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How does the adjudication work for CPP Disability claims?

Any Ontario residents who suffer an injury or illness that leaves them unable to return to work will likely have questions about their Canada Pension Plan Disability benefits. Before disability claims can be paid, the application must be approved. Understanding the requirements for eligibility might provide answers to some of the questions.

Upon receiving an application, the first thing CPP will check is whether the applicant’s contributions during his or her working years were sufficient. Once that aspect is approved, the file will proceed to the medical adjudicators, who include trained nurses, specialists and CPP physicians. Based on the CPP Adjudication Framework, they will consider the application.

The medical assessment will include the determination of the severity of the applicant’s condition. For eligibility, his or her condition must be severe and declared to be prolonged and indefinite or likely to lead to death. Along with the diagnosis, the medical adjudicators will also consider prognosis and the severity and nature of the condition along with the effect the illness and the proposed treatment will have on the applicant’s ability to work. Adjudicators will look at the person’s age, how productive he or she was, and the income he or she earned.

Many applications for eligibility to file disability claims are denied, but that does not mean all is lost. A lawyer who is experienced in fighting for the rights of Ontario employees can explain all options. These might include a request for reconsideration and even an appeal if that request is also rejected. The lawyer can then advocate for the client throughout ensuing procedures.

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