HUMA Committee Report

In any government program that requires individuals to meet specific eligibility conditions, the application and approval process is sometimes problematic for applicants and program administrators alike. The CPP(D) program is no exception. In fact, Human Resources Development Canada (HRDC) recently reported that persons with disabilities applying for the CPP(D) continue to find the application and decision-making process difficult to understand.⁷⁸

Applications for CPP(D) benefits are made to the Income Security Programs (ISP) Branch of HRDC. The application consists of an application form, a questionnaire requesting medical information and details on the applicant’s education and work history, as well as a medical report completed by a physician. Other supporting documentation is also required. This application is assessed by nurse adjudicators who decide whether the application meets the eligibility criteria or not. During the 1980s, these decisions were made by a two-person panel, one of whom was a physician.

Where an initial application for CPP(D) benefits is denied, an individual may appeal the decision. There are three levels of appeal: a request to the Minister of Human Resources Development Canada for an internal reconsideration of the initial decision, and two levels of formal appeal to independent quasi-judicial administrative tribunals: the Office of the Commissioner of Review Tribunals (OCRT), and finally the Pension Appeal Board (PAB).⁷⁹

4.1       The Facts about Applications

Both the number of applications for the CPP(D) and the approval rate for applications have declined since the mid-1990s. A number of factors have undoubtedly contributed to this downward trend including, among others, an improvement in job opportunities, new adjudication guidelines stressing the medical basis for approval, a stricter interpretation of disability and, of course, stricter eligibility conditions. There has also been a downward trend in the number of applications approved. According to information provided by HRDC based on 2002-2003 volumes, 42.6% of applications are initially approved, 6% of total decisions are approved on reconsideration (or 11% of those decisions that deny benefits), and roughly one half do not succeed at any level. While the initial approval rate has decreased over time, the rate of second and third level appeals resulting in positive decisions has increased dramatically since the early 1990s.

As may be expected from the decline in the volume of applications received, the trend in initial CPP(D) decisions also declined between 1990-1991 and 2002-2003. The total number of initial decisions for CPP(D) increased until 1994-1995 and has since fallen (Chart 4.1). The approval rate (i.e., the number of applications approved expressed as a proportion of the total number of initial decisions) also declined between 1990-1991 and 1997-1998, but has increased slightly since then. The proportion of initial applications approved in 1990-1991 was 55.7% of all CPP(D) initial decisions in that year. By 2002-2003, the approval rate had dropped to 42.6%.

4.2       What We Discovered: Applications

Results from our issue poll questionnaire indicated that many people find the application and appeal processes very difficult and time consuming. They told us that these processes are:

•	Complicated — Detailed forms and medical records must be completed by a doctor and the person applying.

•	Lengthy — There are sometimes delays in getting medical records from doctors.

•	Procedurally driven — three stages of appeal that a person could go through could take several years.

•	High in volume — the CPP(D) program receives over 50,000 applications each year. There are almost 20,000 appeals each year for applications that have been rejected. It is estimated that over 30% eventually succeed.

•	Costly — Applicants and appellants must pay for copies of medical records. Those appealing decisions must pay fees for legal assistance or representation.

•	Not optional for some — Some insurance companies and social assistance programs force people to apply for CPP(D) and to even appeal negative decisions. They will not pay benefits if a person does not apply or appeal.80

Generally, we found that the application and appeal process is financially and emotionally stressful for those who have to go through it at a time when they are struggling to cope with physical or mental disabilities as well as a change in life circumstances. For example, individuals have to deal with the costs of acquiring medical records, legal representation and other expenses related to the appeal process (e.g., photocopies, travel expenses) when, for many, their household income has decreased significantly. After this, they also face critical financial difficulties while they wait to receive CPP(D) benefits. Some individuals indicated that they had to borrow from family and friends, dramatically change their lifestyle and even worry about their health. This financial hardship compounds an already uncertain and difficult situation and further impacts on the health of CPP(D) applicants and appellantswhose illnesses are aggravated by sustained stress.

