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OW ODSP Applications and Appeals

OW ODSP Applications and Appeals

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  • LIST OF COMMUNITY LEGAL CLINICS – LEGAL AID ONTARIO http://www.legalaid.on.ca/en/contact/contact.asp?type=cl MEMBERS OF PROVINCIAL PARLIAMENT (MPPs) List of Current MPPs http://www.ontla.on.ca/web/members/members_current.do?locale=en MPP Addresses and Contact Information http://www.ontla.on.ca/web/members/member_addresses.do?locale=en Search for your Electoral District by postal code (Elections Canada) http://fyed.elections.on.ca/fyed/en/form_page_en.jsp ONTARIO OMBUDSMAN Ombudsman Website http://www.ombudsman.on.ca/en.aspx Make a Complaint Online http://www.ombudsman.on.ca/en/make-a-complaint/complaint-form.aspx

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  • 1. To view this presentation as a webinar with sound visit CLEONet http://www.cleonet.ca/training CLEONet is a web site of legal information for community workers and advocates who work with low-income and disadvantaged communities in Ontario. www.cleonet.ca
  • 2. About our presenter… Catherine Manson is a Community Legal Worker and Licensed Paralegal with Flemingdon Community Legal Services with 22 years experience in the legal clinic system. She has been giving presentations on the Ontario Disability Support Plan (ODSP) and Ontario Works (OW) benefits since 2004. She is a member of the ODSP Action Coalition (Co-Chair of the Train the Trainer Committee), and past Chair of the Toronto Region ODSP Action Coalition .
  • 3. Walking the Tightrope: Applying for Income Support in 2010
    • Catherine Manson
    • Flemingdon Community
    • Legal Services
    • [email_address]
    • July 20, 2010
  • 4. Overview
    • Let’s take a closer look :
    • Legal Assistance
    • Where to go for help
    • Income Support
    • Government Sources of Income
    • Application Process – Ontario Works
    • Ontario Disability Support Program
    • I have been Accepted
    July 20, 2010
    • C. Appeal Process
    • Internal Review
    • SBT Appeal
    • Interim Assistance
    • Social Benefits Tribunal Hearing
    • Reconsideration
    • Thank you to HIV AIDS Legal Clinic for origin of this presentation
  • 5. Where to Find Help…
    • This presentation is not a substitute for legal advice. For information about benefits or for help at anytime – especially when a Caseworker says “NO”
    • Contact your nearest Community Legal Clinic
    • http://www.legalaid.on.ca/en/locate/default.asp
    • Community Legal Education Ontario
    • Pamphlet – Getting Legal Help – Community Legal Clinics in Ontario
    • Legal Aid Ontario – 1-800-668-8258
    July 20, 2010
  • 6. Government Sources of Income
    • Federal : - Employment Insurance “EI”:
            • - unemployment benefits
            • - sickness benefits
            • - maternity & parental benefits
            • - compassionate care benefits
            • Canada Pension Plan “CPP”:
            • – retirement/early retirement
            • - disability & child of disabled contributor
            • - survivor & child of deceased contributor
            • - death benefit
            • Old Age Security “OAS”:
            • - Old Age Pension
            • - Guaranteed Income Supplement “GIS”
            • - Spousal Allowance /Survivor’s Allowance
    July 20, 2010
  • 7. Government Sources of Income
    • Provincial : - Workplace Safety & Insurance Board “WSIB”
            • - Social Assistance [Ontario Works (OW) “welfare” and
            • Ontario Disability Support Program “ODSP”]
    • Tax Credits : - GST credit, federal & provincial tax credits, disability tax credit, etc. Through income tax
    • - RDSP-Registered Disability Savings Plan
    • Child Benefits : Federal- Canada Child Tax Benefit, Child Disability Benefit, and National Child Benefit Supplement
            • - Universal Child Care Benefit
            • Provincial- Ontario Child Benefit “OCB”
            • - Assistance for Children with Severe Disabilities
        • - Ontario Child Care Supplement for Working Families
    • Ontario Drug Benefits: - including Trillium Drug Program, Seniors, etc.
    July 20, 2010
  • 8. Who Administers the Money?
    • ODSP (Ontario Disability Support Program) administers the income support program funded by the Province of Ontario
    • OW (Ontario Works), aka Social Assistance aka Welfare is an income support of last resort administered by Municipalities
    • Municipalities often provide monies for discretionary benefits.
