CPP Disability - I want my decision changed

• I was turned down - what are my rights?
• How do I get my decision changed?
• Contact information for appeals
• How do I prepare for my appeal?
• Do I have to pay for a review or an appeal?
• When will I know the decision?
• What happens if I win an appeal?
• Can I do anything else?

I was turned down - what are my rights?

If we decided that you were not eligible for a CPP disability benefit, you have the right to request a review of our decision.

There are three opportunities in the Canada Pension Plan to request a review of your disability application. These must occur in the following order. They are:

• Step 1.
  A request to Social Development Canada (SDC) for reconsideration,
  
  
• Step 2.
  An appeal to the Office of the Commissioner of Review Tribunals,
  
  
• Step 3.
  An appeal to the Pension Appeals Board.
  
  

At every level, you must make your request in writing within specific time limits.

You can request a review of any decision made on your application, including, for example:

• the denial of a benefit,
• the amount of a benefit payment,
• the date the benefit payment begins, or
• the cancellation of your benefit.

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How do I get my decision changed?

1. A request to SDC for reconsideration

At the first level, you have to contact SDC in writing to say that you want to have the decision reconsidered, and you must do this within 90 days of receiving our decision letter. Please include in your letter:

• your name, current address and social insurance number;
• an explanation of why you want to have your application reviewed;
• any new medical or other new information that could affect the decision; and,
• the date and your signature.

Please note: You are responsible for providing all information required to support your case. You can provide this information after letting us know in writing that you want to appeal.

Reconsideration is a review of all of the information about your application in your file by the Department. SDC staff who were not involved in making the original decision will review your file. They will examine your application, as well as any new information supplied by you, or by others on your behalf. SDC staff may also seek more medical information on your case. They may ask you to see another doctor. If this happens, CPP will pay for the doctor's visit and your travel to the doctor if that is necessary. After they finish their review, they will call you to explain the result. They will also send the reasons for their decision to you by mail, so that you will have a copy for your records.

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2. An Appeal to the Office of the Commissioner of Review Tribunals

If you are dissatisfied with the SDC decision on your reconsideration, you can appeal at the next level, which is the Office of the Commissioner of Review Tribunals (OCRT ).

Please note: You are responsible for providing all information required to support your case. You can provide this information after letting the OCRT know in writing that you want to appeal.

Even though the Office of the Commissioner of Review Tribunals reports to the Minister of Social Development , it operates as an independent agency which is separate from SDC. This means that the Minister of SD has no influence on the decisions made by the OCRT and cannot overturn them. This helps ensure that the appeal process is fair and impartial.

To appeal the decision that SDC made on your reconsideration, you must send a letter to the OCRT within 90 days of receiving the SDC reconsideration decision letter. You can also use the Notice of Appeal form available on the OCRT website to prepare your letter. Any other party affected by SDC's decision may also make an appeal to the OCRT. When the OCRT accepts the appeal, the OCRT will request a copy of the information the department used in making its decision. This information is provided to all parties in the appeal.

Staff from the OCRT will contact you about what you have to do to prepare for the hearing and where and when it will take place. They will also send you documents related to your case, and answer any questions you have. If the hearing location is far from your home, the OCRT will reimburse you for reasonable travel and accommodation costs.

At least one month before your scheduled hearing, the OCRT will send you SDC's document called the "Explanation of the Decision". Although our decision letter and reconsideration letter gave the reasons why your application was denied, the "Explanation of the Decision" document contains much more detailed information related to your individual case. This document will help you prepare your case.

At the hearing, you will present your case before a three-member Review Tribunal panel. One member is a lawyer who will chair the hearing; one is a health professional, and the other is an individual from the community, from any walk of life. The panel members are not SDC employees.

All Review Tribunal hearings are closed to the public. At your expense, you may bring someone to help you explain your case, such as a family member or an advocate. An SDC representative may also attend. This level of appeal is meant to be as informal in its proceedings as possible. It is your opportunity to present your case in person to the Review Tribunal panel.