I first applied to start receiving CPP(D) in 1996. I have fibromyalgia and chronic fatigue syndrome and was unable to perform any kind of work. I was constantly being declined for the disability benefits until a final hearing held last May, 2002. This fight I had to endure cost me my marriage and most of my personal possessions. I had to sell everything I owned in order to pay my bills. My husband finally got tired of watching me fight for these benefits and left me in 2002. I had to endure countless hearings and had to pay for countless documents to be produced from my doctors. I am now receiving these benefits thank goodness but would not want to go through that long fight again. It cost me not only my marriage and my personal things but also cost me my health both physically and mentally. (Karen, ON, E-Consultation, Participant)

It can take as long as 3 or 4 years to resolve a case through all stages of appeal. This has a significant financial and emotional impact on applicants who are already coping with disability or illness. (BC Coalition of People with Disabilities, BC, E-Consultation Participant)

While [Review] Tribunal Members attempt to make Hearings relatively informal and uncomplicated, some Appellants still find the Hearing a very stressful and emotional experience. Appellants are frequently people with limited education and little familiarity with legal or bureaucratic processes. Some Appellants are frustrated by their experience with HRDC and some may feel intimidated by the Hearing process.⁸¹

We strongly believe that the application and appeals process needs to minimize these stresses and strains on people. The program belongs to them, not to the program administration.

Recommendation 4.1

The Committee recommends that Human Resources Development Canada (HRDC) establish, as a priority, client-friendly policies and practices in the application, assessment and approval processes for CPP(D).

Recommendation 4.2

The Committee recommends that HRDC process and approve all applications from clients who are terminally ill within 30 days of receipt and that the Government of Canada amend the Canada Pension Plan to eliminate for them the retroactivity provisions.

4.2.1   The Application Process

We heard that persons with disabilities experienced a number of difficulties with the application process. These ranged from accessing information on the CPP(D) program, filling out the forms, and receiving an informative response to their application in a satisfactory time frame. The majority of respondents to our Issue Poll indicated that developing an easier application process should be the first priority for the government.

4.2.2   Is Information and Documentation Related to the CPP(D) Program Readily Available?

During the Subcommittee’s roundtable meeting on 21 May 2002, some participants indicated that it is difficult to get basic information about the CPP(D). Some clients get stuck in a telephone menu that ultimately is unable to provide the necessary information. The time required to process applications for the CPP(D) can be lengthy, an obvious problem for individuals who do not have ready access to savings or other means of income support. In other instances, clients receive correspondence that provides no information as to why benefits are being denied.

While some online participants spoke to us about the helpfulness of staff in local CPP offices, others told us that they found it difficult to get basic information about the CPP(D) program and that, in some instances, the information provided by HRDC was either incorrect or confusing. Many participants stated that the documentation provided by HRDC on the CPP(D) program is either too difficult to understand or not available in an alternate format accessible to persons with disabilities. Making CPP(D) information more readily accessible is a priority of Canadians who participated in the e-consultation.

It is the experience of clinic personnel and of our client group, that it is difficult to access the CPP program. Unfortunately, the program at present, does not have a client service focus and persons inquiring about benefits often find it difficult to obtain information and have their concerns heard. (Algoma Community Legal Clinic, ON, E-Consultation Participant)

Clearly there is a feeling on behalf of applicants that they do not have enough information about the program and their eligibility under different circumstances to be assured that they will be provided financial security. (Canadian Aids Society/Canadian Working Group on HIV and Rehabilitation, ON, E-Consultation Participant)

[HRDC should] provide applicants with dignity and a robust sense of citizenship through the provision of genuine control over and full engagement with, the CPP(D) application process. That is not the way the system works. Empower applicants with information, skill development and networking. … (Traci Walters, National Director, Canadian Association of Independent Living Centres)⁸²

Raising awareness of the CPP(D) program (a different question than providing program information) is a key issue addressed in the solutions submitted to the Subcommittee. Many participants believe that a large number of persons with disabilities are unaware of the existence of the CPP(D) program and do not know that benefits may be available to them.

