Physician's Guide - Making a decision on the application
The application is sent for medical adjudication only after all materials have been reviewed to confirm that the applicant meets the contributory criteria. CPP looks at all information on the application form, the medical report and any other supporting documents.
Who makes the decision to grant or deny the application?
Adjudicators who are medical professionals and are extensively trained in CPP legislation decide whether a patient meets the "severe and prolonged" CPP disability criteria. For more complex cases, adjudicators may consult with CPP physicians.
Does CPP consider other factors besides medical information in making the decision?
While medical information is key, eligibility is based on an assessment of the whole person, not on a specific diagnosis only. CPP also considers factors such as age, education and work history. In addition to the detailed information provided by the applicant, CPP may consult with employers, schools and other third parties who may be able to provide additional information on the applicant's functional capacity. CPP does not consider socio-economic factors, such as the unemployment rate in an area or the availability of work.
What other information does CPP need to make a decision?
The information you provide as the applicant's treating physician is important to the adjudicators making the decision. If required, the adjudicators may also seek information from specialists or from independent medical examiners. This ensures that CPP has enough information to be reasonably satisfied that your patient meets eligibility requirements for benefits under CPP legislation.
Your patient will qualify if the "severe" and "prolonged" criteria are both met. However, CPP assesses the severity of the disability first. If your patient does not meet the "severe" criteria, CPP does not consider the question of whether the disability is prolonged.
Can my patient appeal a decision?
Applicants can appeal if CPP denies their application for a benefit. They can also appeal the amount of a benefit, the date when a disability benefit begins or the cancellation of a benefit. If your patient decides to appeal a decision, CPP may ask you for additional information relevant to your patient's ability to work.
Before deciding to appeal, applicants might wish to talk to CPP about their case. They can call 1 800 277-9914 (English) or 1 800 277-9915 (French) or 1 800 255-4786 (TTY), free of charge.
Continuing eligibility
How long will the benefits be paid?
Recipients can continue to receive benefits as long as they are under 65 years of age and their condition continues to be severe and prolonged, as defined by CPP legislation. CPP periodically reviews eligibility to ensure that recipients continue to qualify for disability benefits. CPP disability benefits are automatically converted to a CPP retirement pension the month following the recipient's 65th birthday.
A person cannot receive a CPP disability benefit and a CPP retirement pension at the same time. However, applicants between 60 and 65 can apply for both benefits at the same time. A retirement pension will be paid while CPP is making a decision on the disability application.
When will the benefits stop?
It is the responsibility of beneficiaries, not their physician, to keep CPP informed of any changes in their medical condition. If their condition stabilizes or improves enough that they may be able to resume working, they may no longer qualify for CPP benefits. If CPP concludes after a thorough review of the case that they are capable of returning to work, their benefits will be stopped.
What happens if my patient attempts to return to work?
The CPP offers a work trial period for disability recipients who are attempting to return to work on a regular basis. Your patient should notify CPP when he or she decides to return to work, so that CPP can support the attempt to reintegrate into working life or provide services such as vocational rehabilitation. If the return to work fails because of the original medical condition, benefits can be reinstated, provided certain conditions are met.