Why you were denied ODSP disability benefits even though you met financial eligibility criteria

• You meet income eligibility criteria.  However, Ontario Disability Support Program (ODSP) still denied disability benefits.
• Nevertheless, 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 denial. At the end of the day, your ODSP application is a collection of documents. Paper doesn’t usually tell the full story.
• If you meet the eligibility criteria as they pertain to income, the reason the ODSP denied your disability benefits might be that you did not present your case properly.   You did not convince the caseworker 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:

Your health conditions

1. You must have an impairment. You must experience physical or mental health problem(s).   Relevant medical specialists must objectively confirm them.
2.  Your impairment must be substantial. This means that the condition of your mental and physical health must significantly interfere with your daily living activities. It also should render you incapable of finding employment. This doesn’t mean you must have a single severe condition. You may suffer several less serious ailments.
3. Your impairment must be continuous or recurrent. This means that you experience your health problems 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. More frequent attacks might be.
4. 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. It should be a health issue you will have for at least one year. Relevant medical specialist(s) must confirm your prognosis.

Timeline

• In addition, your appeal must be based on the health conditions that you had at the time of your ODSP application.
• Unfortunately, if you develop a condition after the ODSP denied your application, you may need to submit a new application rather than appealing.
• The new application should include your new health condition.

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 four steps.

1. Request for internal review

• The first step is to submit a request for internal review. You have to do it 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 if you can justify the delay.
• Another caseworker at the Disability Adjudication Unit (DAU) will consider your request for internal review.
• It is not often that the ODSP makes a positive decision after a request for internal review. Generally, caseworkers agree with one another.

2. Appeal to Social Benefits Tribunal in Toronto

• If the ODSP denied your request for internal review or did not send you a response within 30 days, you can appeal.
• You need to submit your appeal to the Social Benefits Tribunal.
• The tribunal is like a court with less formal procedures. It specializes in hearing appeals from the denial of ODSP disability benefits.

3. Provide additional documents and information to the Social Benefits Tribunal

• At this stage, it is essential to lay out your arguments and medical information properly. The purpose is to show that you meet the definition of a disabled person the ODSP uses.  We described it 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 to change the ODSP decision.
• 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.

4. Hearing at the Social Benefits Tribunal

• If the ODSP does not change its decision after the submission, the Tribunal schedules a hearing.
•  The Tribunal holds the hearing in an environment that is court-like but somewhat less formal.
• At the hearing, you will have a chance to present your case orally. The Tribunal will likely also ask you questions.
• A paralegal can represent you at the hearing.

Why you may need a paralegal in your disability benefit appeal

There is much that a paralegal can help you with your appeal. At Spectrum Paralegal, we will help you:

Assess your chances of success

• We make our assessment based on your current state of health. Our extensive experience allows us to evaluate how likely the Tribunal will consider you disabled under the definition of disability in the ODSP Act.

Handle all paperwork

• We handle all required paperwork. We submit the request for internal review, appeal, and submission. As such, you will not need to worry about forms and deadlines.

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

• We will 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 submission

• We will 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 present your case in the right way. Additionally, 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 

• Spectrum Paralegal will represent you at the Social Benefits Tribunal Hearing in Toronto and GTA. 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 and prepare you for that. 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. As always, we’ll be happy to help. Please note that, unfortunately, we cannot accept legal aid.