An increased awareness program could easily be achieved through cooperation between federal governmental departments. While the T4 is a standard form generated by Revenue Canada, information about the CPP disability benefits could be attached to the T4 slip, perhaps as a tear-off sheet that could be kept for future reference. Each year, all employees Canada-wide would then be reminded of the federal programs that could be available to them. This tear-off sheet could include information about both Canada Pension Plan (including disability, retirement, survivor benefits etc.) and Employment Insurance (regular and special benefits).

This simple measure could result in vastly increased awareness. While this only captures those who had earnings in the prior year, this would reach most potential applicants. (Northumberland Community Legal Centre, ON, E-Consultation Participant)

I think that there should be a publicity campaign about this, and perhaps mail outs to persons over fifty, as the older one gets, the less employable one becomes, and the more health problems arise.

Perhaps a web site would be helpful.

Perhaps a flyer included with income tax returns to save funds.

Perhaps media blitzes.

Information circulated through support groups, etc. I am a founder and leader of a large support group for people with chronic pain and this would be an easy way to circulate information. (Anonymous, NB, E-Consultation Participant)

Recommendation 4.3

The Committee recommends that CPP(D) prepare and implement a comprehensive communications plan for CPP(D), that includes strategies to provide information to clients or potential clients of the program. People with disabilities, or their representatives, should be consulted during the development of this plan. This communications plan should include:

a.	training for frontline HRDC staff to provide appropriate responses to questions about CPP(D) and to assist people in filling out application forms;

b.	a targeted campaign to raise awareness of the program among organizations and community groups in contact with large numbers of possible applicants;

c.	better utilization of the resources of other government departments (particularly the Canada Customs and Revenue Agency); and

d.	formation of partnerships with other federal departments, provincial governments, income support programs, non-governmental organizations, support groups and qualified health care professionals to provide information about CPP(D).

4.2.3   Completing the Application and Filling out the Forms

In order for applicants to apply for the CPP(D), they must be able to understand the application form and the application process. Some clients, particularly those with low literacy skills, are unable to complete an application form and many more do not know how to launch an appeal. For many clients, the application process is too complicated for them to carry out on their own. A significant number of people that we heard from expressed frustration at the complexity of the forms that have to be filled out and submitted to apply for CPP(D) benefits.

My first issue is with the length and the detail of the form. … With the help of a friend, it took WEEKS to complete the forms and I had to be involved as there was information he had no way of attaining. Also, it appears that in the majority of cases, the first application is automatically rejected and most people are forced to apply several times. The appeal is also a lengthy, involved process. If I were well enough to fill out the forms and prepare for a tribunal, most likely I’d be able to work. (Judith, ON, E-Consultation Participant)

My worst problem was the difficulty filling out the forms. … I found it extremely hard to understand the vague instructions, fill out the questions, and even know where to start. …

The guide was NO HELP in explaining what to do, what information the government required, or where to start. I found it physically/emotionally hard on my entire system, and at that stage of my disease I didn’t need to feel worse. …I can’t imagine being illiterate, blind, dyslexic or have some other form of disability and filling out those forms. I believe that the government shouldn’t approach it with a ‘One Size Fits All’ approach, but should tailor the process to each person’s ability. (Joni, BC, E-Consultation Participant)

What could be done right now to support people? We all know they need appropriate information, they need to understand it, and they need to know about how to deal with this stuff. (Traci Walters, National Director, Canadian Association of Independent Living Centres)⁸³

The Subcommittee wonders why the community has been left to perform the job that the CPP(D) program should be carrying out itself in terms of providing assistance to those who need help. To us, this is a sign that HRDC is not as client-focussed as it claims to be. Many of our witnesses and online comments spoke about the need for accessible documents for CPP(D).

Special extremely large text, oral, or even papers with Braille for those who are blind; oral questions with the guidance of someone who cares for those who are illiterate or have severe cognitive problems; and, utilising the internet with speaking programs such as the one I am using now. The government should look into these types of tailor-made approaches to the application process. I also believe that an improved GUIDE should be developed hopefully with actual disabled people helping develop it. Able-bodied people really have no idea of the barriers that we disabled people face and couldn’t even begin to understand. (Joni, BC, E-Consultation Participant)

All application processes for CPP(D) must be made accessible by addressing language and cultural adaptation, education and literacy, cognitive and learning capacities. (Canadian Aids Society/Canadian Working Group on HIV and Rehabilitation, ON, E-Consultation Participant)

Another issue that people raised constantly, particularly those who assist applicants, is the cost of pulling together all the information that is required to complete the application.

