A deluge of disability appeal work rooted in flawed Ontario Disability Support Program application and medical review processes may eat up a big chunk of newly available funds for expanded legal aid services, according to legal clinics.
The Ministry of Community and Social Services’ adjudication process rejects applications for disability support on the basis of missing information that the application form doesn’t actually require, resulting in a barrage of appeal assistance requests piling up at the door of legal clinics, says Mary Marrone, director of advocacy and legal services at the Income Security Advocacy Centre.
“Over the years, other areas of law have gotten pushed out because of the disability appeals,” says Marrone, adding the work makes up more than 50 per cent of the casework legal aid clinics do.
“It’s consuming a huge amount of legal aid resources.”
The comments come as the government announced a second increase to the legal aid income eligibility threshold effective April 1 to $17,753 for a single person receiving clinic services. When it comes to disability support, the ministry offers no support to individuals navigating the application system, according to Marrone. And the problem with the initial application process recurs when the ministry conducts a medical review from ODSP recipients to ensure they still require income support.
Instead of creating a separate medical review system, the ministry simply sends the same application forms individuals completed the first time, says Marrone. As the Ontario government promises new funding for expanded legal aid eligibility and services, Marrone worries the disability caseload may consume the new resources. “We are concerned that the increased demand for services from the clinic system to handle the work associated with the current medical review process will undermine our ability to provide new services to newly eligible clients for clinic services. It compounds the existing problem of other services being pushed out because of services that clinics need to provide as a result of a flawed disability adjudication process at the Ministry of Community and Social Services.”
The ministry turns down more than 50 per cent of applications for ODSP, according to Marrone, who says the problem is often in the application process itself.
“There are a lot of criticisms of the form that it doesn’t adequately capture a lot of the information the [disability adjudication unit] needs to make its decision. They routinely expect more information than what’s in the form. People are often turned down because of what is not filed.”
When the ministry grants some ODSP applications, it attaches a note to them to conduct a medical review of the recipient after a certain period of time. For years, the reviews languished, resulting in a backlog of some 60,000 cases. The ministry has now started actively doing the reviews again. While the review itself is important, the process compounds a problem the initial application creates, according to Marrone.
“They’re using that same flawed process for review,” she says.
“Someone can spend two years getting on ODSP and then get a two-year review date and then has to repeat the entire process. There has to be a more efficient way of reviewing a client’s file.”
Sally Colquhoun, co-ordinator of legal services at the Kinna-aweya Legal Clinic in Thunder Bay, Ont., says doctors filling out medical review forms tend to do perfunctory work on them with the assumption that the ministry already has background information on the patient. But as was the case with one of Colquhoun’s clients recently, that can lead to refusals of continued disability support.
“What they’re supposed to look for in a review is whether there’s been an improvement. You’re not supposed to be starting from scratch and proving that you’re a person with disability,” she says, adding that some people with disabilities may not be getting treatment and may not have doctors to fill out the forms at the review stage.
The ministry should carefully assess which cases need medical reviews, says Colquhoun, who suggests the process seems unnecessary in many situations.
For its part, the ministry says that although the forms for medical review seem similar to the ones completed when clients first apply for support, the process isn’t in fact a reapplication for benefits.
“Specially trained staff who work in the disability adjudication unit of the Ministry of Community and Social Services compare the completed medical review forms to the information submitted previously to determine if a client’s medical condition has changed and whether this change affects their eligibility for ODSP,” said Kristen Tedesco, a spokeswoman for the ministry.
While the ministry understands that going through a medical review can be “overwhelming and stressful” for some clients, the process is necessary, according to Tedesco.
“However, we fully recognize that the process should not cause undue stress for recipients,” she added, noting the ministry is making strides to improve the process.
“We are dedicated to improving customer service to Ontario’s most vulnerable citizens and enhancing the application process. For example, we have introduced the ODSP health-care professional’s guide, which helps to ensure health-care professionals complete the application fully and accurately on behalf of their patients.
“We are also consulting with external stakeholders, including legal clinics and health-care professionals, on how best to improve the application package.”
Lenny Abramowicz, executive director of the Association of Community Legal Clinics of Ontario, says any improvement to the process would help free up clinic time to provide other types of services.
“Presently, we have our hands full doing this work, which isn’t necessary, and we’d be able to do much, much more work in many other areas . . . and further the government’s anti-poverty agenda if we weren’t bogged down with this,” he says.
