September 2017

13.3 - Recovery of Interim Assistance

Summary of Policy

The Social Benefits Tribunal (SBT) can order the payment of interim assistance if it is satisfied that a recipient will suffer financial hardship during the time it takes to complete its review and give notice of its decision.

If the SBT upholds a decision that the recipient is not a person with a disability as a result of a medical review, the interim assistance they received is considered an overpayment. In this circumstance, recovery of the interim assistance is limited to the difference between the interim assistance paid and the amount that the recipient would have been eligible to receive under Ontario Works for the same period. The balance is recommended for write-off.

Overpayments assessed due to the receipt of interim assistance should include amounts provided for benefits, except where the amount of the benefit cannot be quantified. (See Directive 11.1 Recovery of Overpayments).

Legislative Authority

Section 27 of the ODSP Act
Sections 66 and 67(4) of the ODSP General Regulation

Intent of Policy

This directive addresses the recovery of overpayments in cases where a recipient has received interim assistance but their appeal is denied at the SBT.

Application of Policy

Standards

  • A copy of the appeal decision must be kept on file.
  • ODSP staff must review the appeal decision and the amount of interim assistance paid.
  • The overpayment calculation must be documented on the file.

Where the Tribunal's decision indicates that the recipient was not eligible for any income support during the period of time that interim assistance was paid (i.e. if a prior cancellation decision was upheld), the entire amount of interim assistance is assessed as an overpayment.

Where the Tribunal determines that the recipient was eligible to receive some income support, but at a lower amount than was paid as interim assistance, then the difference between these two amounts would be assessed as an overpayment.

Notice must be given to the recipient of the amount of the overpayment, the reason, the period for which it was incurred and their right to appeal. If a recipient had a dependent spouse when an overpayment was incurred, the Director must also give notice in writing to the spouse respecting the overpayment.

Recovery of an Overpayment Assessed Due to the Receipt of Interim Assistance - Medical Review AppealsWhere the SBT upholds a decision of the Director that an individual does not meet the definition of a “person with a disability” as a result of a medical review appeal, the following policy applies:

  • If the appellant was otherwise eligible for Ontario Works during the overpayment period (e.g. the period when interim assistance was paid), the amount of the overpayment that is to be considered collectible is the difference between the interim assistance paid and the financial assistance that the recipient would have been eligible to receive under Ontario Works, had they received Ontario Works financial assistance instead of interim assistance.
  • The balance of the overpayment (i.e. the total amount of Ontario Works financial assistance that the recipient could have received) should be recommended for write-off.

The above approach should only be taken after the SBT has made its final decision.

Determining Eligibility for Ontario Works

ODSP staff are to contact their counterpart Ontario Works staff to determine whether the appellant would have met the Ontario Works financial eligibility requirements during the overpayment period.

If the recipient was otherwise eligible for Ontario Works during the overpayment period (i.e. the period when interim assistance was paid), the amount of the overpayment that is collectible is the difference between the interim assistance paid and the amount of financial assistance that the client would be eligible to receive under Ontario Works. The balance of the overpayment is recommended for write-off.

If instead, Ontario Works staff confirms that the recipient would not have met Ontario Works financial eligibility requirements during the overpayment period, the full overpayment is recoverable.

For ease of administration, the calculation of the amount of financial assistance that the recipient would be eligible to receive under Ontario Works is the maximum Ontario Works rate of their family composition during the overpayment period.

Example 1

Louise, an ODSP client in a board and lodging arrangement, was found to not meet the definition of a person with a disability after a medical review and, as a result, her income support was cancelled effective November 1.

She subsequently proceeded through the internal review process and then to the SBT. She requested and was granted interim assistance effective November. Her monthly income support would have been $812 (board and lodging rate) and $69 (special boarder allowance), so the interim assistance paid to her was also $881 per month. She was paid interim assistance until the final SBT decision was received in January. The cancellation was upheld. The amount of her overpayment that will be recovered depends on whether she was eligible for Ontario Works at the time of her appeal.

Eligible for Ontario Works

Not Eligible for Ontario Works

If Louise was eligible for Ontario Works for the period in which interim assistance was paid (November to January), then the collectible overpayment is $861.

(3 months x [$812 + $69 Board and Lodge and Special Boarder Allowance for interim assistance received]) - (3 months x [$525* + $69* Board and Lodge and Special Boarder Allowance amount for Ontario Works])

= (3 x [$812 +$69]) - (3 x [$525* + $69])
= $2,643 - $1,782
= $861 (collectible) and $1,782 (recommended for write-off)

If Louise was not eligible for Ontario Works during the overpayment period, then the collectible overpayment is $2,643

(3 months x $812 + $69 Board and Lodge and Special Boarder Allowance for interim assistance received)

= 3 x $881
= $2,643

*as of October 2017

Example 2

In August, Adam underwent a medical review and he did not meet the definition of a person with a disability. His income support was cancelled in December (the 1st day of the 4th month following the Disability Adjudication Unit decision).

Adam proceeded through the internal review process and the SBT hearing process. He requested and was granted interim assistance effective December. His monthly income support would have been $1151 per month (basic needs and shelter), and so, the interim assistance paid was also $1151 per month for December and January.

In early February, the SBT upheld the decision that Adam is not a person with a disability.

Eligible for Ontario Works

Not Eligible for Ontario Works

If Adam was eligible for Ontario Works for the period in which interim assistance was paid (December and January), then the collectible overpayment is $860

(2 months x $1,151) - (2 months x [$337 basic needs + $384* shelter allowance])
= $2,302 - $1,442
= $860 (collectible) & $1,442 (recommended for write-off)

If Adam was not eligible for Ontario Works during the overpayment period, then the collectible overpayment is 2 months x $1,151 = $2,302.

 

*as of October 2017

Related Directives:

6.2 Basic Needs
6.3 Shelter
6.4 Board and Lodging
11.1 Recovery of Overpayments
13.1 Notice of Decision and Internal Review
13.2 Appeals