Ontario is improving the medical review process to help Ontario Disability Support Program (ODSP) recipients whose medical condition has not improved.
This new medical review process is easier for both ODSP recipients and health professionals - saving time and effort.
Previously, the ODSP medical review process used the same form that was required for a person’s initial ODSP eligibility assessment.
Now, if the ODSP recipient’s medical condition has not improved and is not expected to improve, they will continue to receive ODSP support, and will not have to undergo another medical review, provided the person continues to meet all other eligibility requirements.
Only in cases where improvement is reported or prognosis is unknown, will the health care professional be asked to provide further information.
The new medical review process was developed through substantive consultations with a disability working group, made up of individuals from the medical, legal and advocacy communities.
Improving the medical review process is part of a wider effort to improve ODSP disability adjudication. This work aligns with Ontario’s efforts to continue to reform social assistance, guided by the principles of fairness and simplicity.
The ministry will start to mail out the new medical review package beginning in April 2017 and will increase the number of packages sent to the recipients from the current 600 to up to 1,330 per month.
A medical review of your disability allows us to determine whether you continue to meet the Ontario Disability Support Program's definition of disability. If you were NOT assigned a medical review at the time you originally qualified for the program, this will not affect you. A medical review date is set when a person's condition might improve over time.
Recipients will receive Income Support and other benefits while we do their medical review as long as they continue to meet all other eligibility requirements.
When it is time for your medical review, you will be notified and sent a Medical Review Package. It contains:
The medical review forms will need to be filled out by an approved health care professional, such as your doctor.
You will have 90 days to send in your forms. If you need more time to complete your forms, you can ask the Disability Adjudication Unit for an extension.
Specially trained staff who work in the Disability Adjudication Unit will:
If you still meet the program's definition of disability, you will continue to receive Income Support and other benefits as long as you continue to meet all other eligibility requirements of the program.
If you no longer meet the program's definition of disability, you will no longer be eligible for Income Support as a person with a disability. However, this decision will not affect your Income Support for three months. This is to give you time to get used to the change in your circumstances.
If you disagree with this decision, you can ask to have the decision reviewed. This is the first step in the appeal process and is called an Internal Review.
If you don't agree with the decision from the Internal Review, you may be able to appeal the decision to the Social Benefits Tribunal.
If your Income Support has stopped, you can apply to Ontario Works if you still need financial help.