
    • In order to qualify for CPP disability benefits, an applicant must have contributed to the CPP in four of the past six years; or three of the past six years if they were contributing for at least 25 years.
    • There are some exceptions in the eligibility requirements. Someone who had no income or low income because they stayed at home to raise their children may qualify for CPP disability benefits.

Why CPP disability benefits are denied

Many applications for CPP disability benefits are denied, although about half these cases are successful in gaining benefits when they appeal.  Here are some of the most common reasons for denied CPP benefits.

  • Not being fully aware of the CPP disability rules.  If you don’t know the requirements, you may fail to submit crucial information, or you may give the wrong answers when talking to a CPP caseworker (and unknowingly give them a reason to deny your claim).
  • Insufficient medical reports showing that your disability is severe and prolonged. Your application requires doctors’ reports and medical tests which substantiate that your disability is severe enough to prevent you from regularly working at any type of job, not only the job you were working at before you became disabled.
  • Application or appeal is past the deadline   Both your initial application and an appealed application may be denied if you missed the applicable deadline.  However, your application may still be eligible if you had good reason for the late application.  For example, if you stopped working for several years before applying but had enough years of making CPP contributions before becoming disabled, you may still be eligible for CPP disability benefits.  
  • When appealing, you failed to fully address the reason for the denied claim, for example, by not providing the required proof or information to substantiate the claim.  

Remember, since many serious medical conditions continue to evolve, even if you are denied CPP disability benefits in your initial application, new or changed medical reports may make you eligible for benefits on appeal.

If you were denied CPP disability benefits for any reason, seek the advice of an experienced disability claims lawyer who well understands Canada Pension Plan rules and processes. A disability claims professional can significantly increase your chances of making a successful claim or appeal, and can speed up the process for resolving a disability claims dispute.

Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.