Physician's Guide - Canada Pension Plan disability benefits
A CPP disability benefit provides a modest monthly payment to people who satisfy the contributory requirements and who are deemed to have a "severe and prolonged" disability, according to CPP legislation.
A CPP disability benefit:
- is taxable;
- is based on contributions – no special payments for medical equipment, drugs or health-related services can be added;
- is an "all or nothing" benefit: a person either qualifies or not – no partial benefits are paid;
- stops when a person no longer qualifies;
- is unrelated to financial need; and
- is not intended for cases for short-term disability
Eligibility for disability benefits
What are the eligibility criteria?
The CPP legislation has strict eligibility criteria for disability benefits. Your patient must apply in writing. He or she must:
- be under 65
- have contributed to the CPP for a minimum number of years
- have a "severe and prolonged" disability that prevents him or her from working at any job on a regular basis
(See Appendix 1: "Do You Qualify for Canada Pension Plan Disability Benefits?")
While your patient is receiving a CPP disability benefit his or her children under the age of 25 may also be eligible for a benefit. Children between the ages of 18 and 25 must be in school full time to be eligible. These benefits are not automatic – your patient or your patient's children must apply.
A CPP disability benefit is not based on a contributor's pre-disability earnings. Rather, it depends on the amount of CPP contributions paid while working and the length of time he or she contributed to the Plan.
How does CPP decide if my patient is eligible?
Generally, your patient must have contributed to the CPP in four of the last six years. However, there are other provisions in the legislation that may make your patient eligible.
If your patient has not worked recently because of a medical condition, the Late Applicant Provision may help. Contributors who meet all conditions of eligibility except that their contributions were made too long ago to meet the minimum qualifying period may still be eligible for benefits. Each case must meet the rules in effect at the time the applicant became disabled. Applicants must have been continuously unable to work in any job from that date to the present and into the foreseeable future.
The Incapacity Provision may also help patients who were unable to apply on their own because of their medical condition (patients with a loss of cognitive function due to a severe stroke, for example). Their representative can use this provision to apply for a CPP disability benefit on their behalf at a later date. As their physician, you will be asked to fill out a special form, the "Declaration of Incapacity - Physician's Report", as part of the application process.
How does CPP determine whether my patient is eligible on the basis of his or her medical condition?
To be eligible to receive disability benefits, the applicant must have a physical and/or mental impairment that is both severe and prolonged, as defined by CPP legislation.
"Severe" means that a person is incapable of regularly pursuing any substantially gainful occupation. This means that a disability stops your patient from doing any type of full-time, part-time, or seasonal work on a regular basis. This is different from most other long-term disability insurance systems in that they may base eligibility for benefits on an incapacity to return to the person's former job. The CPP bases eligibility on the applicant's incapacity to do any type of paid work on a regular basis.
"Prolonged" means that the disability is of indefinite duration and will continute to prevent your patient from going back to work in the next 12 months, or is likely to result in death.
Other CPP definitions
Incapable:
Not able or fit to pursue any substantially gainful occupation as a result of the disability.
Regularly:
The capacity to work is sustainable.
Pursuing:
To actually engage in an occupation - not to be confused with looking for work.
Any:
Work that a person might reasonably be expected to do by virtue of:
- possessing the necessary skills, education or training;
- having the capacity to acquire those necessary skills, education or training in the short term; and
- having reasonable access to suitable employment, given the individual's limitations.
Substantially gainful occupation:
Work that is productive and profitable. This is measured in part by a dollar amount that is set annually and against which a person's earnings are compared. However, earnings alone do not determine whether the regular capacity to pursue work exists. CPP also assesses elements of performance and productivity.