October 2016

2.4 Referral to the Ontario Disability Support Program

Legislative Authority

Sections 13, 38(2), 38(3), 55(1) and 58 of Regulation 134/98.
Sections 4 and 5(1) of the Ontario Disability Support Program Act, 1997.
Sections 4, 18, 27 and 28 of Regulation 222/98.

Audit Requirements

Processes and local procedures for referral to the Ontario Disability Support Program (ODSP) are followed and occur within the five day standard.

Referrals where the ODSP asset limit exemption is applied is with the applicant's informed agreement and is allowed only once during the applicant's lifetime.

The Agreement to Reimburse form is voided where an Ontario Works applicant or participant applies for the ODSP and is determined to be eligible.

Adequate documentation is on file to support decisions.

Application for Assistance form (Part 1) is updated where an update has not occurred within 3 months of referral to the ODSP.

Application of Policy

Anyone has the right to make an application for ODSP if he/she believes him/herself to be "a person with a disability" as set out in the ODSP legislation.

In some cases, Ontario Works applicants or participants may not be aware of the ODSP. As such, all applicants and participants should be informed of the ODSP and their right to apply.

When completing an application for Ontario Works or reviewing an active file, staff may note circumstances that indicate the need for further investigation to determine whether a referral to the ODSP is appropriate, including:

  • the applicant or participant appears to have medical reasons that prevent or restrict participation in employment assistance activities;
  • the applicant or participant has been in receipt of Workplace Safety and Insurance Board (WSIB) benefits or some other insurance benefit which has expired;
  • the applicant or participant has previously received ODSP income support as a person with a disability or was a former grand-parented Family Benefits Allowance recipient;
  • the applicant or participant believes they are a person with a disability as defined under the ODSP;
  • the applicant or participant is a member of an ODSP prescribed class; or
  • the applicant appears to qualify for ODSP rapid reinstatement.

Participants are not obligated to pursue income support under the ODSP.

An application to ODSP is not an approved Ontario Works criterion for a restriction or deferral from Ontario Works participation requirements.

Where an assignment or direction is in place and the file is being transferred from Ontario Works to ODSP, all assignments and directions are closed in Ontario Works as of the last day of the month prior to ODSP date of grant. The assignment or direction will be opened in ODSP as of the ODSP date of grant.

Who is Eligible for ODSP

Eligibility for ODSP is based on an applicant’s individual circumstances, including his or her financial situation and disability.

The ODSP Act defines a person with a disability as a person who has a:

  • substantial physical or mental impairment that is continuous or recurrent and expected to last one year or more;
  • the direct and cumulative effect of the impairment results in a substantial restrictions in one or more of the activities of daily living (i.e., the ability to attend to personal care, function in the community or function in a workplace); and,
  • the impairment, its likely duration and restrictions have been verified by a prescribed health care professional.

Persons in Financial Need

Persons who are in financial need and who wish to apply for the ODSP may be eligible for Ontario Works financial assistance, pending ODSP eligibility determination.

ODSP asset limits may be applied for applicants applying to Ontario Works who have indicated their wish to apply for the ODSP. The ODSP asset limit exemption can only be applied once in a person's lifetime. The exemption is only applied when:

  • the applicant's assets are in excess of Ontario Works asset limits thereby making him or her ineligible for assistance;
  • the applicant has not used the ODSP asset limit exemption in the past; and
  • the applicant agrees to use the one-time ODSP asset limit exemption and signs an Agreement to Reimburse form in the event that he or she is found ineligible for the ODSP. If the applicant is found eligible for the ODSP, the agreement is voided.

Staff should refer to the ODSP Policy Directives for the appropriate asset limits. The ODSP Policy Directives are available on the Ministry of Community and Social Services website.

Once an exemption is applied, it remains in effect until a determination of eligibility for the ODSP is made and, where applicable, any subsequent internal review and/or appeal to the Social Benefits Tribunal (SBT) are completed and a final decision is provided.

If the applicant or recipient is determined to be ineligible for ODSP, the amount of the reimbursement will be the lesser value of the entire amount of financial assistance paid or an amount equivalent to the value of assets in excess of the Ontario Works asset limit for the benefit unit on the day of the final disposition of the ODSP application.

Direct Referrals to Local ODSP Offices

In some cases, Ontario Works delivery agents refer applicants or participants to a local ODSP office to apply directly to the program. A direct referral to a local ODSP office is made when the applicant or participant:

  • is not in immediate financial need (including persons under 18 years of age);
  • applied to the ODSP through Ontario Works and was subsequently found to be financially ineligible for Ontario Works, regardless of whether or not the Ontario Works eligibility decision is being appealed;
  • appears to be eligible for ODSP rapid reinstatement, regardless of whether or not he or she is in immediate financial need; or
  • is a member of an ODSP prescribed class.