Many clients end up having to cover the cost of medical reports necessary to establish eligibility. In the past our clinic covered some of these costs but still sought to recover from clients when the file was closed. Presently, we are asking clients to cover the costs of such reports up front. In all such cases clients should be reimbursed for costs of these reports as financial considerations work to prevent low income disabled persons from accessing benefits. (Algoma Community Legal Clinic, ON, E-Consultation Participant)

…ways to streamline the appeal processes [should] be examined to ensure claims can be resolved more quickly. Because CPP only pays for medical reports it requests, applicants are sometimes unable to provide all the possible medical information to support an appeal. If they cannot afford to pay for medical information, they can lose the appeal. People should not be denied fair appeal because they do not have the means to provide documentation. (BC Coalition of People with Disabilities, BC, E-Consultation Participant)

There should be some mechanism for reimbursement of the costs incurred for medical reports and assessments provided by the applicant. Assessments of functional abilities are extremely useful in cases where the primary disability is pain-based and/or subjective in nature. Since the administrators at CPP seldom, if ever, send an applicant for an independent assessment of functioning, applicants are left shouldering the costs of these assessments themselves. If these reports and assessments are used in the adjudication or appeal process, then the applicant should be reimbursed those costs. (Northumberland Community Legal Centre, ON, E-Consultation Participant)

Recommendation 4.4

The Committee recommends that the application forms and the accompanying guide be reviewed and revised to ensure that they are written in plain language, are as short as possible and provide clear information on how to submit the application. All information should be made available in alternate formats.  Persons with disabilities, advocacy organizations representing them and the health care community should be consulted in this review process.

Recommendation 4.5

The Committee recommends that CPP(D) launch a targeted outreach program for organizations, support groups and individuals who provide information and assistance to applicants for CPP(D). This outreach program should have dedicated resources to answer their questions and provide them with up-to-date information about application procedures.

Recommendation 4.6

The Committee recommends that HRDC, at its own expense, make greater use of independent medical examinations, functional capacity examinations and/or vocational assessments to provide more information about an individual’s inability to work.

Recommendation 4.7

The Committee recommends that when an individual’s application for CPP(D) is approved, the applicant should be reimbursed for the cost (upon submission of a receipt) of additional assessments (medical or functional) in addition to the physician’s report currently paid for by CPP(D).

4.2.4   The Response to the Application

Two themes recurred in the e-consultation as well as testimony from witnesses and previous reviews of the CPP(D) program: the delays in processing the initial application and the unsatisfactory level of detail in the denial letters.

According to evidence presented before the Subcommittee in May 2002, HRDC is supposed to have a service standard of 62 days for processing applications.⁸⁴ External factors, however, can increase actual processing time, as program administrators must wait for applicants and their physicians to provide the necessary information in order to determine benefit eligibility. The experience of a significant number of individuals who shared their stories indicate that it actually takes 4 to 5 months for an application to be processed and a minimum of two to three years to go through the appeal process. Several of our witnesses recommended fixed timelines — 60 days to process an appeal and another 60 days for a reconsideration of decision. The current longer time lag produces much of the stress that applicants told us that they endure.

Improvement of assessment for applications and appeals. Something has to be done to change the one year to decide in both situations. That is not fair financially for the applicant as it is an insurance that people have paid into. The turn around time must be less than three months. Seeing the applicant can shorten the time.

Extra medical reports requested by CPP can be obtained by the applicant/family when visiting the physician & sent to CPP if they are informed of this in the application package. (Joan, ON, E-Consultation Participant)

We also heard that many CPP(D) applications result from insurance companies and other income support programs requiring their claimants to apply for CPP(D) benefits. Many of these claims are subsequently denied by CPP(D) but, in the meantime, assessing these claims undoubtedly increases the time required to approve other CPP(D) claimants.

