Disability

Ontario residents have access to two disability programs: the Ontario Disability Support Program (ODSP) and the Canadian Pension Plan Disability Benefits (CPPD). Both programs make monthly payments to those who cannot otherwise support themselves due to a disability. The CPPD benefit program is geared towards people under 65 years old, who have worked in Canada and contributed to the CPP. The ODSP is intended for persons of any age, who have little or no work experience in Canada.

Reasons for Denial of Benefits

The most common reason for denial is that your disability was not considered “severe” and “prolonged”. Most of the time, this is due to the difficulty of demonstrating a disability as such on paper, by the limited means of forms and reports that are included with your application.

Another reason for denial of benefits is not satisfying the general criteria. For CPPD this generally means a lack of sufficient contributions to the CPP. For ODSP, this usually means that after consideration of your family’s size, income, housing costs, and assets, the ODSP does not consider you to be in financial need.

Appealing Decision

There are several points of the disability benefits decision that you can appeal. You can appeal:

• Denial of benefits for disability-related or financial reasons.
• The amount of benefits you receive.
• The starting date for your benefits.
• Cancellation of benefits.

Most commonly, appeals are filed because the CPPD or ODSP have denied disability benefits based on the consideration that the individual is not disabled.

Appealing any decision of either program is a process of several steps.

Appealing A Decision of the ODSP

Step 1: Requesting an Internal Review from the Disability Adjudication Unit (DAU)

At the first stage, you or your representative must, within 30 days of the original decision, file a written request to review the original decision with the Disability Adjudication Unit. The request must include detailed reasons for why you disagree with the original decision, and provide, if applicable, additional information about your case that would help the DAU overturn the original decision. The caseworker who reviews your case will not be the one who made the original decision.

Step 2: Appealing to the Social Benefits Tribunal (SBT)

If the internal review decision is still negative, you can appeal to the Social Benefits Tribunal (SBT), within 30 days of receiving your internal review decision. The appeal is prepared using a specific form. You or your representative has, once again, the opportunity to send any additional documents or information that would be helpful to your case. You then need to attend an oral appeal hearing together with your representative, if you have one. Your case is heard by the Social Benefits Tribunal, in a semi-formal setting, and a representative of the Disability Adjudication Unit might be present, as well.

Appealing a Decision of the CPPD Benefits Program

Step 1: A Request to Service Canada for Reconsideration

At this stage, you or your representative makes a written request to Service Canada to reconsider the negative decision, including reasons for why a reconsideration is necessary, and attaching any new helpful information. Your application and any additional information is reviewed by a Service Canada employee who was not involved in making the original decision. This must be done within 90 days of receiving the original decision.

Step 2: An Appeal to the Office of the Commissioner of Review Tribunals (OCRT)

If the original decision was not overturned after a reconsideration, you or your representative has the option of, within 90 days, filing a written appeal of the denial of disability benefits to the Office of the Commissioner of Review Tribunals, which is independent of Service Canada. Representatives of OCRT will review the information you used to originally apply for disability benefits. You or your representative also has the option to include any and all additional information that might be helpful in overturning the decision. You will need to appear for an oral appeals hearing, where you can bring a representative to speak to your case in person. The hearing is made as informal as possible, and is chaired by a three-member committee: a lawyer, a health professional, and a member of the community.

Step 3: Appeal to the Pension Appeals Board (PAB)

If the decision of the OCRT is still negative, you or your representative can, within 90 days of the decision, request permission to appeal the decision to the Pension Appeals Board. If the PAB does not see grounds to appeal the decision, the decision of the OCRT stands. If the PAB allows your appeal, you once again have the chance to provide additional information on your case and present it at an oral hearing. This hearing is more formal. It is heard by a panel of three judges, and a lawyer and a medical professional knowledgeable about your case will be present on behalf of Service Canada. PAB decisions are final, though a judicial review may be requested.

How We Help With Disability Benefits Appeals In:

• Aurora
• Brampton
• Etobicoke
• Markham
• Mississauga
• Newmarket
• North York
• Richmond Hill
• Scarborough
• Thornhill
• Toronto
• Vaughan
• York