CPP Benefit Claims – Does Choosing Your Own Doctor Affect Your Success?
Any person who makes a claim for Canada Pension Plan (CPP) disability benefits must supply medical evidence that he or she has a “disability” which is “severe and prolonged”. This is routinely done through expert evidence provided by a qualified, impartial doctor to whom the claimant has been referred by other treating physicians. Essentially, this test requires a claimant to establish that they are competitively unemployable on a full-time or part-time basis.
However, what if the claimant refers himself to a doctor of his or her own choosing? For the purpose of establishing a claimant’s disability benefits claim, does that taint the doctor’s evidence and make it less persuasive? That was one of the questions tackled by the Federal Court. The claimant in that case had been involved in a motor vehicle accident in 2005 and complained that he had medical problems ever since that left him unable to work. He was dismissed from his last job as a line cook in 2010 after complaining of numbness in his arms that left him unable to fulfill his job requirements. The claimant made no effort to find work after his dismissal and instead applied and was denied twice for CPP disability benefits in 2011 and 2012.
In order to satisfy that he had “severe and prolonged disability” within the meaning of the CPP definition, the claimant offered reports from two doctors to whom he had referred himself for evaluation and treatment. One physician was a psychiatrist who diagnosed the claimant with moderate to severe depression and concluded that he “would be expected to meet the requirements for CPP disability”. The other physician was a pain expert, who reported that the claimant was “incapable of regularly pursuing any substantially gainful occupation.”
After considering these reports along with other evidence, the Social Security Tribunal’s General Division (the SST) rejected the claimant’s initial claim for CPP benefits concluding that he did not meet the threshold of having a “severe and prolonged disability.” An appeal court refused him permission to appeal and his later application to a reviewing court was also rejected.
In the appeals, the claimant had argued that the various decision-makers had improperly considered the evidence from the two self-referred doctors and had given the evidence insufficient weight. The claimant argued that if that evidence had been properly considered, his benefits claim would have been successful.
The Federal Court considered the claimant’s argument in the context of the previous hearings.
In this regard, the Court noted that the evidence that had been provided to the SST respecting the claimant’s medical and physical conditions had been contradictory. According to the Court, it was the job of the SST to review all of the evidence and to choose which of all the available expert reports should be given more or less weight. The Court stated the assessment of the evidence was conducted against the background of the CPP definition of “severe and prolonged mental or physical disability” which required the claimant to be “incapable regularly of pursuing any substantially gainful occupation,” and that his disability be “likely to be long continued and of indefinite duration or is likely to result in death.” The Court noted that these tests required the Tribunal to assess whether the claimant was still employable in the “real world context.”
In assessing the evidence of the two doctors, the Court concluded that while it was true that it should not automatically be ruled out simply because the claimant had referred himself for evaluation, this did not mean that their evidence was to be given the same weight as other expert medical evidence. Rather, the evidence from the claimant’s doctors, it had to be viewed in light of the fact that these doctors’ evaluations and reports were requested by the claimant himself for the specific purpose of supporting his CPP disability benefit application. Furthermore, the Court noted that the bigger problem with these reports was that neither report provided any extensive analysis on how the claimant’s medical conditions prevented him from performing some type of work in the “real world.”
The Court therefore concluded that the SST had properly evaluated and weighed all the evidence from all sources to conclude that while the claimant did have some limitations, he had no “significant abnormalities” that left him incapable of working entirely. The Court also noted that the claimant had made no effort to look for alternative work after his last job ended in 2010. In the end, the Federal Court ultimately decided that the lower courts and the SST had made no error and that prior decisions on this point, which had been unfavorable to the claimant were reasonable.
  F.C.J. No. 558; 2017 FC 534.