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Personal Characteristics and Socio-Economic Factors
Purpose
The purpose of this section is to define the personal characteristics considered by the Canada Pension Plan (CPP) and provide additional direction for the consideration of personal characteristics in the determination of a "severe" and "prolonged" disability.
Table of Contents
- 1. Introduction
- 2. Policy
- 2.1 Personal Characteristics
- 2.1.1 What to Consider
- 2.1.1 What to Consider
- 2.2 Socio-Economic Factors
- 2.2.1 What Not to Consider
- 2.1 Personal Characteristics
1. Introduction
Personal characteristics are those intrinsic factors that are unique to a particular person and directly affect that person's regular capacity to pursue any substantially gainful occupation.
Personal characteristics have always been considered in the determination of a "severe" and "prolonged" disability. However, personal characteristics alone do not establish entitlement to CPP disability benefits. The determination of CPP disability eligibility is based on the overall evidence related to the medical condition, work capacity and personal characteristics. The overall evidence must establish on a more likely than not basis, that the person is "incapable regularly of pursuing any substantially gainful occupation."
The Federal Court of Appeal decision in Villani touched on many key aspects of CPP disability adjudication namely: consideration of personal characteristics, taking a "real world" approach to adjudication, the primacy of the medical condition in decision-making, taking into account an applicant's efforts to work and the notion of employability.
The subsequent Federal Court of Appeal decisions in Rice and Angheloni clearly state that socio-economic factors such as labour market conditions, or where the claimant lives, are not relevant to the assessment of the severity of a disability for CPP purposes.
2. Policy
Personal characteristics will be considered in the determination of CPP disability. Socio-economic factors will not be considered in the determination of CPP disability.
2.1 Personal Characteristics
The medical adjudicator will consider personal characteristics as part of a comprehensive approach to a case. The medical adjudicator will determine when, where and if personal characteristics, in combination with the medical condition and work capacity evidence support the determination of a "severe" and "prolonged" disability under the CPP.
The personal characteristics to be considered are:
- age,
- education,
- work experience.
Personal characteristics are to be evaluated as follows:
- on a case-by-case basis,
- always in conjunction with a medical condition,
- considering the interrelationship among the three characteristics,
- considering the impact of these characteristics on the medical condition, work capacity and the person's ability to do perform in a substantially gainful occupation.
2.1.1 What to Consider
The personal characteristics of age, education and work experience directly affect a person's ability to work.
When the evidence related to the medical condition is not decisive, the disability determination also requires consideration of work capacity evidence and personal characteristics.
Age
Age, alone, does not entitle a person to a CPP disability benefit. However, age, in terms of function, is an important consideration. With increasing age there is a gradual reduction in the reserve capacity of most body organs. This can affect a person's ability to recover from injury or illness and his or her ability to sustain work.
Individuals are affected differently and at a different rate by the aging process. With increasing age, the physical findings related to the medical condition change. The medical condition usually deteriorates and there can be an associated increase in the incidence and severity of impairments, leading to disability. Therefore, given the same medical condition, the picture portrayed by all of the evidence for an older person can be significantly different from that of a younger person.
The medical adjudicator must determine, within the context of the medical condition(s), how the person's capacity for any work is affected or influenced by the person's age.
Education
A lack of education, alone, does not establish entitlement to a CPP disability benefit. Generally speaking, the more education an individual has the more likely it is that the person will be able to do some form of work.
Education includes both formal and informal knowledge and skills obtained through a learning process and/or work experience.
Both the individual's formal education and informal education must be considered within the context of the disability to determine if the person's level of education affects the capacity for any work.
Work Experience
Work experience is the third personal characteristic contributing to a comprehensive evaluation of an individual.
Like the other two personal characteristics of age and education, findings related to work experience alone do not entitle a person to a CPP disability benefit. Work experience must be evaluated within the context of a disabling medical condition and how it affects that particular person's regular capacity to pursue any substantially gainful occupation.
