Fewer claimants successful when appealing disability benefit denials

Canadians with long-term and debilitating illnesses who believe they have been unfairly denied federal disability benefits are finding it increasingly difficult to get those decisions overturned.

In 2005-06, nearly 60 per cent of claimants were successful when they appealed the rulings of federal bureaucrats who said they did not qualify for payments under the Canada Pension Plan disability program.

But that success rate has declined year over year for the past eight years, with one slight upward tick in 2009-10. And, by 2013-14, just 43.4 per cent of appellants were able to convince an adjudicator of the new Social Security Tribunal (SST) that they had been wrongfully denied.

Coupled with the backlog of nearly 10,000 appeals that are waiting to be heard by the tribunal, and new rules that allow adjudicators to accept or deny appeals without actually hearing from the claimants, critics say many ill and disabled Canadians are being left in desperate straits.

“For many people, it’s heartbreaking,” said Peter Beaudin, an advocate with the B.C. Coalition of People with Disabilities. “They have been working to support their families all their lives, and suddenly they are facing the loss of their homes – their marriages are in trouble because of the stress.”

It is a problem even for sick and injured people who have private disability insurance through their employers. The payout of the private insurers is reduced dollar-for-dollar by the amount paid by CPP’s disability program, so the insurers generally insist that their clients also apply for the federal benefits. If the government benefits are denied, the private benefits are often terminated.

In recent years, bureaucrats within Employment and Social Development Canada and its predecessor, Human Resources and Social Development Canada, have refused about 60 per cent of initial applications for CPP disability benefits. Large numbers of those rejections are overturned when claimants request that their cases be reconsidered.

If the claim is again denied, it can be appealed to the SST. That is often enough for the government to seek a resolution. But, if that does not happen, the case will be decided by one of about 35 full-time adjudicators of the SST who were appointed last year to replace a system of three-person review panels drawn from a pool of 350 part-time members.

It is not clear why the success rate for appeals would have declined over time. A spokesman for the department said in an e-mail he is not in a position to comment on the decisions of the previous review panels. And the senior director of the SST said decisions are made on the basis of evidence.

But “the numbers are pretty stark when you see the number that have been refused tracked back to 2005,” said Rodger Cuzner, the Liberal critic for employment and social development.

Jinny Sims, the NDP critic, said the reduction in successful appeals has been dramatic. “For there to be that kind of a shift that quickly shows that the adjudicators may be looking at the files with a different set of directions.”

Ms. Sims also said it seems “highly irregular and highly unfair” for the SST adjudicators to be able to decide, unilaterally, that they will not hear directly from claimants who have launched an appeal. It is important, she said, for appellants to be able to tell their story.

Source: http://www.theglobeandmail.com/news/politics/fewer-claimants-successful-when-appealing-disability-benefit-denials/article19501881/

Gloria Galloway

The Globe and Mail

Published Monday, Jul. 07 2014, 8:51 PM EDT
Last updated Monday, Jul. 07 2014, 8:51 PM EDT