Canada Pension Plan (CPP) Disability Legal Referral Questionnaire

Complete this questionnaire to request a connection with a lawyer or paralegal on our Preferred Legal Provider Network about a CPP disability matter. LegalPro Connect uses your answers to prepare a factual referral summary. Submitting this form does not mean a provider has accepted your case and does not submit a benefits application, request reconsideration, file an appeal, or preserve a deadline.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Part 1. Your Age and CPP Benefits
What is your current age?
Are you currently receiving a CPP retirement pension?
When did you start receiving your CPP retirement pension? An approximate month and year is fine.
Part 2. Your Work and CPP Contribution History
Briefly describe your work and CPP contribution history, including when you last worked. It is fine if you do not know your exact contributions.
Have you contributed to CPP for at least 25 years total?
Did you stop working or have low earnings to care for a child under age 7?
Part 3. Your Medical Condition and Ability to Work
What medical condition or conditions are related to your CPP disability application or appeal?
How do your medical conditions affect your ability to work regularly?
What have your treating healthcare providers told you about how long your medical conditions and work limitations are expected to last?
Briefly describe your current treatment or care, including any difficulties accessing or continuing recommended treatment.
When did your medical conditions begin affecting your ability to work regularly? An approximate month and year is fine.
Has a treating healthcare provider supported work restrictions or time away from work because of your medical conditions?
Part 4. Your Education, Work Experience, and Support Needs
Highest level of education
Are there any accessibility, communication, language, or other support needs you would like a lawyer or paralegal on our Preferred Legal Provider Network to know about?
Briefly describe your previous jobs and main work duties.
Part 5. Your CPP Disability Application or Appeal
What is your current work status? Select all that apply.
If you are working, self-employed, volunteering, or selected Other, briefly describe your activities, usual hours, and any difficulties caused by your medical conditions.
What is the current status of your CPP disability application or appeal?
What would you like help with from a lawyer or paralegal on our Preferred Legal Provider Network?
Date on the most recent CPP disability decision letter you want help with (if applicable)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What reasons were given in the CPP disability decision you want help with (if applicable)?
Does any Service Canada, tribunal, or court letter give you a deadline? If so, enter the date and what the letter asks you to do.
Upload your CPP disability decision letter and any relevant Service Canada or appeal correspondence (if available).

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Are you currently represented by a lawyer or paralegal in this CPP disability matter?
Which other disability benefits have you applied for or received? Select all that apply.
If Other, please describe the benefit.
LegalPro Connect provides referral and information services, not legal advice or representation. Your answers and uploaded documents are used to prepare a factual referral summary for a lawyer or paralegal on our Preferred Legal Provider Network to consider. Submission does not guarantee a referral or provider acceptance and does not create a lawyer-client or paralegal-client relationship. Submitting this questionnaire does not submit a benefits application, request reconsideration, file an appeal, or meet, preserve, or extend any deadline.
LegalPro Connect

First NameLast Name
Legal Disclaimer acknowledgement
Consent to referral and information sharing
Should be Empty:

Part 1. Your Age and CPP Benefits

Part 2. Your Work and CPP Contribution History

Part 3. Your Medical Condition and Ability to Work

Part 4. Your Education, Work Experience, and Support Needs

Part 5. Your CPP Disability Application or Appeal