|Updated January 2011|
The purpose of this webpage is to describe and clarify eligibility, referral and granting for applicants to Ontario Disability Support Program Income Support (ODSP) from Ontario Works (OW). A detailed description is provided of the procedures to identify and support applicants to ODSP from OW throughout the application process for each type of ODSP application for OW.
You can also see a summarized description of the process of applying to ODSP.
On June 1, 1998, the province introduced new legislation and regulations, the Ontario Disability Support Program Act and Regulations (ODSPA) for people with disabilities at least 18 years of age; and people aged 65 and over who do not qualify for a pension under the Old Age Security Act. The new legislation replaced the Family Benefits Act (FBA) and the Vocational Rehabilitation Services Act (VRS).
A person who is 'blind, disabled or permanently unemployable' and receiving FBA on or before May 31, 1998 remains on ODSP as long as s/he continues to meet the financial eligibility criteria as set out under ODSP.
People in immediate financial need can apply to ODSP through OW. Everyone has the right to make an application for ODSP on the belief that s/he is a person with a disability. This belief held by the person is sufficient to require OW to initiate an application to ODSP from OW. It would be contrary to the legislation for OW to deny or to delay in responding to any request for an application to ODSP. It is not up to OW to presuppose the outcome of the ODSP application. The OW medical form, 'Limitations to Participation' cannot be used as a precondition or otherwise to exclude applicants to ODSP. It can be used though to initiate a conversation about application to ODSP based on the medical information being provided. The adjudicator at the Disability Adjudication Unit (DAU) determines if a person meets the definition as set out in the Act.
The applicant must agree to have her/his file referred to ODSP before the referral can be made. ODSP is a voluntary program and the applicant does not need to apply to ODSP as a condition of OW eligibility. ODSP is specifically excluded as an available financial resource under Section 13 of Ontario Regulations 134/98 of the Ontario Works Act, 1997. With the applicant's agreement, the caseworker must action the referral by explaining the application process, referring to ODSP and issuing the Disability Determination Package (DDP).
Consideration of an application to ODSP may come up at any time a person or family is receiving OW assistance. It can be at Intake immediately after financial eligibility for OW has been confirmed, when reviewing the circumstances of an ongoing file or if a change in health status is reported. It may be identified and suggested by either the caseworker or the applicant. The caseworker must discuss the option of applying for ODSP whenever a potential referral to ODSP is indicated. Without this information, the applicant may not be aware of the ODSP program.
Applying to ODSP from OW is different for applicants who require medical adjudication by the Disability Adjudication Unit (DAU) and those who don’t. Applicants who don’t require an application through the DAU are members of a prescribed class or applicants who qualify for rapid reinstatement.
Application to ODSP from OW on the basis of disability is a three step process:
Effective June 1,1998, the following case classes are eligible for ODSP:
The determination of financial eligibility by OW applies to all applicants, those who require adjudication by the Disability Adjudication Unit and those who do not.
Determining eligibility for OW assistance in the context of application to ODSP is based on the same rules as OW eligibility with the possible exception of assets, allowable and discretionary. The way the referral is done depends on the person's role within the OW benefit unit; applicant, spouse or dependent adult. Financially eligible OW applicants and spouses apply through OW. Application for an OW dependent adult with a disability is a self-referral to ODSP.
Once the application forms are completed and signed, the caseworker will determine financial eligibility for OW assistance, using the one-time asset exemption as applicable.
In assessing eligibility for OW, it is crucial that applicants are aware of the option to apply the ODSP asset rules for the OW eligibility assessment. When an application to ODSP is being made, the ODSP asset levels, rather than the OW asset level can apply once in a lifetime for the financial assessment with the agreement of the applicant. This permits the exemption of assets according to ODSP asset limits. This option must be offered to applicants when the asset level exceeds the OW asset level and application is being made to ODSP.
If the applicant is not eligible for ODSP when the application is finally determined including any period of an Internal Review and appeal, and the assets exceed the OW asset level, reimbursement would be required. The amount to be reimbursed is the lesser of the financial assistance paid or the value of the assets in excess of the OW asset level. If the assets are below or equal to the Ontario Works asset limit, the applicant continues to be eligible for Ontario Works and is not required to make a reimbursement of financial assistance paid.
