How to succeed in applying for the Disability Tax Credit:

For Physicians and Patients

The Disability Tax Credit is extremely important for many disabled Canadians. Provincial support programs pay measly amounts. It’s hard to imagine how individuals can survive on that (<$1169/month Ontario)! The truth is, most don’t. They rely on family members, food banks, and charities. Any tax savings is more food in their bare cupboards. Income reforms are long overdue. The DTC ensures a tax free income for most recipients, who are low income.

The DTC allows individuals eligibility for the Registered Disability Savings Plan (RDSP) entitling them to significant bonds and grants in a tax sheltered account, based on family net taxable earnings. Bonds do not require plan contributions, while grants are based on contributions to the plan. It’s rare for the government to dole out gifts, but these are here, and a necessary “retirement” income boost for many who will not be able to accrue CPP contributions. RDSPs are important to open up as soon the DTC is approved. After age 50, grant and bond eligibility ends. Withdrawals must begin by age 60. Funds may be accessed earlier for other reasons. See link. Note, not all banks support self-directed investing. Most only permit the use of bank owned products: GICs, mutual funds etc. Only go to a bank that allows a self-directed account (TD, National Bank). TD Bank has good job assisting clients with this option. Disabled clients need a good return on investments. A GIC paying 2% is not that. No bank should restrict investment options to disabled clients. I cannot believe this practice persists!

The Application

The CRA is supposed to assess individuals without bias to the underlying diagnosis. I am going to assume that is the case now, though history tells us how difficult it was for those with mental health problems to qualify. Many psychiatrists told their patients not to bother applying (and some still do). They are wrong. There is a revised section on mental health functions.

About 7 years ago (a guess) the CRA added a new section the “Cumulative Effect of Disability”, which was finally the additional leeway that was needed to capture those patients with severe disability but who were never able to qualify under the onerous other categories. MS patients, who may have mild to moderate disability with periods of severe disability, were often excluded outright, for example.

I have provided some general suggestions below. I am not an expert. I have experience with my own patients, and also living with a disability for 20 years.

1. No one should have to pay a private service or a percent of their tax credit to obtain the DTC. That’s criminal in my opinion. The key is the effort the physician or nurse practitioner made in completing the form, and how well the patient related limitations to him or her. It should be a close collaboration.
2. You are given the options of nurse practitioner and other health care practitioners to complete the form. I would never recommend using one of these individuals alone. They can and should provide supplementary statements, but I would always recommend a physician complete the form. I know I may take criticism here, and perhaps it is appropriate. I expect that the CRA will give deference to physicians over other practictioners. I realize that may not be practical in some cases. That’s OK. A nurse practitioner who functions as a defacto family doctor, and knows you well will be preferable to a clinic doctor you see once every other year.
3. Overwhelm the CRA with relevant documentation: Include specialist consultation reports, imaging, audiograms, Ophthalmology reports, retinal scans, Rehabilitation Medicine consultations etc. Everything relevant to the application, even if remotely so. Subjective patient complaints are supported when there is objective evidence of disease or pathology.
4. Document restriction and/or loss of function. Having a Rehabilitation Medicine consultation document restricted movement, extent of injury, and that the patient reported symptoms are congruent with the level of reported disability will always be helpful. Chronic neuropathic pain and severe fatigue may be completely disabling effects of MS in the absence of other severe deficits. Sometimes, waiting the 3 months for an additional consultation is worthwhile. Neurologists, in my own experiences, are often poor in describing the impact of a disability on an individual. I realize that’s a gross generalization. They are improving. Rehabilitation Medicine physicians are gold in this regard. Family doctors can weave consult reports into a supportive narrative.
5. Complete each section. If there is partial but mild visual loss, complete the section on vision. Even if is not related to the underlying medical condition that precipitated the application. It all supports the most important (IMHO) section: Cumulative Effects of Disability.
6. Mental Health: If the disabling illness is a psychiatric diagnosis, this should be documented as fully as possible. As I noted, not all psychiatrists will be experienced in completing these forms. It may be helpful to have them dictate a narrative report using this section, and the section on “Cumulative Effects of Disability” on the DTC form as a guide. Individual patients must be as thorough as possible. For example, they must report the number of panic attacks that occur in an average day or week. Their duration and the level anxiety that follows, and what they prevents an individual from doing. This could be provided to the family physician who could complete the DTC section and refer to the psychiatry statement. If the individual is also receiving counselling with a psychologist or social worker, than this individual should also prepare a statement or complete this section as above. Two mental health professionals are twice as valuable.
7. Cumulative Effects of Disability: This is an opportunity to indicate the disabling impact on the patient globally. Your role as a patient: Give your family doctor a list of effects that were not captured elsewhere. For the physician, this can be the most important section. Nothing prevents you from including a narrative report on this section, especially if you feel an individual specialist perhaps did not document disability adequately.
8. Life sustaining therapies: Be as open minded as possible. It doesn’t have to be tube feeding and ventilation. Let the CRA worry about whether it is eligible: Examples: Immunoglobulin replacement for immunodeficiencies (monthly IV at hospital or sc. weekly at home); cancer therapy (chemotherapy- some are 24 hr infusions), home hydration, IV therapy, radiotherapy, hemodialysis, peritoneal dialysis etc. Consider the cumulative time of multiple treatments, including travel time to appointments. All are disruptive to quality of life. Even if the 14 hour requirement is not met, include the therapies and also make reference to them in the cumulative effects of disability section, even if it has to be in a narrative paragraph.

In summary, document, document and document. Include brief narrative reports to elaborate where a check mark doesn’t seem appropriate. Refer to attached documents and reports. Provide them labels or numbers. Make it easy for CRA staff to follow.

I hope these are helpful suggestions.