Part 1 - Canada Pension Plan Disability Benefits

The Appeal Structure

There are three possible levels in the appeal process:

  • A Reconsideration Request
  • The CPP Review Tribunal
  • The Pension Appeals Board

A Reconsideration Request

If an application for disability benefits is denied, the applicant can request a reconsideration within 90 days of receiving the denial letter. The reconsideration request is sent to the regional director (in Victoria). The request should be sent by registered mail to ensure that it is received within the limitation period. Any additional information to be submitted to CPP for their consideration should be sent with the request or as soon as possible after. The minister makes a new decision based on all of the information he or she has received. There is no hearing at this level.

The CPP Review Tribunal

A refusal of the reconsideration request can be appealed to a CPP Review Tribunal. Such an appeal must be requested within 90 days of receiving the reconsideration decision. The review tribunal is made up of three members. The chair of the tribunal is a lawyer. One of the panel members must be from the medical profession, and is often a doctor or nurse, although this person could be someone from a number of other professions within the medical field.

The review tribunal considers all of the medical evidence, as well as the verbal evidence provided by the appellant and any other witnesses, at the hearing. The minister is represented by a regional representative. The decision of the review tribunal is mailed to the appellant and the minister after the hearing ends.

The Pension Appeals Board

The decision of the review tribunal can be appealed to the Pension Appeals Board. This is the last possible level of appeal. To appeal to the board, the appellant must first obtain leave to appeal from either the chairman or the vice-chairman of the board. Both the minister and the applicant have the right to ask for leave to appeal to the Pension Appeals Board. Therefore, a win at the review tribunal level does not necessarily mean that the applicant will receive disability benefits. Benefits are not paid until the minister has decided whether or not to seek leave to appeal further.

The board is the most formal level of appeal in the CPP process. The appeal is conducted in the Federal Court of Canada, before federal court judges. Although the board is considered to be an administrative tribunal, its format is much more judicial than most tribunals in administrative law.

Most disability benefit appeals at the board level are heard before a panel of three federal court judges, although some appeals may be heard before a single member. A majority decision is required in order to succeed in the appeal.

An appeal before the board is considered a trial de novo. That is, it is a new hearing, and the case is reheard in its entirety. The onus is on the applicant to show that he or she meets the eligibility requirements for the benefits he or she seeks. This is the case whether the applicant is the appellant or the respondent in such an appeal.

The minister is represented by a lawyer at the board. The minister calls a doctor, employed by CPP (who has never examined the applicant), to present the evidence used by the minister to find that the applicant does not qualify for disability benefits. The applicant is then given an opportunity to cross-examine this medical witness.

Both CPP Review Tribunals and the Pension Appeals Board have their own rules of procedure, which should be consulted before initiating an appeal at either level. Failure to do so may prevent an appeal from proceeding, especially at the board level.