Under ODSP, there are also some assets that are discretionary. Discretionary assets are exempt while the client is in receipt of assistance from OW. OW cannot assess ODSP discretionary assets. OW would inform the applicant that OW cannot make a decision about the discretionary asset and that the decision regarding the exemption of the asset will be made by the ODSP staff prior to determining eligibility for ODSP income support. If the ODSP staff finds that the asset is not exempt, the applicant may be found ineligible for ODSP or may be given a time frame in which to dispose of this asset.
For more detailed information on assets, please refer to the ODSP Directive 4.1 Definition and Treatment of Assets.
For applicants who have an injury, illness or disability OW allows for a temporary deferral of mandatory participation requirements based on medical documentation. The assessment is based on the applicant’s circumstances to determine the participation and the deferral or restriction required.
Applicants to ODSP aged 65 and over and not eligible for OAS, have a categorical deferral from mandatory OW requirements.
In addition to the regular recourse of an Internal Review and an appeal with the Social Benefits Tribunal, if the applicant is not eligible for OW, even with the ODSP asset level applied, the letter of OW ineligibility is provided and the applicant is informed to apply directly to the local ODSP office. In this situation, the application becomes a self referral to ODSP. OW cannot provide the referral or the Disability Determination Package (DDP) to people who are not eligible for OW.
The Disability Adjudication Unit (DAU) determines medical eligibility based on the information provided in the Disability Determination Package (DDP). The DDP is the set of forms used to collect the applicant's medical information. Once the complete DDP is received by the Disability Adjudication Unit, the adjudicator will compare the applicant's health status presented in the Disability Determination Package with the definition of disability set out in ODSPA. The applicant and the OW office will be notified of the DAU decision.
Detailed information about the Disability Determination Package (DDP) is available.
An individual qualifies as a person with a disability if:
Also Community Legal Education Ontario (CLEO) provides a clear language version of the definition of disability set out in ODSPA,
|a substantial physical or mental health problem that is expected to last one year or more, and substantially limits a person's ability to work, look after him/herself, or carry out daily activities at home and in the community.|
Being recognized as a person with a disability by the DAU is not the same as being granted ODSP. Once the medical determination is completed, the local ODSP office grants ODSP benefits for active OW recipients.
The Disability Adjudication Unit (DAU) is the centralized unit for the medical adjudication of applications for the province of Ontario. The adjudicators at the DAU have several responsibilities.
OW Applicant and Spouse Both Applying to ODSP
If both the applicant and spouse believe themselves to be a person with a disability, both could apply to have their medical information assessed. If both are accepted, the ongoing monthly ODSP rates would be higher than if only one of the two was accepted as a person with a disability, $838.00 vs. $1130.00 on the monthly basic needs.
Correctional Facilities and Halfway Houses
Although persons in correctional facilities and halfway houses are not eligible for income support, a process to ease the transition to the community has been established. As appropriate, correctional facility physicians will complete the DDP and return it to the DAU. Upon release, the individual will be advised by the correctional facility to contact either OW or ODSP to establish financial eligibility. OW is the contact for people in immediate financial need.
Once financial eligibility has been established, the referral would be completed for the DDP to be adjudicated by the DAU.
Any inquiries or requests for a DDP from a correctional facility or halfway house should be directed to the DAU.
For more information refer to ODSP Income Support Directive 1.2 Disability Adjudication Process, Applicants in a Lawful Place of Confinement.
For grandparented ODSP recipients who are subsequently incarcerated, please refer to the section about Incarcerated Individuals.Nursing Homes
For residents who are admitted to nursing homes for a short stay and retain their community accommodation, their full income assistance shall be paid for up to six months and reduced to an amount equivalent to the personal needs allowance (PNA) on the seventh and subsequent months. With eligibility for OW established, application to ODSP from OW can proceed, including providing the Disability Determination Package (DDP) and referring to ODSP.
Click for information about Patients in Hospital.
