Why you were denied ODSP disability benefits even though you met financial eligibility criteria
If you meet income eligibility criteria and were still denied Ontario Disability Support Program (ODSP) disability benefits, it doesn’t mean that you don’t deserve disability benefits or aren’t eligible. There are a lot of factors beyond your control that can lead to you being denied ODSP benefits. At the end of the day, your ODSP application is a collection of documents, and paper doesn’t usually tell the full story. Usually, if you meet the eligibility criteria as they pertain to income, the reason you were denied ODSP disability benefits is that your case simply wasn’t presented in a way which, on paper, convinced the case worker that you meet the definition of disability under the ODSP program.
What you need to show to be successful in appealing the ODSP decision
Formally, the ODSP considers someone disabled if the person experiences “a substantial mental or physical impairment that is continuous or recurrent and is expected to last one year or more.” Broken down, this definition means the following:
- You must have an impairment. You must experience physical or mental health problem(s) that were objectively confirmed by relevant medical specialists.
- Your impairment must be substantial. This means that the condition of your mental and physical health must be such that it significantly interferes with your daily living activities and renders you incapable of finding any employment. This doesn’t mean you must have a single extremely serious condition. A state of health that is characterized by many less serious ailments can be con
- Your impairment must be continuous or recurrent. This means that your health problems must be such that you experience them constantly, or at least with a large degree of frequency. For example, back pain that you experience once every three years for a week at a time would not be considered recurrent, though more frequent attacks might be.
- Your impairment must last one year or more. The nature of your health condition must be such that it is not a short temporary issue, such as a three month recovery after a car accident, but a condition you will have for at least one year. Your prognosis must be confirmed by relevant medical specialist(s).
In addition, your appeal must be based on health conditions which you had at the time of your ODSP application. If you develop a condition after your application was denied, you must submit a new application with the additional condition included, rather than appealing the previous one.
We have extensive experience in appealing denial of ODSP disability benefits – feel free to contact us for a free assessment of your case and the potential chances of success in your appeal, based on a discussion of your current state of health.
The ODSP Appeal Process in Toronto
In Toronto and all of Ontario the process for appealing an ODSP decision has up to three steps.
- Request for internal review. If you were denied ODSP disability benefits and you want to appeal the decision, the first step is to submit a request for internal review within a month of the negative decision letter. The request can include additional medical or other information. You may be able to submit a request for internal review after the 30 days have passed, but you will need to justify the delay. When you make such a request, another case worker at the Disability Adjudication Unit (DAU) will review your application once again. In our experience, it is very rare that disability benefits are provided after only a request for internal review. Generally, case workers agree with one another.
- Appeal to Social Benefits Tribunal in Toronto. If your request for internal review is denied, or you do not receive a response within 30 days, you can appeal the decision by submitting an appeal to the Social Benefits Tribunal. The tribunal is like a court with less formal procedures, which specializes in hearing appeals from denial of ODSP disability benefits.
- Provide additional documents and information to the Social Benefits Tribunal. At this stage, it is very important to properly lay out your arguments and medical information, to show that you meet the definition of a disabled person used by the ODSP, as described above. Once you provide this information, called a submission, the Tribunal will review your file once again. In many cases where we prepared the submission, the submission alone was enough for the Social Benefits Tribunal to provide benefits to our clients. As you provide your submission, the DAU will provide theirs, arguing why it does not believe you are disabled and why you should not receive benefits.
- Hearing at the Social Benefits Tribunal. If the Tribunal does not overturn the negative ODSP decision after the submission, it schedules a hearing. A hearing is held in an environment that is court-like, but somewhat less formal. In Toronto, the hearings are held at 1075 Bay Street. At the hearing, you will have a chance to orally present your case, and the Tribunal will likely also ask you questions. You can be represented by a paralegal at the hearing.
The value of being represented by a paralegal in your disability benefit appeal
There is much that a paralegal can help you with in your appeal, to ensure that the appeal is successful and you get the disability benefits you deserve. At Spectrum Paralegal, we will help you:
- Assess your chances of success based on your current state of health. Our extensive experience allows us to evaluate how likely you are to be considered disabled under the definition of disability in the ODSP Act.
- Handle all paperwork, submitting the request for internal review, appeal, and submission. You will not need to worry about forms and deadlines.
- Explain how to best substantiate your case. We will advise you which medical specialists to see and which medical assessments to see to obtain what will be considered adequate proof of your health condition.
- Communicate with your doctors to request and obtain reports to substantiate your condition, ensuring that the doctor covers all points necessary to show that you meet the ODSP’s definition of disability.
- Prepare an expert submission, which will use your medical information, reports and test results to show that you meet the relevant legal definition of “disabled.” We will refer to relevant case law and legal arguments to make sure your case is presented in the right way. Our founder has extensive experience in ODSP appeals, and has set several of his own precedents in the Social Benefits Tribunal, arguing on his clients’ behalf (read more here).
- Represent you at the Social Benefits Tribunal Hearing in Toronto. We will prepare you for the hearing and explain what you need to highlight as you talk about your health. We will strive to make the hearing less stressful for you: at the hearing, your representative will ask you questions for which you are prepared, so you don’t have to speak unprompted or answer many questions from the Tribunal, which could be intimidating. You will have support at the hearing – you won’t be going alone.
As we’d mentioned, please feel free to contact us for a free assessment of your case. We’ll be happy to help. Please note that unfortunately, we cannot accept legal aid.