So I was denied and have to appeal. It’s one of those situations where my phycologist is on side. So the initial application addressed all their issues.
I’ve read on here what you do in that situation is just directly address their issues citing the evidence from the first appeal.
I’ve done that, and am just wondering if anyone has any other tips or anything?
Also, bit of a side note. Doesn’t the adjudication framework say that the criteria is the person has to be unable to work for the next year? My denial letter made it sound like that’s not the case.
The current qualification criteria for bothCPP-D benefits and the Disability Tax Credit require that the illness be severe and prolonged. So if you are expected to recover or go back to work after 12 months it will be harder for you to be approved.
Oh, I’m not lol. But I was under the impression that the adjudication framework said that the line for “severe and prolonged” is 12 months. Or am I misrembering?
I too was denied the first time I had appealed. I think this is just standard for everyone. I did win my appeal.
First thing you need to do is ask them for your full and complete file and inform them that you are going to appeal.
The information they require is ‘objective’ reports from professionals or experts.
You have to have a detailed assessment most times. They look at the probability of winning, the better your reports the less their probability.
Physical injuries are easier to document.
If it is mental health related be prepared to go through three rejections of appeals unless you have an assessment from a Psychiatrist. Personal physician reports and Psychologists usually do not fit the bill of objectivity for most insurers.
Also, know the case manager is not your service agent, they are an agent for the insurer whose job is to reduce claims. They gather information to fight you. Always say, I am not well, I feel unwell, I have not improved.
If the third appeal fails, hire a lawyer, that’s your best recourse.
The key is to identify all the red flags (from the adjudicators’ perspective) and to address them in your submissions. Sounds like disability not prolonged is one of the red flags.
David Brannen
Disability Lawyer with Resolute Legal
The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.
How long did it take to get a reply when you won your appeal? Why were you denied in the first place. I was denied as well but I sent a reconsideration letter. It’s been 3 months and no response yet!
I was denied in Nov 2019 and had until 8 feb 2020 to file my appeal. I dropped it off at their office on the 5th Feb and found out end of June that I had won my appeal so 4 months.
In my experience a shorter more to the point appeal letter, is better than a long unfocused appeal letter. See the article I referenced above for guidance.