The applicant has 90 days from the date of the referral to the DAU to have the DDP completed and returned to the DAU. It is crucial that the applicant and the caseworker keep in touch about the progress of the referral throughout the 90-day period. This is an important time to support application to ODSP from OW. This time can go very quickly for the applicant, given the time sometimes needed to get the medical documentation to support the application. If the applicant identifies that additional time is needed for the return of the DDP, either the applicant or the caseworker, on the applicant's behalf, can request an extension of the DAU.
An extension for the return of the DDP can be requested by sending a fax to the DAU. (FAX @ 416-326-3374 or 416-326-2985 or 416-326-6913)
The DAU will forward two letters to the applicant during the 90-day period if the DDP has not been received by the DAU. The first letter would be sent at 60 days to remind the applicant of the time frame for the return of the DDP.
A second letter to the applicant would follow at 90 days to indicate that the referral has expired without the DDP being received. If the Disability Determination Package is not received within 90 days of issue the application is considered withdrawn.
This information is also sent to the referring OW office. At this point the caseworker must follow-up with the applicant to determine her/his understanding and intentions regarding the ODSP application. This follow-up can include offering supports, including by way of referral for assistance to have the DDP completed.
If the client has any inquiries about the forms or his/her application, s/he can also contact the DAU at 1-888-256-6758.
The DAU will assess additional medical information after the DDP has been received at any time, during or following the adjudication, up to thirty (30) days prior to a hearing at the Social Benefits Tribunal (SBT).
When the applicant has been determined to be a person with a disability, the applicant is notified by a Letter to Applicant - Determined to be a Person with a Substantial Disability. The letter will also contain the medical review date for the applicant if one has been assigned. It is beneficial for applicants to retain this letter for their records.
For applicants receiving OW, this information is also sent to the OW office. Within five (5) days of receiving this information the referring OW office must send the file to the local ODSP office.
ODSP offices no longer need to re-confirm financial eligibility for active OW applicants to ODSP. ODSP will grant ODSP within 21 days of receiving notice of the DAU decision. OW continues to assist until ODSP is granted.
For applicants to ODSP who are no longer receiving OW, ODSP must confirm current ODSP financial eligibility.DAU Decision: Not a Person with a Disability
When the applicant has been determined not to be a person with a disability, the applicant is notified by a Notice to Applicant - Determined NOT to be a Person with a Substantial Disability. The referring OW office and the local ODSP office are also informed of the decision. The decision to deny ODSP by the DAU can be the subject of an Internal Review with the DAU and an Appeal with the Social Benefits Tribunal.
Although it is the responsibility of the DAU to inform the applicant of the medical decision, the OW caseworker and the applicant would discuss a course of action. This may include a referral to a community legal clinic for assistance with this matter. The community legal clinics are available to assist with matters of poverty law, including appealing ineligibility decisions by the DAU. The clinic would assess the merits of an appeal.
The request for an Internal Review of the decision by the DAU must be made within thirty (30) days of receiving the original decision. Because of the short time frame to request an Internal Review, it is crucial that the caseworker and applicant are in contact. Requests after the thirty (30) day period may be accepted with an explanation of why the request is being received longer than ten days following the decision.
Additional medical information, if available, can be provided to the DAU when requesting an Internal Review.
Additional medical information can be provided at any time in the application process up to thirty (30) days before a Social Benefits Tribunal (SBT) hearing.
If the Internal Review confirms the original decision by the DAU, the caseworker and the applicant would again be in contact to discuss a further course of action. This could include the potential of an appeal of the decision to the Social Benefits Tribunal and the resources available to assist with an appeal. An SBT appeal cannot proceed unless an Internal Review has been requested. If the Internal Review decision is not made within ten days, the decision can be appealed to the Social Benefits Tribunal within forty days of the request for the Internal Review.
If the Internal Review or SBT decision overturns the original decision, the OW office would forward the financial file to reflect the full application period for the ODSP grant.