Applicants or participants who are members of an ODSP prescribed class and who are in immediate financial need may, if found eligible, receive Ontario Works financial assistance before being referred to a local ODSP office.

Exemptions from the ODSP Disability Adjudication Unit (DAU) Process

Members of a Prescribed Class

Applicants who are members of a prescribed class do not require a referral to the DAU or a Disability Determination Package (DDP), and are granted ODSP income support if they are found to be financially eligible.

The following are considered members of a prescribed class:

  • A person in receipt of federal Canada Pension Plan Disability Benefits (CPP-D);
  • A person in receipt of Quebec Pension Plan Disability Benefits (QPP-D);
  • A person aged 65 or over and not eligible for Old Age Security;
  • A person who on May 31, 1998 was a recipient or spouse of a recipient of benefits under specific case classes under FBA;
  • A former resident of a Schedule 1 facility under the Developmental Services Act (DSA) who ceased to be resident of that facility on or after June 1, 1998.  Note: the Schedule 1 facilities under the DSA include Huronia Regional Centre (Orillia), Rideau Regional Centre (Smiths Falls) and South Western Regional Centre (Blenheim); or
  • A person living in the community as a renter, owner, or a tenant and who is eligible for services, supports and funding under the Social Inclusion of Persons with Developmental Disabilities Act (2008).

The following are also members of a prescribed class but only while residing in the institutions listed:

  • A person residing in a facility that was a former Provincial Psychiatric Hospital (PPH), the Centre for Addiction and Mental Health, or Homewood Health Centre;
  • A person residing in a home under the Homes for Special Care Act or in an intensive support residence or supported group living residence under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008.

ODSP Rapid Reinstatement Rules

Rapid reinstatement is a re-application process for granting ODSP income support to a former ODSP recipient without re-adjudicating the applicant's disability. The rapid reinstatement process does not require a referral to the DAU or a Disability Determination Package to be submitted to the DAU.

Former ODSP recipients may qualify for rapid reinstatement provided they are financially eligible and they:

  • were grand-parented from the Family Benefits Act and became ineligible for ODSP due to income from employment, training or the operation of a business; or
  • were previously adjudicated as a person with a disability under the ODSP Act and were not terminated from ODSP as a result of a medical review that determined they no longer qualified for ODSP as a person with a disability.
  • See ODSP Directive 1.3: Rapid Reinstatement for more information.

Referrals to the Disability Adjudication Unit

If an applicant or participant has a disability that may meet the requirements of the definition for disability under the ODSP Act, he/she may wish to apply for ODSP.

A referral must be made to the DAU before the person is provided a DDP.

The DAU is responsible for determining if a person meets the legislative definition of a “person with a disability” under the ODSP Act.

Prior to referring the applicant to the DAU, staff must ensure the information in Part 1 of the Application for Assistance has been reviewed and updated within 3 months of the referral. If Part 1 of the Application has not been updated within 3 months of the referral, staff are required to undertake a review and update the Application.

The DDP should not be provided to the applicant unless an electronic referral has been made to the DAU in the Social Assistance Management System (SAMS), either through Ontario Works or by ODSP offices (for dependant adults and First Nation referrals). Only one DDP should be provided to each applicant, unless there are extenuating circumstances such as the loss of the original package.

The DAU requires a completed DDP in order to make a determination of disability. The DDP includes the following forms:

  • Health Status Report (HSR)
  • Activities of Daily Living Index (ADLI)
  • Self Report Form
  • Consent to the Release Medical Information
  • Instruction Sheet

Note: When providing the DDP, ensure the applicant’s member ID is recorded on the HSR.

The DDP contains instructions for the applicant on the outside of the package.. A separate instruction sheet is provided inside.

The instruction sheet provides direction on who can complete the HSR and the ADLI, the importance of the Consent to Release Medical Information Form and the Self Report that the applicant or a designate can complete if they wish.
Instructions for health care professionals on how to complete the HSR and ADLI are found on the front page of the HSR and ADLI.

If a health care professional or an applicant has questions about completing the forms, they should be directed to call the DAU at 1-888-256-6758. This information is also noted on the instructions. Note: Ontario Works staff should not instruct health care professionals on how to complete the HSR or on scoring the ADLI and Intellectual Emotional Wellness Scale.