    • First Nation Reserves administer OW programs and 95 % of the program is funded by the federal government.
    July 20, 2010 FIRST NATIONS
  • 9. 2010 Income Support Rates
    • Ontario Works
    • Single
    • Basic Needs $221
    • Shelter $364
    • $585
    • Couple
    • Basic Needs $438
    • Shelter $572
    • $1010
    • Ontario Disability Support Program
    • Single
    • Basic Needs $578
    • Shelter $464
    • $1042
    • Couple (1 disabled) (both dis.)
    • Basic Needs $855 $1153
    • Shelter $729 $ 729
    • $ 1584 $ 1882
    • Double Disabled Couple
    • Actual Entitlement$1742
    July 20, 2010
  • 10. How to Apply?
    • If one has access to the Internet – try the Eligibility Estimator found on the Ministry of Community and Social Services Website – this is a quick tool to see if a person might qualify for Ontario Works
    • Every Municipality/First Nation Reserve in the Province has access to a District Social Services Administration Board/Ontario Works office
    • 1 st Step to getting assistance - Call the local office
      • Telephone Intake Screening Process - information required:
        • I.D., Housing, Banking/Financial, Custody/Support Orders, School or Training Programs and Employment information for all members living in your home
      • Some Shelters and/or Institutes may have Ontario Works caseworkers visit to take applications
    • 2 nd Step - an In Person meeting will be set up at the closest local office
      • All original documents are required
      • Bring an Interpreter if one is needed, OW does not provide interpreters;
      • Friends or Advocates may attend the meeting,
    • If Denied – Ask for a “Written Notice of Decision”
    July 20, 2010
  • 11. Application Forms July 20, 2010
      • The OW/ODSP Application form can be found on the Ministry of Community and Social Services website linked to the Central Forms Repository
      • This application may be used as evidence in an Social Benefits Tribunal (SBT) appeal or Court of Appeal as one swears to the truth of information provided
      • To assist vulnerable persons, one could review forms with applicants to ensure all information available before the interview
  • 12. Income, Earnings and Assets
      • To Be Reported by the 7 th of the Month for ODSP and the 21 st of the month for OW
      • All income including credit card cash advances:
      • Earnings, foreign pensions, child support, CAS support
      • Assets or windfalls (lottery winnings, inheritances, gift money, WSIB payments, LTD, EI, CPP and OAS payments, Child Tax Benefits)
      • Changes in address,
      • Changes people living or moving from home, rental income
      • Children turning 18 or Adults turning 65
      • ODSP Assets over $5000 for Recipient, $2500 for Spouse, $500 for dependent child
      • OW Assets over – Single - $572, Couple -$989; Couple w 1 dependent - $1630; Single with one dependent - $1550; $500 for each additional dependent
    July 20, 2010
  • 13. Exempt Asset??
    • Principal Residence
    • Pain & Suffering Awards
      • ODSP - $100,000.00;
      • OW - $ 25,000.00
      • WSIB NEL award, & B165 payments
      • Car Accident, Family Law Awards, First Nation Awards,
      • Criminal Injuries Compensation, Hep C awards
    • Inheritances ODSP - $100,000.00 (held in trust)
    • Lottery Winnings $5000 or less in a 12 month period
    • Registered Education Savings Plans
    • Registered Disability Savings Plans (must qualify for Federal Disability Tax Credit)
    • Disability Related Education, Items or Services
    • Disaster Relief payments
    • Business or Self Employment Assets – OW - $10,000; ODSP - $20,000
    July 20, 2010
  • 14. Participation Agreements (PA)
    • Every adult person in the benefit unit is required to attend a meeting with the OW caseworker to review finances, possible employment readiness or barriers to employment
    • A Participation Agreement outlines a person’s responsibility to look for work, or attend a training program or volunteer through the Community Placement process
    • A person may be asked to attend an update meeting every 3 months
    • If a person is working part-time, they must be looking for i) more work, ii) full time employment, iii) training program, iv) participate in a volunteer capacity that improves employment skills or opportunities
    July 20, 2010
  • 15. Deferrals for PA’s
    • If a person is unable to work – then a Deferral Letter or Limits to Participation form may be required and signed by a Third Party Agency or health professional to show why the person cannot work (health issues, caregiver responsibilities, religious reasons, maternity leave)
    • If there are children under the age of 5 and not in school full time, there is no requirement for the caregiver parent to look for work
    July 20, 2010
  • 16. APPLYING FOR ODSP July 20, 2010
  • 17. ODSP Application Process
    • You can apply for ODSP in a number of ways:
    • Application through Ontario Works
    • If income is less than OW Income rate
    • Application directly to ODSP
    • Grand-parented from Family Benefits
    • Fast track application for “prescribed class”
    • including people:
      • Age 65+ and not receiving Old Age Security
      • In receipt of CPP-D
      • Resident in certain health facilities
    July 20, 2010
  • 18. July 20, 2010 OW Referral for ODSP
  • 19. Self Referral to ODSP July 20, 2010
  • 20. ODSP - Establishing Disability
    • After financial eligibility is established, then disability must be established.
