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Canada Pension Plan Disability Information for Health Care Professionals
- General information about the CPP Disability program
Frequently Asked Questions about CPP Disability
- What is the CPP Disability Benefit?
- What are the eligibility criteria for CPP Disability benefits?
- Where are the application forms?
- Who is authorized to fill out the CPP Disability medical report?
- What medical information is required for the CPP Disability medical report?
- Does CPP Disability consider other factors besides medical information in making the decision to grant or deny benefits?
- What is the process for benefits to be granted or denied?
- What is the billing procedure for medical reports?
- How is a patient's personal information used and protected under the Canada Pension Plan legislation?
- Can a patient access his or her personal information?
- Where can I find more information about the CPP Disability program?
- My patient is between 60 and 65, has stopped working and might qualify for disability benefits. What should the patient apply for: a retirement pension or disability benefits?
Returning to Work for CPP Disability beneficiaries
- What support is available to CPP Disability benefit recipients who wish to return to work?
- Can my patient earn work-related income while receiving CPP Disability benefits?
- If my patient needs to return to CPP Disability benefits, do I need to fill out a form?
Do you still have questions?
Frequently Asked Questions about CPP Disability
What is the CPP Disability Benefit?
The CPP Disability benefit provides basic earnings replacement in the form of monthly benefits to Canada Pension Plan contributors who have made the required contributions and are determined incapable of regularly working at any substantially gainful job due to a severe and prolonged physical and/or mental disability. The CPP Disability benefit:
- does not provide additional payments for prescription drugs, medical supplies, assistive devices, or other health-related services;
- is not intended for short term disability coverage; and
- automatically changes to a CPP retirement pension at age 65
A separate monthly benefit is paid to a CPP Disability recipients children under the age of 18, and between the ages of 18 and 25 if the children are in full time attendance at school or university.
What are the eligibility criteria for CPP Disability benefits?
To qualify for benefits, the applicant must:
- have contributed to the CPP for a minimum number of years;
- be under the age of 65 and not be receiving CPP retirement benefits for more than 15 months;
- have a severe and prolonged disability as defined by CPP legislation; and
- apply in writing and provide the information required by the legislation, including a physician's medical report.
Note:
Severe means that a person has a mental or physical disability that regularly stops him or her from doing any type of substantially gainful work.
Prolonged means that a persons disability is expected to be long continued and of indefinite duration, or is likely to result in death.
Where are the application forms?
Anyone who wants to apply for a CPP Disability benefit, or any individual who wants to help someone apply, can contact Service Canada to obtain the CPP Disability benefit application kit. Applicants can also get an on-line version of the CPP Disability benefit application kit and print it out. The kit includes the:
- Application for Disability Benefits Form (to be completed by the applicant)
- Questionnaire for Disability Benefits Form (to be completed by the applicant)
- Medical Report Form (to be completed by the applicant's physician)
Find out more about the CPP Disability application process.
Who is authorized to fill out the CPP Disability medical report?
A physician completes the medical report for CPP Disability benefits on behalf of his or her patient. In exceptional circumstances, such as when applicants live in remote areas, a nurse or nurse practitioner may complete the medical report.
What medical information is required for the medical report?
The following information related to an applicants medical history is required for the medical report:
- The medical diagnosis of the physical and/or mental illness(es)
- The findings upon which the diagnosis was made
- The resulting physical and/or mental functional limitations or restrictions
- The date of onset of the limitations or restrictions
- The prognosis of the medical condition(s)
- The impacts of treatment(s)
- Whether the medical condition(s) are episodic, continuous, resolving, or unknown
Does CPP Disability consider factors other than medical information in making the decision to grant or deny benefits?
Yes. While medical information is of primary importance, CPP Disability takes a holistic approach to decision-making. For example, factors such as a persons age, education, as well as transferable work skills and experiences are considered. However, local socio-economic conditions are not considered.
What is the process for benefits to be granted or denied?
Decisions to grant or deny benefits are made by medical adjudicators, who are nurses, in Service Canada regional offices. For more complex cases, physician medical advisors in the Medical Expertise Division of the CPP Disability program are available to provide consultation and guidance.