Recommendation 4.8

The Committee recommends that HRDC:

a.	include in the CPP(D) application form a question asking all applicants to identify any third party that required them, for whatever reason, to submit an application for benefits to CPP(D); and

b.	charge the third party the cost of processing any such unsuccessful application.

Recommendation 4.9

The Committee recommends that HRDC explore ways of speeding up the flow of information required to complete an application. The department, for example, could encourage the electronic transmission of medical information from physicians provided this can be done in a manner that ensures confidentiality.

4.2.5   Denying Applications — A Routine Procedure?

Canadians have a perception that the CPP(D) application process is impersonal and designed to keep people out. A majority of those who participated in the online consultation believe that applications are routinely denied to discourage and eliminate people who do not have the strength or resources to go through the appeal process. The following quotation is indicative of the distrust we heard from witnesses:

I complete a CPP application almost every week and do not yet have a patient who was approved on the first go regardless of severity of illness. It seems there must be a covert policy to say no just to weed out those who do not have the persistence, energy, resources etc. to appeal. This is not a fair policy. And perhaps it increases cost since there are so many appeals. (Eleanor, AB, E-Consultation Participant)

We heard that applicants receive form letters with few details specific to their case. Some people indicated that letters to CPP(D) applicants might not provide any, or adequate, information about why benefits are being denied or about how to appeal a decision. Even when they are denied during the administrative review, or reconsideration stage, individuals do not receive any comprehensive explanation of the reason for the decision. It is only when an individual appeals a denial to the Review Tribunal that he receives an explanation of the reasons for HRDC’s denial that includes the facts of the case, and how the legislation was applied to these facts. Even at this point, the information is not provided in sufficient time (four to six weeks before a tribunal hearing) to allow many people the adequate time to gather together additional information (e.g., reports from medical specialists).

The “form” letters which are sent to clients, advising them of a denial of benefits are confusing and should be revised to provide information to persons in plain language. Moreover such letters should be revised to provide specific information on why persons were denied, and clearer information about the appeals process. (Algoma Community Legal Clinic, ON, E-Consultation Participant)

Currently an appellant does not receive the reasons for a minister’s decision denying them disability benefits, the detailed reasons specific to that appellant, until just before a review tribunal hearing. This means that they get the detailed reasons specific to them about four or five weeks before a hearing. If this review of the minister’s reasons reveals a real hole in their case that they can fix, they have very little time to go to get the additional information…. We think it might make much more sense if the department were encouraged to provide detailed applicant-specific reasons to the applicant at the time of reconsideration so they know the case they have to meet when they go on to a review tribunal, so they have a better understanding. (Anna Mallin, Member of the Review Tribunal Panel)⁸⁵

The Review Tribunal Panel members told us in their submission that the problems associated with the failure to communicate a denial in an appropriate manner complicated the whole appeal process. It frustrates applicants (even when the denial may be justified). It makes the rest of the appeal process difficult by encouraging individuals to apply for reconsideration and move forward with appeals that they would ultimately lose. We agreed with them when they outlined the advantages: fewer requests for reconsideration, fewer appeals, better-prepared applications for reconsideration or appeal.

4.2.6   Reassessments

In May 1993, Income Security Programs initiated a pilot project to review the continuing eligibility of CPP(D) beneficiaries who may have regained their capacity to work. Since then, reassessing CPP(D) beneficiaries has become a permanent feature of the program. The proportion of CPP(D) benefits that are terminated as result of all reassessment decisions has declined since 1993-1994 and has remained relatively stable since 1997-1998.

As a result of approximately 8,900 reassessment decisions in 2001-2002, 1,988 individuals (including those who have returned to work) had their benefits terminated. This represents about 22.3% of all reassessment decisions that year. These reassessments generate significant savings for the program: in 2001-2002, the cessation of benefits attributed to CPP(D) reassessments generated annual savings worth roughly $18.7 million.⁸⁶

Recommendation 4.10

The Committee recommends that HRDC eliminate the use of form letters to deny an individual a CPP(D) benefit. HRDC should provide each client whose application is denied with a personal letter written in plain language (and in alternate formats if requested) that sets out all specific information related to the individual’s circumstances, explains the reasons for the denial of benefits and includes all information needed to appeal the decision. The Committee further recommends that similar procedures be followed for all reassessments.