In relation to determining eligibility for a CPP disability benefit, a person's work experience includes:
- the type(s) of work done,
- reason(s) for stopping work, and
- the pattern of work activity indicated by the Record of Earnings.
When determining continuing eligibility for a CPP disability benefit, the evaluation of work experience also includes:
- the number of years out of the workforce.
The Type(s) of Work Done
The type(s) of work done reflects the physical and mental capacities required in the person's previous jobs. These include the degree of physical endurance (heavy to sedentary work), and mental aptitudes (hearing, seeing, memory, and routine mental functions for complex problem solving). These previous job experiences can determine the employment options for some individuals with functional limitations.
Generally, there are more physical barriers to returning to heavy work than to sedentary occupations. Skills acquired in a previous job or jobs may enable a person to find other work that is suitable to the person's limitations and restrictions.
Reasons for Stopping Work
A person can stop work for many reasons which may or may not relate to their disability. The determination of eligibility for CPP disability benefits is based on a person's capacity to work as it relates to a medical condition. Socio-economic factors such as industry closures or seasonal lay-offs are not considered in a CPP disability determination. Other personal reasons such as returning to college, trade school or university, bankruptcy, moving, early retirement, child or elder care, in and of themselves do not establish eligibility to a CPP disability benefit.
A person's disability must regularly prevent him or she from working at any occupation that he or she might reasonably be expected to pursue.
The Pattern of Work Activity as Indicated by the Record of Earnings
The Record of Earnings is pertinent only when it is reviewed in relation to the medical condition.
The pattern of work activity indicated in the record of earnings can be a useful indicator of a person's capacity to work at a substantially gainful level since starting their contributions to the CPP. The Record of Earnings can identify gaps in the work history or fluctuations in earning patterns. This provides some indicators of the person's capacity to earn at a substantially gainful level. When reviewed with other evidence it may identify a pattern of work activity and/or a decline in earnings that is consistent with deterioration in the medical condition.
By considering the type of work done, reasons for stopping work, and the pattern of work activity indicated by the Record of Earnings, the medical adjudicator determines whether the person's past work experience is pertinent to his/her regular capacity to pursue any substantially gainful occupation.
Individuals may have had an employer who provided extensive work accommodations so that they could perform a job within the regular workforce. If they subsequently lose such employment, they should not be determined to be capable of pursuing any substantially gainful occupation as a result of that employment experience alone. Determining whether or not the individual has capacity for any substantially gainful occupation requires an assessment of the interrelationship among their medical condition(s), their performance, productivity and profitability and their personal characteristics.
2.2 Socio-Economic Factors
The Federal Court of Appeals (FCA) decision in Rice and Angheloni state that socio-economic conditions are not considered in a CPP disability determination.
Socio-economic conditions, such as the unemployment rate or the availability of certain types of jobs in a particular locality, are factors that exist in society which are outside the context of the individual with the disability. They affect groups or populations living in regions or provinces, or the country as a whole, and may constitute a barrier to work.
Similarly, factors such as the lack of child care or elder care, family responsibilities or preferred working hours are also not to be considered in a CPP disability determination.
2.2.1 What Not to Consider
Socio-economic factors are not considered when determining a "severe" and "prolonged" disability.
Although these factors may constitute a barrier to work they are not related to a person's regular capacity for any work as a result of a "severe" and "prolonged" disability as a person cannot change these socio-economic conditions. For example, a person cannot influence the local economy or the skills required for regional industries. Another way of looking at this is that, two individuals with identical conditions and personal characteristics would have the same disability determination made regardless of where they lived. For example, we would not find one disabled because unemployment is high while the other was not, because jobs were available.
Examples of socio-economic conditions are:
- regional unemployment rates
- local access to specific jobs
- types of major industry in a region
- types of occupations offered by regional industries
- occupational skills needed for those industries
- predominant language spoken in the region. If a person was able to work using a language other than English or French, and contributed to CPP as a result of this work activity, this regional factor cannot be considered in determining eligibility.