    • Decisions about disability (medical eligibility) for every ODSP application in Ontario are made by the Disability Adjudication Unit (DAU). The DAU is in Toronto and decides or “adjudicates” based on the forms in the applicant’s Disability Determination Package “DDP”.
    • The “DDP” forms package is given to the applicant to be completed and returned to the DAU within 90 days of receipt (not the local OW or ODSP office)
    • The DAU may grant a 60 day Extension of Time to submit the DDP if requested before the 90 days have expired
    • The “DDP” detailed medical information
    • stays at the DAU. It is not on
    • the client’s file at the local ODSP office .
    July 20, 2010
  • 21. Disability Determination Package (DDP)
    • Health Status Report (yellow) (completed by any of: doctor,
      • registered nurse extended class, psychologist, ophthalmologist/optometrist)
    • Activities of Daily Living Index – back half of Health Status Report (completed by above or any of: audiologist, chiropractor, occupational or physical therapist)
    • Self Report (pink) (completed by client or advocate) which is optional but must be signed and returned – this is a person’s chance to tell their own story
    • Medical Consent form;
    • Notes: OHIP/ODSP reimburses the Health Professionals who complete the Health Status forms
    • Include as many Specialist Reports as possible
    • Keep a copy of your DDP and send it “registered mail” .
    July 20, 2010
  • 22. I HAVE BEEN ACCEPTED! NOW WHAT July 20, 2010
  • 23. Rights and Responsibilities July 20, 2010
      • The ODSP Rights and Responsibilities form can be found on the Ministry of Community and Social Services website linked to the Central Forms Repository
      • This is a valuable form as it outlines what benefits are available, what information must be reported to ODSP, and cautions about fraud if information is not truthful or provided in a timely manner
      • This form may be used as evidence in an SBT appeal or Court of Appeal as one signs stating they have received a copy of the form
  • 24. Keeping Records
    • Keep letters, benefit statements, and work stubs, etc.
    • Make and keep copies of any documents submitted to any program
    • If you bring a document to the office, ask front office staff to date stamp your copy
    • Keep fax confirmation cover sheets
    • Make records about conversations, contacts, etc.
    July 20, 2010
  • 25. Cheque Stubs
    • Be sure to keep your OW/ODSP cheque stubs .
    • The stubs tell you [and us]:
      • how your “gross entitlement” is calculated
      • the amount of any deductions, if any, and what the deductions are (for example: CPP, employment income, child support, etc.)
      • your Case or Member ID number, the worker number, and the local office
    July 20, 2010
  • 26. What Are Benefits?
    • In almost every case, in order to access these benefits you must:
      • Know about them!
      • Ask for them!
      • If a specific form is required, ask for the form!
      • Know if the benefit is a Mandatory or Discretionary benefit
      • All “mandatory” benefits can be appealed
    • *Discretionary benefits may not be appealed, but can still be reviewed by a Supervisor and then a Manager
    July 20, 2010
  • 27. The Appeal Process: Someone Said “NO” July 20, 2010
  • 28. What if they say NO? Step # 1
    • Notice of Decision - All Decisions must be in writing from the Administrator or Director.
    • The appeal process must start by requesting an Internal Review which must be:
      • In writing – one sentence - “I want an internal review of this decision.”
      • Provide any missing information
      • As of May 1, 2009 – 30 days to submit a written
      • Request an Internal Review
      • *Contact your local community legal clinic for help
    • You can request an extension if you’re past the 30 days (and you should)
    • *Even decisions which are not appealable can be internally reviewed.
    July 20, 2010
  • 29. July 20, 2010
  • 30. What if they still say NO? STEP # 2
    • If the internal review is not successful, file an appeal to the Social Benefits Tribunal (SBT) (www.sbt.gov.on.ca)
    • Submit the appeal form within 30 days of the internal review decision. **Contact your local community legal clinic for help.