CPP Disability medical adjudicators may request additional information from treating physicians, or from other sources.
Applicants who are deemed ineligible for benefits may request an internal review of the initial decision to deny benefits. Subsequently, an applicant who is denied benefits can appeal to the Review Tribunal.
What is the billing procedure for medical reports?
Physicians need to mail their invoice to the Service Canada office address noted on the application form. Payment will be made by cheque and mailed to the address noted on the invoice.
CPP Disability will pay up to $85 to physicians for completing the application medical report.
CPP Disability may ask physicians to provide supplementary information in the form of a narrative report and will pay from $50 to $150, depending on the complexity and length of the report.
How is a patient's personal information used and protected under the Canada Pension Plan legislation?
The personal information of patients is administered pursuant to the CPP legislation and the Privacy Act.
Can a person access his or her personal information?
Yes. In accordance with the Access to Information and Privacy Act, applicants have the right to formally request a copy of their CPP Disability file, including the medical reports and supporting documents. Appropriate exemption to the release of information may be applied if release of medical information is considered to be contrary to the best interest of the individual (Section 28 of the Privacy Act).
The Access to Information and Privacy Division staff and specific positions within HRSDC have the authority to decide whether or not information should be released in response to access requests received from clients/patients.
Where can I find more information about the CPP Disability program?
My patient is between 60 and 65, has stopped working and might qualify for disability benefits. What should the patient apply for: a retirement pension or disability benefits?
If you think a patient might qualify for CPP disability benefits, he or she may want to apply for both a retirement pension and disability benefits at the same time. While a person cannot receive both at the same time, he or she may qualify to begin receiving a retirement pension while waiting for the CPP disability benefit application to be assessed, which usually takes longer. If the patient is already receiving a retirement pension when the application for disability benefits is approved, CPP Disability will switch the person to disability benefits if he or she:
- is under the age of 65;
- has earned a specified minimum amount and contributed to the CPP while working for a minimum number of years;
- has been receiving a CPP retirement pension for less than 15 months; and
- has been deemed to be disabled, as defined by the CPP legislation, before the effective date of his or her retirement pension.
Returning to Work for CPP Disability beneficiaries
What support is available to CPP Disability beneficiaries who wish to return to work?
The CPP Disability program encourages beneficiaries to work to their potential and offers the following return to work support:
- Automatic reinstatement is a financial safety net for people receiving CPP Disability benefits who try to return to work. If a beneficiary returns to work but is unable to continue working because of the same or a related disability, he or she can ask to have the benefit restarted without having to go through the usual reapplication process.
- The CPP Disability program offers vocational rehabilitation for CPP Disability beneficiaries who meet the criteria and wish to transition to regular employment.
- CPP Disability beneficiaries who are not yet ready to return to regular employment are encouraged to volunteer, attend school, participate in training or skills upgrading. These activities do not affect continuing eligibility for benefits or the amount of monthly benefit.
Can my patient earn work related income while receiving CPP Disability benefits?
Beneficiaries can earn up to an annually determined modest amount ($4,800 in 2011) before having to advise CPP Disability of their work related earnings. This level of earnings does not result in cessation of benefits, however, it is a point at which supports and services are offered to help with work efforts.
If my patient needs to return to CPP Disability benefits, do I need to fill out a form?
Yes. Physicians must complete a separate Reinstatement of CPP Disability Benefits Physician Confirmation Form in order to help their patients return to CPP Disability benefits. The procedure for physicians to obtain payment is shown on the form.
If a patient no longer has the customized form provided when he or she left CPP Disability benefits, another can be obtained by contacting Service Canada at 1-800-277-9914 (Teletypewriter users contact 1-800-255-4786). The form is not available online.
Do you still have questions?
Contact us
Physicians and patients can contact the CPP Disability Program directly by calling:
- 1 800 277-9914 (English)
- 1 800 277 9915 (French)
- 1 800 255-4786 TTY
Find out more about Canada Pension Plan Disability Benefits.