At any time before the hearing, you can provide new information to support your appeal to the OCRT. You should always mail  your new information to the OCRT as soon as possible and far in advance of your hearing date. The OCRT sends SDC any new information received from you. If SDC agrees that your new information supports your eligibility for a disability benefit, SDC can reverse its original decision. Depending when such information is received and investigated, a hearing may not have to take place.

After your hearing, the OCRT will send a registered letter to you and SDC explaining the Review Tribunal's decision and the reasons for it.

Information on paying for a review or appeal, when you will know the decision and what happens if you win an appeal is provided below.

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3. Appeal to the Pension Appeals Board

If you are dissatisfied with the OCRT decision, you can then request leave (permission) to appeal to the Pension Appeals Board (PAB). You must make this request in writing, within 90 days of receiving the OCRT decision letter. Or, you can print the Application for Leave to Appeal and Notice of Appeal from the PAB website. The Minister of Social Development , or any other party affected by the OCRT decision, may also request leave to appeal to the PAB.

Please note: You are responsible for providing all information required to support your case. You can provide this information after letting the PAB know in writing that you want to appeal.

Even though the PAB reports to the Minister of Social Development , the PAB is an independent agency which is separate from SDC. This means that the Minister of SD has no influence on any decisions made by the PAB and cannot overturn them. This is to make sure that this level of appeal is fair and impartial.

At this level of appeal, a PAB judge must review your request and give you permission to present your case before the PAB, before you can proceed.

If SDC believes that the OCRT decision is not in agreement with the CPP legislation, they can also ask for permission to appeal to the PAB.

If the PAB judge decides not to hear the appeal, you and SDC will be notified by mail. This means that the decision made by the Review Tribunal is final and your appeal ends. However, you may request a judicial review of the PAB's decision not to hear your case.

If the PAB judge decides that there are grounds to hear your appeal, you and SDC will be notified in writing. The PAB will then schedule a hearing date in your province at the next available opportunity.

You can send the PAB any new information that you think might support your appeal. You should always send the PAB your new information as soon as possible and far in advance of your hearing date. The PAB will forward your information to SDC. If SDC agrees that this new information supports your eligibility for a disability benefit, it can reverse its original decision and offer to settle. If such information is received early enough, an appeal hearing may not have to take place.

The PAB panel is usually made up of three judges. PAB hearings are open to the public, and all their decisions can be made available to the public.

At a PAB hearing, a lawyer and a physician knowledgeable about the medical details of your case represent SDC. The PAB does not expect people who appeal to have legal counsel. If you decide to have legal counsel or another person represent you at your expense, this is your decision. You may be eligible to claim some of the costs related to your hearing.

After the hearing, the PAB will inform you and SDC of its decision. PAB decisions are final for both you and the Minister of SDC. This means that your appeal ends. However, you can ask for a judicial review of the PAB's decision.

Information on paying for a review or appeal, when you will know the decision and what happens if you win an appeal is provided below.

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Contact information for appeals

Contact SDC,
Contact the OCRT , or
Contact PAB 

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How do I prepare for my appeal?

Before deciding whether or not to appeal, you need to first clearly understand the reasons for SDC's decision. You should ask yourself the following questions:

1. Did I make enough contributions to the CPP? (You need to have made a certain amount of CPP contributions recently to qualify for a benefit.)
   
   
2. Does my medical condition stop me from being able to return to my job or any other job on a regular basis over the long term? (To qualify, a disability has to be both severe and prolonged enough that a person cannot work at his/her own job or any other job regularly over a long period of time.)