4.3       The Appeal Process

When an application for a disability pension is denied, applicants are informed in writing that they have the right to a reconsideration. At this first level of appeal, the applicant who has been turned down may request the Minister of Human Resources Development to conduct an administrative review (reconsideration) of the initial decision. This review of the application is carried out within the Department of Human Resources Development Canada (HRDC). A request for reconsideration must be made within 90 days of the denial, and someone other than the person involved in the initial adjudication reviews the application.

The number of reconsideration decisions has fluctuated since 1993-1994, the earliest period for which these data are available (Chart 4.2). Although the percentage of benefits awarded at the first level of appeal has declined by more than one half during this period, the reconsideration approval rate has been relatively stable since 1995-1996.

When someone is not satisfied with a decision at the reconsideration stage, the individual may appeal this decision to a Review Tribunal (second level of appeal).⁸⁷ The Office of the Commissioner of Review Tribunals is the organization responsible for conducting these appeals. Currently, those who appeal get a hearing before a review tribunal approximately 12 to 18 months after their initial application for CPP(D) benefits was sent to HRDC. Each tribunal is composed of three persons: a legal member (lawyer), a medical member (a physician) and a community member. For each hearing, each of these is selected from a panel of between 100 to 400 people appointed by order-in-council. The panel members serve part-time.

The volume of appeals received reached its highest point in 1997-1998, while the number of decisions rendered peaked in 1999-2000 (Chart 4.3). The number of appeals received and decisions rendered in a given fiscal year do not add up because there is a time lag between the receipt of an appeal and the rendering of a decision.) It is interesting to note that the proportion of appeals decided in favour of claimants has increased steadily since the early 1990s. In 1992-1993, the allowed rate (i.e. the number of favourable decisions expressed as a percentage of total decisions in a given fiscal year) was 21.8%. In 2001-2002, the allowed rate was 41.6%, more than 90% higher than nine years earlier.

If a client or the Minister of Human Resources Development Canada is dissatisfied with a decision of the Review Tribunal, either of them may appeal this decision to the Pension Appeal Board (PAB) — the third level of appeal. The PAB consists of judges appointed by order-in-council. PAB decisions may be subject to a judicial review by the Federal Court. In order to appeal to the PAB, an appellant must first make a formal request to appeal the decision of the Review Tribunal. If accepted, the case will proceed to a PAB hearing. If not, the decision of the Review Tribunal stands. While the data presented in Chart 4.4 refer to all CPP appeals, appeals related to CPP(D) are estimated to account on average for 95% of all CPP cases at the PAB. The volume of PAB decisions has increased substantially since the early 1990s, a result that is undoubtedly connected to the growth in second-level appeals during the same period. In addition, the proportion of PAB decisions (at or prior to a hearing) in favour of claimants (as opposed to the Minister) has increased steadily since 1998-1999 and today represents some three fifths of all CPP decisions rendered by the PAB.

 

4.3.1   What We Discovered: Appeals

Some of the key issues that emerged in the online consultation and in the testimony of witnesses to the Subcommittee included the complexity of preparing for a hearing as well as the cost and physical difficulty involved in attending a hearing in person. We also heard that some clients who are not supported by families, friends or advocates can find the appeal process cumbersome and complex. Several witnesses told us that the application and appeal process was too long and stressful. Some people, such as those with low literacy levels, can find the process intimidating.

The Appeal process is ‘‘deadly’’ — far too time consuming. We regularly tell people that if their application is turned down it may be two to three years before the appeal is settled. Many disability rights advocates have experienced the death of a client while waiting. In the field of mental health this could be from suicide. (Anonymous, BC, E-Consultation Participant)

People don’t realize that some people out there — or half of the people out there — with only a grade five or a grade six education can’t even read right or don’t understand what they read. I’m going to tell you it’s a pretty heartfelt feeling when these people come to me at different times and ask me, “What do I do? These people are intimidating me?” They send out a letter and say it’s an informal panel you’re going to be before. Whether it’s informal or not, these people are terrified to death. (Dave MacKenzie, Canadian Injured Workers’ Alliance)⁸⁸

4.3.2   Improving the Appeal Process

While we know that the policy intent of the CPP(D) program is a positive one, we acknowledge that the application and appeal process is a negative experience for many people. It would not be difficult both to “humanize the process” and to give applicants and appellants an opportunity to understand what is required.

