What does it mean when someone on ODSP is given a medical review?

Question: 
I get income support from the Ontario Disability Support Program (ODSP)and have been given a "medical review" date. What does this mean?
Answer: 

More people who get income support from the Ontario Disability Support Program (ODSP) are given a "medical review".

Income support for people with disabilities

To qualify for income support from ODSP, people have to qualify:

  • financially, and
  • in most cases, as a "person with a disability".

What are medical reviews?

Even if someone qualifies as a "person with a disability", the Disability Adjudication Unit (DAU) may give them a "medical review" date. They do this if they think the person's health might improve.

A medical review is how the DAU checks the person's disability or health status to see if they still qualify for ODSP.

The DAU is a part of the Ministry of Community and Social Services. It decides whether people meet the ODSP definition of a "person with a disability".

In the past, many people's medical review dates came and went without a review.

In January 2013, the government started doing regular medical reviews again. And it is currently increasing the number of people being reviewed each month. This means that both people with medical review dates coming up and people who were supposed to have a review and haven't yet had one could now be facing a medical review.

How does someone qualify as a "person with a disability"?

An approved health professional, such as a doctor, must confirm that:

  • the person has a physical or mental health problem that is expected to last a year or more, and
  • their health problem limits their ability to work, look after themselves, or do daily activities at home or in the community.

The law also says that the health problem must be substantial and it must limit the person's abilities in a substantial way.

An ODSP applicant who qualifies financially gets a Disability Determination Package. It has forms that they fill out and forms that their doctor or another health professional has to fill out.

CLEO's booklet ODSP Applications: Information for Health Professionals can help health professionals when they fill out ODSP forms.

The forms must be completed and sent to the DAU in Toronto within 90 days.

What happens if the DAU has set a medical review date?

When the DAU is ready to do a medical review, they send out the Disability Determination Package. The forms all have to be filled out again and sent back to the DAU within 90 days.

If a person can't get the forms completed and sent in within the 90 days, they can ask the DAU for more time. But they have to prove that they have a good reason. For example, they could not complete the forms because they were in the hospital.

What happens on a medical review?

The DAU decides if the person still qualifies as a "person with a disability" based on the forms and medical evidence that they send in.

It's important for people to include all the information that shows they qualify. This includes information about both:

  • new health problems
  • health problems that they gave the DAU information about in the past

People continue to get income support while the DAU does its review. If the DAU decides that someone no longer has a disability, they will only get 3 more months of income support before being cut off.

What if someone's income support is cut off after a medical review?

People can appeal to the Social Benefits Tribunal. The first step is to ask for an internal review.

CLEO's booklet Appeals and internal reviews has more details, including information about time limits and a form that can be used to ask for an internal review.

Getting legal help

For advice or help dealing with ODSP or with an internal review or an appeal, contact a community legal clinic.

To find the nearest legal clinic, visit the Legal Aid Ontario website.

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