A "yes" answer to the following questions may help your appeal:

• If I already applied for a disability benefit, was there important medical information that was not submitted in relation to my application?
• Were there times when I did not work, or worked less, in order to raise my young children?
• Did I work or live in a country other than Canada? If you did not make enough contributions into the CPP, and if Canada has a social security agreement with the country where you worked, international credits can help you qualify for a CPP benefit.
• Is my condition worse now compared to when I originally sent in my application?
• Did I apply to split pension credits with my common-law partner or spouse when we were divorced or legally separated?

You can help by providing as much information as possible throughout the process.

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Do I have to pay for a review or an appeal?

No, you don't have to pay to request a review or to appeal. You may choose to have a family member, friend or paid representative such as a lawyer or advocate represent you at either the Review Tribunal or PAB hearing. Your advocate may charge for representing you, but this is a matter for you to agree on with them before they take your case. SDC will not cover these costs.

The OCRT will pay you for reasonable travel and accommodation costs to attend your hearing. They will not pay for travel costs of family members or friends or representatives, or for loss of income or professional fees.

SDC will pay you for reasonable travel and accommodation costs to attend your PAB hearing. If SDC appeals an OCRT decision to the PAB, SDC will pay for your legal fees up to a specified limit ($200 a half day and $300 a full day). If you appeal the OCRT decision, SDC will pay some portion of the legal fees if the PAB rules in your favour ($200 a half day and $300 a full day).

Review Tribunal panel members and PAB judges hearing your appeal will ensure that you (or your representative) have opportunities to present your case in a fair and informal manner.

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When will I know the decision?

Reconsideration service standard

To make at least 70 per cent of our decisions within 120 calendar days (4 months). The time begins when we receive your written request to reconsider your application.

Note: If additional information is needed, it may take longer to process your application.

The time can vary significantly depending on the complexity of the case. The reason for this is that we sometimes need to get additional medical information from your doctor(s) or ask you to go to a specialist for an examination. When this happens, we sometimes have to wait for the information we need. If you would like to know the status of your reconsideration decision, please feel free to contact SDC.

After the Review Tribunal hearing is over, it generally takes about six weeks to receive its decision. You can contact the OCRT  for the status of your decision.

In most cases, the PAB makes a decision on applications for leave in about two months or less. If you are given leave to appeal, it then takes additional time for the PAB to schedule a hearing in your area, and then to make a final decision on your appeal once the hearing takes place. You can contact the Pension Appeals Board  for the status of your appeal.

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What happens if I win an appeal?

If your appeal is successful at the reconsideration level, SDC will notify you of the amount of your benefit, including any retroactive payment, and when you can expect your first monthly payment.

If your appeal is successful at the Review Tribunal level, there is a 90-day appeal period during which all parties may request leave to appeal to the PAB. However, it generally takes about a month for SDC to complete a review of a Review Tribunal decision. If there is no appeal, SDC will notify you of the amount of your benefit, including any retroactive payment, and when you can expect your first monthly payment.

If your appeal is successful at the PAB level, there is a 30-day period during which all parties may request a judicial review of the PAB decision to the Federal Court of Appeal. After 30 days, if SDC or any other party has not appealed the PAB decision, SDC will issue your payment, and will notify you of the amount of your benefit, including any retroactive payment, and when you can expect your first monthly payment.

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Can I do anything else?

Judicial Review of the Federal Court of Appeal (FCA)

If you have tried all appeal levels, and the final decision is not in your favour, or if you were denied leave to appeal to the PAB, you can seek judicial review at the Federal Court. The Federal Court is not another appeal level. The Federal Court has the power to review how a decision was made by a tribunal such as the PAB. It looks at whether a tribunal properly exercised the powers given to it under law, or based its decision on erroneous findings of fact without regard to the material before it. If the Federal Court finds that the PAB did not apply the law correctly in its decision, it refers the decision back to the PAB, usually ordering the case to be re-heard by different judges.

There are specific rules and short time frames (30 days) for filing an application to the Federal Court  for judicial review.

If you have tried all appeal levels and the final decision is not in your favour, there may be other resources which may help you with your income needs.

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