Ontario Disability Support Program
The Ontario government pays disability benefits to entitled recipients under the Ontario Disability Support Program (ODSP). Eligibility for benefits under ODSP requires proof of a substantial physical or mental impairment that is continuous or recurrent for at least a year or more. The impairment must be severe and disabling, leading to functional limitations in daily living impact and significant work restrictions. In addition, to be qualified, the applicant must demonstrate financial need based on income thresholds and asset limits.
Pursuant to section 4 of the Ontario Disability Support Act, a person must submit medical documentation of a “substantial physical or mental impairment” which is long-term or recurrent and expected to persist for one year or more. The medical condition must be documented by a physician and is subject to an assessment by the caseworker using established criteria. The impairment is considered “substantial” if supporting evidence is provided that demonstrates an interference with daily personal tasks, volunteer or vocational pursuits, or restricted daily activities. If the initial application for income support is denied, the person has the right to appeal the determine made by the tribunal within a set reconsideration period and appeal deadlines.
The Act excludes illnesses caused by alcohol or drug addiction. The exclusion does not include addiction to prescription medications. Also, the exclusion does not apply if the addiction is caused as a result of a substantial physical or mental impairment. To maintain benefits, the recipient may be subject to ongoing review and is expected to satisfy eligibility requirements.
Illnesses Covered Under Disability Act
Generally, these illnesses include chronic conditions which affect a person’s daily activities. These types of conditions may include serious chronic illnesses with functional limitations where a person requires personal care.
Other types of conditions may include:
- chronic pain,
- depression,
- complications from surgery or prolonged healing, and
- concussion syndrome.
Other illnesses may include:
- multiple sclerosis,
- post-partum depression,
- cancer,
- heart disease,
- fibromyalgia,
- developmentally delayed,
- severe arthritis,
- diabetes, etc.
These types of conditions include those which interfere with daily activities, vocationally or personally. The person must be receiving medical care and attend a rehabilitation program or active treatment to qualify.
It is important to obtain detailed medical reports from treating physicians and specialists. General information such as coded descriptions on an OHIP summary or abbreviated diagnoses does not adequately describe complications that prolong the illness.
A denial of benefits is often the result of misinterpretation of the expected recovery date for the type of illness briefly described, without including complicating factors. Oftentimes, a psychological condition is a complicating factor that can be overlooked.
The Canada Pension Plan Act
The Canadian government also pays benefits before age 65 based on disability. A person may qualify for a Canada Pension Plan Disability benefit with a severe and prolonged mental or physical disability. This type of qualifying illness would include conditions that are not responsive to treatment or extensive rehabilitation efforts.
An application for CPP disability will include statements from treating physicians and specialists which comment on investigations, failure to respond to treatments.
Illnesses covered by disability acts do not need to be caused by accidents or any specific causation.
Although this process can be complicated, contacting an experienced disability lawyer can help.
