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FM Tender Points
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by Sue Linton (c) 1995

The first major hurdle with an illness like FM is diagnosis. Once a person is diagnosed, the question arises: "O.K. I've got this. Now how do I deal with it?"

One of the most stressful decisions a person with FM is faced with is whether or not they can continue working. This is a decision that will affect every aspect of your life and cannot be made without careful consideration of the alternatives, extensive financial planning, finding the right doctor, and a firm resolve not to take "no" for an answer.

Once you have made the decision that you can no longer work, there are several alternatives that you can pursue. Unemployment insurance will pay sick benefits for 15 weeks depending on how long you have been working. Canada Pension Plan provides disability benefits based on contributions you have made during your working life. Many employers, like the federal and provincial governmen1ts, have group disability policies that provide employees with benefits if they qualify. All plans have waiting periods and stringent guidelines that must be met before granting disability benefits.

When I applied for disability benefits, no one told me that I would have to wait for over a year before receiving any money. Careful financial planning is a must. If you can, try to save some money before you apply for disability benefits. At the very least, try to pay some bills that would become difficult to pay if you had no income for a period of time. Ask family members if they would be willing to lend you some money or apply for a line of credit while you are still working. You must be aware of and plan for the period of time when you will be without any income.

Finding the right doctor is the most important aspect of applying for disability benefits. You must find a doctor that will listen to what you have to say. You are the one that has to live with this condition every day and you have a right to choose a doctor that will agree with your point of view that you are incapable of work and provide you with the necessary documents to substantiate you disability claim. Before you quit your job and apply for disability benefits, make sure your doctor is behind you 100%, agrees with your decision to stop work, and will do his best to help you file a successful claim. It may take three or four tries before you find the right doctor but it is well worth the time and effort.

Applying for disability benefits is complex, problematic and at times an uphill battle. You must be prepared for a fight. From my own personal experience and from talking to other people who have applied for disability benefits, it is a fact that CPP seldom accepts anyone on the first claim. The same is true for other insurance companies (like SunLife Canada) - nine times out of ten your first claim will be turned down. That is why it is so important to appeal the decision. You have the right to disagree with any decision made in regards to your disability claim.

Applying for UI Sick Benefits

If you are employed and decide you can no longer work, the first step is to apply for unemployment sick benefits. If you have worked for 20 weeks out of the last 52 weeks, you are eligible to apply. If accepted, you will receive up to 15 weeks of benefits at a rate of 55% of the salary you were earning. If you are a low income earner and have dependents, you can receive up to 60% of your salary. You will be required to produce a record of employment (your employer will prepare it for you) and a medical certificate from your doctor. Make sure that the doctor states in his letter that you are incapable of work and to describe the condition in detail.

UI sick benefits are the easiest to apply for and receive. There is less paperwork, the requirements are not too stringent, and it is available to everyone who has worked for 20 weeks. The only drawback is that you can only collect benefits for 15 weeks. The number for general information is: 992-1300.

Applying for CPP Disability Benefits

While you are collecting UI sick benefits, you should apply for CPP disability benefits. Applying for CPP is very time consuming and complicated but it is well worth it in the end because if you are accepted, you can collect benefits until you are 65 with very little additional paperwork or confirmation from doctors over the years (after age 65 your benefits are converted to old age pension and recalculated).

There are many requirements that must be met before you apply for CPP. First, you must have contributed to CPP (worked at a job) for 5 of the last 10 years and be working when the disability occurred. Second, you have to be under age 65. Third, your disability must be severe and prolonged. These are key words that seem simple but require a lot of evidence and explanation from your doctor to satisfy CPP's definition. A copy of the requirements is included with your application. Read it carefully and make sure your doctor satisfies each requirement completely or your claim will be delayed.

To apply for CPP benefits the first thing you must do (after finding a good doctor who is willing to support you and fill out the forms) is to call the information line (990-1500) to request an application. Once you have received the application, fill out the portion that you are required to fill out and bring the doctor's portion to his office. Your doctor will probably charge you to fill out these forms (my doctor charged me $50 and billed CPP another $50). From my experience, doctors hate to fill out forms and write reports, so make sure you let your doctor know it is important he fill out the forms as soon as possible because you are without an income. If he takes more than three weeks, call his office to remind him. I called my doctor's office every day for 2 weeks until he finally finished the forms. When your doctor does finish the forms, request a copy for your records. You must keep copies of everything, even noting phone conversations to your doctor and CPP. You will need this info if your claim is denied and you have to appeal.

The forms are very long and complicated, with many sections. Read them very carefully and make sure all sections are complete. If you miss anything, your claim will be delayed. If you need help, call the information line. The sooner you get the forms to CPP, the sooner your claim will be processed. The address to send your application to is: Canada Pension Plan, Income Security Programs, 240 Sparks St, Level C3, Ottawa, Ont, K1A 0K9.

Once your application has been sent all you can do is wait. You will receive an acknowledgement of your application in the mail stating the date they received it. From that time it may take from 3 to 9 months to process your application and receive a decision. Most often the claim is denied. The most common reason for denial of disability claims is incomplete information. They will send you a letter that will explain why you were denied benefits. You must appeal that decision (all it really means is they need more information). You have the right to appeal any decision made by CPP up to 3 times (per decision). You have 90 days from the date on the letter to appeal. Watch the time closely because if you pass the 90 day time frame you lose the chance to appeal. You will probably have to see your doctor again and get another letter from him. This time, make sure he understands exactly what you need. The letter from CPP will state exactly what they need (i.e."your doctor's letter did not completely satisfy our criteria for severe and prolonged illness"). Give him a copy of the letter from CPP, highlighting the areas he has to expand on. Remind him again you are without any income and ask if you could see the letter before sending it to CPP. This way you can make sure he has covered the requirements and has written a strong, supportive letter.

Appealing a decision

The address to send your appeal to is different than the one to send your application to: Canada Pension Plan, Appeals and Control Programs, Income Security Programs, Director Appeals Division, Place Vanier, 355 River Road, Ottawa, Ontario, K1A 0L1. After this has been sent to CPP, you must wait again. It should not take longet than 3 to 5 months for your appeal to be processed. You can call periodically to check on the status of your claim (Appeals: 954-4945).

If your claim is accepted, you will receive a letter and a notice of entitlement detailing how much you will receive each month and stating the effective date of your claim. The effective date of any claim is always 4 months after the date of the onset of the disability (e.g. if you got FM in Sept 1989, your effective date would be Jan 1990). You can appeal this date if you feel it is not right. You are entitled to payment dating back to the effective date. Always check their figures and amounts. If they are wrong you may end up having to pay money back to CPP when the mistake is caught (this happened to me).

If you have children, you will receive additional benefits until they reach 18. When they reach 18, if they are not in school, your benefits will be reduced. If they continue in school, those benefits will be redirected to the child for as long as he or she remains in school, up to age 25.

A final note on CPP disability benefits. Income taxes are not deducted from your check. You must call or write to request that income taxes be deducted from your check. I recommend that you do this because if you do not you will be faced with a large tax bill at the end of the year - one that is very difficult to pay on a limited income.

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