Medical Adjudicator Called - Thoughts?

Hi everyone,

I applied for CPP back in January (Date received by CPP January 18, 2020) as I have struggled with anxiety, PTSD, insomnia and depression for many years and have a lengthy medical history with respect to it. I put in a tremendous amount of effort to keep gainful employment however because of my illness could never maintain any kind of job.

At the end of March I received a phone call from CPP advising that they had received my application and that I did Meet the basic requirements. They confirmed that they did have my full application and my doctor’s records.

The Medical Adjudicator called today And asked me a few basic questions regarding my condition. Wanting to know if it has changed at all in the past couple of months, which it has not and if I ever expected to return to work full time which I do not. I advised at the most I would be able to do maybe in a couple of years is volunteer or casual employment.

She was very nice and understanding. I did ask her if she believed I was eligible for CPP pension and she said that that was why she was calling as she has not yet made her decision. I wondered if this is something that she could not divulge at that point in time. She did say that the good news was that she was the " end of the line" quote and so a decision would be made quite soon And that “if” I was approved it would then go to the benefits department and they would issue the appropriate payments. She also said that at this point she could request more information from my doctor if needed but that she may not necessarily need to do that. Again, she did indicate that the decision should be made quite soon.

Can anyone weigh in on approximately how long it might take from a call with the medical adjudicator before a decision is made? I would appreciate if someone could share their experience(s) dealing with the medical adjudicator and the outcome.

Lastly, I just want to encourage everyone who is waiting for their application to be processed - Especially with the extended processing application times as of late - That the applications are moving along and that it is possible to have an answer within a reasonable amount of time. They received my application at the end of January and hopefully will be a decision quite soon putting it at approximately 4-5 Months from beginning to end.

Thanks much. :slight_smile:

Jenny - the medical adjudicator at Service Canada is the person who makes the final decision on your claim. This person is a highly qualified medical professional. This person is not a clerk or an admistrator. Likely you were speaking to a nurse practitioner. or a registered nurse. Your claim was already fully assessed to make sure you met all the qualifying criteria for contributions and any child benefits BEFORE it moved to the “end of the line” - the final step - medical adjudication. The medical adjudicator makes the decision.

The medical adjudicator reviews your full application and reads your medical file. They complete a report to explain the rationale for approving or rejecting your claim on a “medical” basis. They don’t do this based on criteria they make up. CPP has extensive medical adjudication guidelines. The medical adjudicator uses their medical expertise, the CPP medical adjudication guidelines, your medical file, your application and discussions with you/others to make a decision on your case. When the adjudicator hung up the phone, she either completed her detailed report, including her decision, or sent off a letter to your doctor. If you are approved or not approved you can tell on line within days as some data changes (other posters have provided details). If further information was required from your doctor, a letter would have been sent to your doctor right away. If you were approved, in normal times it takes a couple of weeks for the “Benefits” department to calculate backdated lump sums.

Don’t be discouraged if you are not approved. If you get a rejection letter, it will be from the medical adjudicator you spoke to and it will offer you an opportunity to speak with her. I would first order my full CPPD file from Service Canada as it will provide absolutely everything they have including her full internal report. I would then phone and arrange to talk to her and she will explain explicitly why your claim was not approved and she may even tell you where your application and medical information was lacking. You should file a reconsideration request.

It’s not a perfect system and human judgment is involved, but it is entirely possible to be approved even for invisible disabilities!

3 Likes

There’s no saying if my situation is similar, but it was a week between the medical adjudicator calling and my application switching to “complete” (which mean “approved” in my case).

2 Likes

Thanks much for the info. When you spoke to the adjudicator did they give you any indication that it would be approved? What kind of questions did they ask you? She only really asked me a few: If I thought I would ever be able to work again, if my condition has changed or improved at all and if I had done any volunteer work previously and would consider that at some point.

Thanks Joanne for all of the great info. I have been checking around my service account for any indication of approval or denial but it is still in progress. My direct deposit information is entered but that is it.

My direct deposit information appeared 9 months before I was approved. I’m not sure it’s an indicator.

My adjudicator call ended up not being about my health! She was more interested in my failed back-to-work attempt, how much I’d grossed (I did it as a self employed. She would not give any guidance on approval. Not sure if this is a typical experience.

I had multiple specialists reports, letters of support from occupational therapist and speech-language pathologist and rulings from insurance companies in my favour. So, those 300-pages might have already swayed their opinion – I don’t know!

Good luck.

1 Like

Jenny - I don’t have any recent information about what shows up on Service Canada when you are approved. I know they have made major changes to their website over the last few years.

If you are approved, on the My Service Canada Website under “Estimated Monthly CPP Benefits”, “Disability Benefits”, it will say “Our records show you currently receive CPP disability benefits.” I don’t know at what point in the process that message shows up, but that’s how I knew I had been approved several years ago. When you are receiving CPP Disability Benefits on an ongoing basis, that’s what the message says even today, so that might be a hint for you.

As far as the questions the medical adjudicator asked you and geekything, all of the questions noted earlier in this thread are consistent with CPP’s Disability Adjudication Framework. While they might not seem like “medical” questions, receiving CPPD is not based on your medical condition alone, except when you have a terminal medical condition which is expected to result in your death within 6 months. Many other things are considered when the medical adjudicator assesses your claim. It’s really how your medical condition has prevented you from working in the past, present and future (indefinitely).

I’m trying to make it simple… I’m sure it’s much more complicated and, of course, I’m no expert!

2 Likes