    • Hearings are held in English or French, Interpreter service can be requested on the appeal form,
    • If you do not submit a Request for Internal Review – you cannot file an appeal to the SBT
    July 20, 2010
  • 31. Appealable To SBT?
    • Any Variation, Suspension or Cancellation of Support
      • Overpayments
      • Reduction in benefits
      • Denial of Disability Benefits
    • Mandatory Benefits
      • Mandatory Special Necessities – diabetic, surgical supplies, transportation
      • Special Diet (until new regs released)
      • Drug Card
      • Dental Card ( not dependent adult)
      • Vision (not dependent adults)
      • Community Start Up and Maintenance Benefits
    • Community Placement for ODSP recipients
    • Discretionary Benefits - paid to OW or ODSP recipients
        • - 3 categories:
        • health related,
        • non-health related,
        • “ other special items & services”
      • Some Municipalities have an Alternate Dispute Resolution Committee for disputing Discretionary Benefits
    July 20, 2010 YES NO
  • 32. July 20, 2010
  • 33. Interim Assistance July 20, 2010
  • 34. What Happens After Filing an Appeal to the SBT for Income Supports?
    • 1) An Acknowledgement Letter from SBT with new File Number
    • 2) Notice of Hearing with the Appeal Date – current practise – scheduled three to four months from date appeal filed.
    • 3) Receipt of the Director’s Submission : Administrator’s/Director’s reasons for cancellation, suspension or variation of income benefits. This will include copies of relevant documents available to the OW or ODSP office in making the original decision
    • Appellant submissions – to be submitted to SBT and OW/ODSP local office or appeals’ unit 20 calendar days (for non medical issues) and 30 calendar days (for medical issues) before the hearing
    • 5) OW/ODSP Appeal Units or local office – will review any new information and submission. A settlement may be negotiated before the hearing.
    July 20, 2010
  • 35. Day of the Hearing
    • Attend at the hearing and sign in
    • Block hearings – 9 am, 11 am, 1 pm or 3 pm
    • Bring a book – one may have to wait to be heard
    • Private Hearing - In attendance there may be:
      • i) the Tribunal Member,
      • ii) a Case Presenting Officer (CPO) from OW or ODSP;
      • iii) an interpreter if requested;
      • iv) your legal representative
      • v) a friend/family member who can be an observer (who is not allowed to speak at the hearing)
    • Witnesses will be asked to wait in waiting room until called.
    • To start the hearing – the Tribunal Member will confirm everyone’s identity, ask applicant/interpreter to swear an oath to the truth of information to be provided; and provide information on the conduct of the hearing.
    July 20, 2010
  • 36. The Hearing - continued
    • Hearings are normally 1 to 1½ hours in length
    • If a question is asked and not understood – ask for clarification
    • You present your case first, your legal representative will lead you through a list of questions
    • The CPO and the Tribunal Member will ask further questions
    • Once all questions have been asked, your legal representative and the CPO will give closing arguments
    • If you need a break, or to stretch or to move – ask the Tribunal Member
    • No Decision is given verbally – decisions are to be sent by mail within 60 days of the hearing
    • A Tribunal Member may only confirm or overturn the Director and/or Administrator’s original decision
    • If one fails to attend the hearing without an accepted reason – A Decision can be made to confirm the Director’s Decision which stops one from appealing same case for 2 years.
    July 20, 2010
  • 37. Reconsideration Step # 3
    • Once a decision has been received either party has 30 calendar days to file a “Reconsideration”
    • A reconsideration hearing may be granted if there is an error in law or error in facts in the decision, or if a person did not attend the hearing due to illness or other emergency. Was the Tribunal notified of emergency – day of hearing?
    • The Chair of the SBT makes the decision whether to grant a new hearing
    • IF a reconsideration is granted – a new or “de novo” hearing will be scheduled – this allows you to present the case again before a different Tribunal member
    • If this reconsideration decision is Negative – one can file leave to appeal to Divisional Court if there is an error in law
    July 20, 2010
  • 38. Notes/Questions? July 20, 2010
  • 39. This webinar was brought to you by CLEONet For more information visit the Social Assistance and Pensions section of CLEONet at www.cleonet.ca For more public legal information webinars visit: http://www.cleonet.ca/training