The Subcommittee is concerned about the large number of applications that are initially rejected, particularly in light of the high rate of successful appeals. This feeds the widespread perception that HRDC is trying to discourage people from accessing CPP(D). It also places undue stress on people at a vulnerable time in their lives. Adjudicators who look at the initial application should also have a better understanding of the ‘whole person’ who is functioning in the real world.

We have concluded, therefore, that the best way to improve the appeal process is to address issues before they reach the point where someone launches an appeal. HRDC must spend the time and resources to take more effective measures to resolve cases before they reach the Review Tribunal. Members of the Review Tribunal panels emphasized this point in their submission.⁸⁹

Recommendation 4.11

The Committee recommends that HRDC allocate more resources to the initial consideration of applications in order to lower the number of unjustified denials and resulting appeals. In light of the important contribution of personalized contact in determining the eligibility of an applicant, the Committee further recommends that there be person-to-person contact between an applicant and the person adjudicating the application before a decision is reached on the application.

Recommendation 4.12

The Committee recommends that following an initial denial of an application for CPP(D) benefits, HRDC should automatically put in place a reconsideration procedure. This reconsideration should be conducted by a panel consisting of two health care practitioners — one of whom should be a physician. This panel should have person-to-person contact with the applicant.

Recommendation 4.13

The Committee recommends that HRDC offer and provide translation services to all applicants who speak neither English nor French to assist them with their CPP(D) application.

Recommendation 4.14

The Committee recommends that the Office of the Commissioner of Review Tribunals (OCRT):

a.	include in the request for appeal form a question asking all appellants to identify any third party that required them, for whatever reason, to appeal a denial of benefits to the OCRT; and

b.	charge such third party the cost of processing each unsuccessful appeal.

4.3.3   Is the Mistrust Due to Lack of Information?

Members of the Subcommittee believe that some of the distrust and dissatisfaction with the appeal process stems from a lack of information on the part of appellants. We also believe that there is a difference between making information available and actively disseminating information. The Office of the Commissioner of Review Tribunals (OCRT) attempts to provide basic process related information to appellants but from the evidence that we heard, it seems that the information needs of clients are not being sufficiently met. This was also identified as a problem by a client satisfaction survey commissioned by the OCRT:

The “brown brochure” that is put out from the office of the commissioner itself contains useful information; it’s just that most people don’t understand that it’s available, how to get it, what its relationship is to the process. There needs to be some effort to increase the awareness of appellants and non-appellants of the resources that might be available to them…

There needs to be some effort to increase the awareness of appellants and non-appellants of the resources that might be available to them to assist them in the appeal, their rights at the appeal, and their use of representatives in the appeal process... In looking at those areas of improvement, appellants and non-appellants thought communication with both the office of the commissioner and the CPP office needed to be improved. (Chris Baker, Vice-President, Environics Research Group)⁹⁰

Recommendation 4.15

The Committee recommends that the Office of the Commissioner of Review Tribunals appoint outreach officers who will personally contact every appellant to explain the appeal process, the resources that might be available to assist them in their appeal, and their right to use representatives in the appeal process. This would also provide an opportunity to explain a decision respecting the applicant’s eligibility for disability benefits under the CPP.

4.3.4   Going through the Appeals Process

Some participants expressed a high level of satisfaction with the decision rendered by the Review Tribunal or Pension Appeal Board and felt vindicated when their application was finally approved. Other witnesses and online consultation participants also indicated that they feel that CPP(D) appellants get respectful and fair hearings. A survey commissioned by the OCRT revealed that many people who had appeared before tribunals, had positive perceptions of the tribunal members and of the staff of the Review Tribunal.

