ODSP for Medical Practitioners - Your Legal Rights

ODSP Applications:
Information for Health
Professionals

Purpose of the Program:
(a) provides income and employment supports to
eligible persons with disabilities;
(b) recognizes that government, communities,
families and individuals share responsibility for
providing such supports;
(c) effectively serves persons with disabilities who
need assistance; and,
(d) is accountable to the taxpayers of Ontario.

Some benefits of ODSP:
Recipient is not “on welfare”
More money: $1,053 vs. $592
Recipient can get “employment supports”

About the Ontario Disability
Support Program
Financial support and other benefits for
people with serious health problems who
have low income.
Generally, must qualify financially and
meet definition of “person with a
disability”; some other exceptions.

Definition of “Person with a Disability”
(a) the person has a substantial physical or mental
impairment that is continuous or recurrent and
expected to last one year or more;
(b) the direct and cumulative effect of the impairment on
the person’s ability to attend to his or her personal
care, function in the community and function in a
workplace, results in a substantial restriction in one or
more of these activities of daily living; and,
(c) the impairment and its likely duration and the
restriction in the person’s activities of daily living have
been verified by a person with the prescribed
qualifications.

1. Substantial Impairment
The 3 criteria:
“substantial physical or mental impairment”
lasting one year or more
continuous or recurrent impairment
2. Substantial Restrictions of ADLs
substantial restriction one or more of the following
activities of daily living:
3. Medically Verified
- attending to personal care
- ability to function in the community
- ability to function in the workplace

Definitions
Impairment: physical or functional abnormality or loss
Restriction: limitation to activities of daily living arising
directly or indirectly from the impairment
Substantial: Flexible interpretation related to varying
circumstances, i.e. important, serious,
significant
- note the test is NOT “severe”

Making the Application
1. Individual gets application from Ontario Works
(if they are recipient) or self refers through the
Ministry of Community and Social Services.
2. They must prove financial eligibility.
3. If financially eligible, they will be given the
Disability Determination Package (DDP)
4. The DDP must be completed by an approved
health professional and the original returned
to the Disability Adjudication Unit (DAU) within
90 days from the date the applicant received
the package.

Who can complete the application
The following Health Professionals who are licensed to practice in the Province
of Ontario may complete the forms :
HSR
ADL
Ophthalmologists
Optometrists
Physicians
Psychological associates
Psychologists
Registered Nurses in the extended class (RNEC)
Registered Nurses
Audiologists
Chiropractors
Occupational Therapists
Social Workers
Speech Language Pathologists
Physiotherapists
Registered Nurse (Member College of Nurses)
•Chart prepared by Disability Adjudication Unit

Health Status Report (HSR)
Verifies the applicants
conditions,
impairments,
restrictions, expected
duration, whether
continuous/recurrent,
and prognosis

Sunday
Jane
5’8” 130 3 years x

Tips on completing the HSR
• Include all health conditions
• Clearly describe the physical or mental
impairments
• Clearly detail restrictions
• Include all medications
• Space for notes, including any assistive devices,
treatment history of medications/treatments
tried that have not been effective, side effects,
any other relevant/helpful comments
• Complete the Intellectual and Emotional
Wellness Scale for any applicant with any mental
health condition or symptoms (even if not the
principal condition)

Activities of Daily Living Index
(ADLI)
Verifies the applicants restrictions to
activities of daily living
Contains a grading scale for a list of
activities of daily living
4 class grading scale:
Class 1 – no limitations
Class 2 – mild or slight limitations
Class 3 – medium or moderate limitations
Class 4 – severe or complete limitations

Sample
x xxx x
x x
x x x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x

Tips on completing the ADLI
Interviewing the applicant before
completing the ADLI will help to confirm
accurate ratings
It is very helpful to add further comments
on the form – space is provided.
Try to fully describe the applicant's
situation on the forms
Attach any written reports and “objective
information” such as x-ray reports and
test results

More Tips on completing the DDP
The forms don't ask the most important
questions:
a) does the applicant have a substantial
impairment
b) does the impairment substantially
restrict the applicants activities of daily
living (personal care, ability to function in
community or workplace)
If the answer to these questions is yes,
clearly state that opinion in the forms and
explain your opinion.

Documenting Mental health conditions on the
forms can be difficult. Make sure to provide
details of both:
- the applicant's symptoms, and
- the effects of the these symptoms
* if your file includes GAF scale rating indicating a
substantial ADL restriction, attach it
* if you don`t feel comfortable, refer to have
second DDP completed by another specialist.
The ADLI ratings focus largely on personal care.
Make sure to add comments about restrictions in
ability to function in the community and in a
workplace, if the applicant has restrictions in
these areas

Addictions
Until now, people who have disabling conditions
caused only by drug and/or alcohol addictions
have not been eligible for ODSP benefits
A recent court decision has changed this.
Now, a person's addiction must be considered
when deciding if they qualify for ODSP.

Addiction: Factors Considered
Whether the DSM IV criteria for substance
dependence have been met
Clinical history including signs and symptoms
(withdrawal, tolerance, relapse, overdose,
judgement)
Most responsible substance of abuse and duration
of use
Past history of addiction (age of onset, chronicity)
Presence of co-morbid organic conditions

Continued…
Presence of concurrent (psychiatric) conditions
Substance related treatment and treatment history
(hospitalizations etc.)
Cumulative effect
Functionality (social, financial, legal functioning/responsibility)
History for abstinence and usage
Cognitive and behavioural factors (include risk behaviours)

How is the Decision Made
Completed Application (HSR, ADLI and optional
Self-Report) is reviewed by the Disability
Adjudication Unit, based in Toronto.
DAU states that it applies the “whole person”
approach. Assessing impairments cumulatively,
as well as specific to the overall impact in the
applicant's circumstances.
Written decision is issued to applicant within 90
business days.

Medical Reviews
When an applicant is granted ODSP benefits,
they are likely to be given a review date to
assess whether:
a) the individual’s medical conditions have
improved to the point where they no longer
require disability benefits, or
b) the individual's conditions have remained the
same or worsened and they continue to be a
“person with a disability” making them eligible
for ongoing disability benefits.

At that time, the DAU will check the applicant's
disability or health status again to make sure
that they still qualify
The applicant will be asked to have the forms in
the DDP completed again. They will have 90
days to complete and return the package.
* In doing a medical review it is recommended
that you consult the original application (if
possible). You may also want to note where the
patient’s conditions have remained the same or
worsened since the original application.

Dispute Process
Once an application for disability is denied, there is
a standard dispute process they may access.
1. Internal Review Request – 30 days
1.
2. Appeal to Social Benefits Tribunal – 30 days
You may be contacted to provide additional
information during the appeal process

Legal Clinics
Applicants who have been denied ODSP should be
encouraged to get legal advice from their local
legal clinic.
If you have any questions, call the local legal clinic
Online link to find the local legal clinic by postal
code:
http://www.legalaid.on.ca/en/contact/contact.asp
type=cl

Sample of a Good Application
Note: If no impairments/restrictions/duration verified, condition not considered

Note: All conditions with medications listed should be in previous pages.

Note: IEWS should reflect all intellectual and emotional impairments.

Note: It is helpful to include comments or an overview of patient's functioning.