As with the original application, access to recourse on the application including requesting the Internal Review (IR) and appeal with the SBT, remain voluntary for the applicant and not a condition of OW eligibility. Also, if an appeal has been requested, the once in a lifetime asset exemptions continue to apply until the appeal is finally determined.
Rapid reinstatement is the re-application process through the local ODSP office after a period of ODSP ineligibility. It is a provision that allows for ODSP benefits to be restored without medical adjudication.
Different rules and conditions apply depending on whether eligibility had been established with FBA and automatically transferred to ODSP or previously adjudicated through the DAU and the reason for termination. Restoring the ODSP benefits depends very much on the applicant's individual case circumstances, both at the time of the original grant and when the file closed.
OW may be required to issue assistance pending reinstatement to ODSP and to liaise with the local ODSP office to help get the ODSP benefits restored.
For Termination Less Than Thirty (30) Days
This applies to all ODSP files. If an ODSP file was terminated for less than thirty (30) days, an applicant can return to ODSP for assessment for immediate reinstatement.
OW may be required to issue assistance pending reinstatement to ODSP and to liaise with the local ODSP office to facilitate the restoration of the ODSP benefits.
For Grandparented FBA recipients
Recipients of Family Benefits as a person who is 'blind, disabled or permanently unemployable' were deemed eligible for ODSP on the basis of eligibility for Family Benefits as of May 31,1998. Applicants, having made an application by May 31,1998 and subsequently being determined eligible for Family Benefits allowance by the Medical Advisory Board were also deemed eligible for ODSP on the basis of eligibility for Family Benefits.
The grandparented ODSP status is retained as long as the ODSP claim remains in pay. If the file is closed and later ODSP assistance is required, application would be made either by Rapid Reinstatement for grandparented FBA cases or as a new ODSP applicant. When the provisions for rapid reinstatement are not met, the grandparented status is lost and a new ODSP application is required, including adjudication by the Disability Adjudication Unit or qualification as a member of a prescribed class.
For grandparented FBA recipients, the two requirements to retain the grandparented status for the rapid reinstatement provisions to apply are:
For more information about Rapid Reinstatement for people who were part of the automatic transfer from FBA to ODSP, please see the ODSP brochure Coming Back to the Ontario Disability Support Program - Rapid Reinstatement.For Incarcerated Individuals
The divisional court has ruled that for recipients grandparented from FBA onto ODSP and incarcerated, the period of incarceration must be treated as suspension rather than cancellation of benefits. This divisional court decision is binding for ODSP offices. OW may be required to issue assistance pending reinstatement to ODSP and to liaise with the local ODSP office to facilitate the restoration of the ODSP benefits.
No time limit on the period of incarceration was articulated in the divisional court decision.
Click for more information for people who are applying to ODSP from a Correctional Facility or Halfway House.For ODSP Cases Previously Adjudicated by the DAU
For ODSP cases, which were not grandparented but were previously on ODSP assistance adjudicated through the DAU, the following criteria must be met in order to qualify for rapid reinstatement:
The critical factor is that the applicant left ODSP prior to the medical review being done, if one had been assigned.
For more information about Rapid Reinstatement for people who were previously adjudicated by the DAU, please see the ODSP brochure Coming Back to the Ontario Disability Support Program - Rapid Reinstatement.
ODSPA sets out rules for people who can apply without being adjudicated by the DAU. Application is made through OW to the local ODSP office. Members of a prescribed class from OW include:
An applicant to ODSP who is receiving Canada Pension Plan Disability (CPP-D) does not require medical adjudication by the DAU as part of the ODSP application process. An applicant receiving CPP-D would require only confirmation of financial eligibility for ODSP. Medical eligibility for ODSP is based on and then tied to eligibility for CPP-D.
As with medical eligibility, CPP-D and ODSP can also be blended in terms of benefits. ODSP provides a monthly drug card and other medical benefits that CPP-D does not. With eligibility, ODSP and CPP-D benefits can be blended in this way.
If CPP-D is pending while OW is received, an assignment would be completed for the CPP-D income. Once received the applicant becomes a member of a prescribed class for ODSP and the caseworker must initiate a conversation about referral to ODSP and follow-up accordingly.