If an applicant needs assistance with the completing the Self Report form, Ontario Works staff may assist.

An envelope is provided with the DDP to submit the application directly to the DAU. Applicants should not submit the DDP through the Ontario Works or the ODSP local office.

The DDP is only considered complete when the HSR and ADLI is completed by the appropriate prescribed health care professional, the Consent to the Release Medical Information Form is complete, and the package is submitted in its entirety.
The applicant has 90 days to forward the completed DDP to the DAU, however he or she may request an extension to the deadline. If the DDP is not received within the time frame provided, the application is considered to be withdrawn.

Applicant determined to be a “person with a disability”:

Where an applicant is determined to be a “person with a disability” as defined under the ODSP Act, the DAU will issue a decision letter to the applicant and notifies the appropriate Ontario Works and ODSP offices through a "task" in the SAMS, which acts as a trigger for the Ontario Works office to transfer the file to the ODSP.

For Ontario Works delivery agents without SAMS access, the DAU will provide a copy of the confirmation letter to the ODSP office, who then faxes a file transfer request to the Ontario Works delivery agent.

Ontario Works delivery agents must provide ODSP with electronic access to the file. The hard copy of the file should be transferred within 5 business days.

ODSP staff must review the information contained in the transferred file and contact the applicant within 15 business days from the date the file is received. When making contact with the applicant, ODSP staff will reconfirm financial eligibility, request additional information if needed and arrange for any required forms to be completed and signed. Once ODSP income support is granted, financial assistance from Ontario Works must be cancelled.

Applicant determined to be “not a person with a disability”:

Where an applicant is determined “not a person with a disability” as defined under the ODSP Act, the DAU sends a letter to the applicant outlining the decision and the internal review process. The DAU also notifies the appropriate Ontario Works office of the decision.

The applicant may appeal the decision if they wish. Applicants are not obligated to request an internal review or appeal the decision to the SBT. Ontario Works staff can not impose a requirement on an applicant to appeal a decision.

The applicant has 30 days to request an internal review and the DAU has ten days to respond. Ontario Works retains the file during the internal review and any subsequent appeal to the SBT, and the applicant remains eligible for Ontario Works until a final decision is made. If an internal review or appeal to the SBT results in the applicant being found ODSP eligible, regular file transfer policies and procedures are followed.

Re-applications to ODSP:

If an applicant has been determined to be “not a person with a disability”, an applicant can reapply for ODSP at a later date if there has been a change in their circumstances (i.e. there has been an aggravation of the applicant’s medical condition or a new medical condition).

A participant’s Ontario Works can not be suspended if the person does not appeal a decision of disability by the DAU.

A participant’s Participation Agreement (PA) should be reviewed and updated to reflect any changes in their circumstances. If a participant has a “Limitation to Participation” form on file, it should also be reviewed and updated. The “Limitation to Participation” form may only be revoked if the participant no longer has a documented deferral or restriction to participation.

ODSP Applications in Unique Circumstances

A person under the age of 18 is not eligible for ODSP income support in his or her own right. However, Ontario Works delivery agents may take an application to determine financial eligibility up to six months before the person's eighteenth birthday.

A person detained in a correctional facility or residing in a community resident that receives funding from the Ministry of Community Safety and Correctional Services Canada is not eligible for ODSP income support. However, Ontario Works Administrators have the flexibility to schedule an intake appointment for an applicant who may, due to an expected change in his or her circumstances (such as leaving a correctional facility), be eligible for assistance within the next ten working days.

In an effort to facilitate a smooth transition into the community, the DAU provides DDPs directly to correctional facilities. Where appropriate, correctional facility physicians or other approved health care professionals can complete the DDP and return it directly to the DAU on behalf of the person leaving a facility within three months of the determined date of departure. Staff are not to provide DDPs if requested to a provincial or federal correctional facility, an advocate or individual in a facility; they are to be directed to contact the DAU.

Applicants are provided direction from the correctional facility once he or she is released to contact either Ontario Works or the ODSP local office to have financial eligibility established.

An electronic referral must be made to the DAU by the Ontario Works or ODSP office for persons who are financially eligible. The DDP is only adjudicated by the DAU once financial eligibility has been determined by Ontario Works or ODSP local office upon the person’s release.

Extended Health Benefits for Applicants Pending ODSP

Extended Health Benefits (EHB) may be provided to ODSP applicants who are not eligible to receive assistance under Ontario Works because their income exceeds budgetary requirements, but who meet all other eligibility criteria (see Directive 7.3: Extended Health Benefits for more information).