As a legal clinic lawyer, I deal with several disability entitlement bureaucracies. At the sharp end of the stick, that is to say where clients meet those who decide their cases, the C.P.P. is one of the best. My clients almost always get respectful and fair hearings. They are listened to, and they are given enough time to explain their lives. (Stuart, ON, E-Consultation Participant)

Despite the level of satisfaction with staff during the appeal process, the Subcommittee is extremely concerned that the rigours of the process itself discourage many people from even starting it. The OCRT’s client satisfaction survey found that almost 80% of people who did not appeal cited stress involved in the appeal as a factor in their decision. To us, this means that many people who are entitled to CPP(D) benefits are probably not receiving them. In addition, witnesses and e-consultation participants expressed how their disabilities made it difficult for them to participate in the appeal process.

In September, 2002 my application was denied. I immediately appealed. I had three doctors saying that I am not able to work at all, my disability is permanent and it will worsen as time goes on. I have been unable to work since March, 2001 and for some time prior to that, work was extremely difficult. My entire life has changed. I can’t work, I rarely leave the house, I have had to give up so much because of my disability yet CPPD says I’m not disabled. I can appeal again but it requires going to a hearing in Ottawa. Ottawa is approximately 4.5 hours from my location. I can’t afford to hire a lawyer, I can’t sit in a vehicle for hours because of my disability —  my disability makes it impossible for me to get there to prove that I am disabled. (Patricia, ON, E-Consultation Participant)

Some of my patients are too ill to even get out of bed never mind to think clearly since CFS/FM/MCI affects cognitive function. It is impossible for them to organize an appeal without help. Usually those who manage have a relative do the work for them. Those without relatives are out of luck. This is not fair. (Eleanor, AB, E-Consultation Participant)

Even those Appellants who were successful in their appeal predominantly mentioned negative emotions rather than positive when describing the Review Tribunal process.⁹¹

We hope that our recommendations to reform the application process, to provide assistance to those who apply, to offer better explanations for those whose applications are denied and to implement an automatic reconsideration will reduce the stress on individuals by promoting a more humane treatment during the application process. Hopefully, this will also reduce the number of people who believe they need to launch appeals.

At the same time, we considered whether the appeal process could be further simplified. The panel members of the OCRT recommended that the final level of appeal to the Pensions Appeal Board should be eliminated. Given that about 60% of PAB decisions are made in favour of the claimant, we hesitate to recommend the elimination of this highest level of appeal — at least until further measures of protection for CPP(D) applicants and appellants are introduced.

The need for representation in the review process featured prominently in our hearings. We have heard, however, that the cost of securing representation was a barrier for many people. Currently, representation is only available for appellants who are able to afford it. Only half of appellants before the PAB are represented by counsel or an agent. The OCRT survey found that 60% of those who did not appeal cited lack of representation as a reason not to appeal.⁹² Our online consultations supported this finding with personal stories and information.

People with MS face challenges and obstacles every minute of their lives; application and appeal processes should take this into consideration at every juncture: make the processes easy, short unrepetitive, less judicial and less inconvenient. For example, getting to a doctor can be a major task that could take hours to actually accomplish and weeks to prepare for. Another ex, asking someone to write and extra letter even or supply one more medical record (while a reasonable request on the surface) doesn’t take into account the severity of some people’s disease: some people cannot write or hold a pen or phone, or are so cognitively impaired they don’t know how to write a letter or who to call. Some people are just too tired to do anything. …Finally, in our office we have MS advocates who take applicants step by step through the application process and type up applications. If they are denied, the advocates will help them appeal. Sometimes they are referred to lawyers. Without this step by step assistance, many people do not get the benefits they have a right to receive because they haven’t filled out the application properly or because the process looks so long and difficult for them. (Anonymous, BC, E-Consultation Participant)

Recommendation 4.16

The Committee strongly recommends that HRDC fund disability organizations (e.g. independent living centres) to help them provide advocacy and service delivery supports to individual CPP(D) applicants and appellants.

Recommendation 4.17

The Committee recommends that HRDC work with the federal Department of Justice to determine to what extent automatic legal assistance can be provided to all those who appeal CPP(D) denials at the Office of the Commissioner of Review Tribunals or the Pension Appeal Board in order to ensure that appropriate representation is available for appellants.