If the applicant loses eligibility for CPP disability benefits, eligibility for ODSP as a member of a prescribed class is also lost. Reapplication to ODSP in the absence of renewed eligibility for CPP-D requires adjudication by the Disability Adjudication Unit.
Aged 65 years and over and not eligible for OAS
An OW recipient aged 65 years and over and not eligible for a provincial pension benefit is a member of a prescribed class. Confirmation of financial eligibility only would be required to qualify for ODSP.
If someone turns 65 and receives confirmation of ineligibility for a provincial pension, for example Old Age Security, while receiving OW, the criteria for prescribed class status are met. The OW caseworker must initiate a conversation about referral to ODSP and follow-up accordingly.
Residents in a Facility
A person is eligible for ODSP without disability adjudication while residing in a facility under:
If the person contacts the OW office while still a resident of or prior to his/her discharge from one of these facilities, he/she should be advised to contact the local ODSP office whose staff will determine eligibility. However, if the person contacts the OW office after being discharged from one of these facilities, the OW caseworker should treat these applicants as they would any other client who may be potentially eligible for ODSP. If a person is not residing in a facility which is covered above and it is determined that he/she is in immediate financial need, he/she can apply for assistance through an OW office. These cases will require disability adjudication and referral to ODSP.
A self referral to ODSP can be made by people who are found not eligible for OW or who are not considered to be in immediate financial need. The local ODSP office would make the initial eligibility assessment and initiate the referral to the DAU accordingly.OW Dependent Adult Applying as a Person with a Disability
An application for an OW dependent adult is a self referral to ODSP. The OW dependent adult must apply directly through the local ODSP office. The OW office cannot complete the referral, nor can the OW office provide the DDP to the dependent adult.
An OW dependent adult with a disability can apply to ODSP in her/his own right six (6) months before her/his 18th birthday. This includes youth who are about to turn 18 years of age and who are receiving Assistance for Children with Severe Disabilities (formerly the Handicapped Children's Benefit) and/or Special Services at Home (SSAH). Income support could then start the first month following the 18th birthday, provided all eligibility criteria are met.
When the ODSP office grants benefits, arrears issued by ODSP reflect retroactive eligibility as of the effective date of grant. OW income is not deducted in the first month of overlap and OW issued is deducted from the ODSP entitlement in subsequent months.
ODSP office locations are available through the Social Assistance Office Finder.
General information about ODSP rates can be found on the Ministry of Community and Social Services website. The ODSP rate tables can be found on Service Ontario's e-laws site, which include the basic needs and shelter amounts.
Although it is the responsibility of the local ODSP office to inform the applicant of the financial decision, the OW caseworker and the applicant would discuss a course of action. This may include a referral to a community legal clinic for assistance with this matter. The community legal clinics are available to assist with matters of poverty law, including appealing ineligibility decisions by ODSP. The clinic would assess the merits of an appeal.
If a client applying as a person with a disability passes away during the application process, and it is determined that arrears are owing, the arrears payment is issued to the surviving spouse and/or dependent(s).
For both single recipients and recipients with a spouse and/or dependent children the ODSP income support for the month in which the recipient dies will reflect the full entitlement, full shelter and basic needs.
Additionally, in cases with a spouse and/or dependents, regulation also allows for the use of discretion by ODSP to extend full income support, without reduction, for three months and possibly up to six months.
Generally speaking, ODSP recipients are automatically eligible for funeral and burial assistance provided by Toronto Employment and Social Services. In providing this assistance, TESS has the right to recover expenditures from available assets and income including final payments or lump sums. For single ODSP recipients only, the last ODSP cheque is paid to the City of Toronto as partial recovery of the funds for funeral/burial expenses. For more information on TESS policy about funerals and burials, please see Funeral and Burials Policy
Disability Adjudication Unit
Social Assistance and Municipal Operations Branch
Ministry of Community and Social Services
Referrals to the Ontario Disability Support Program (ODSP)
See the full ODSP Directives.
Community Legal Education Ontario (CLEO) provides clear language brochures on a wide range of topics of social assistance, including applying to ODSP.