What is the Ontario Disability Support Program (ODSP)?

The Ontario Disability Support Program (ODSP) provides financial assistance to people with severe health problem or disabilities who are in financial need, in order to help them pay for living expenses, such as food and housing.

The following Brochure will give you more information on ODSP eligibility and the application process. This brochure contains only general legal information. The law can change, and each person’s situation is different. If you have any questions about your specific situation, please consult your local community legal clinic, community agency or a lawyer.

By Topic List

Eligibility

The Disability Determination Package

Meeting the Disability Test

ODSP Benefits

How to Apply for ODSP

Participation Agreements

Appealing an ODSP decision

Where to get help

 

Do I Qualify for ODSP?

In order to qualify for ODSP, an applicant must meet the following criteria:

  • Be 18 years of age or older
  • Live in Ontario
  • Meet the financial criteria
  • Have a substantial physical or mental disability that:
    • Is expected to last one year or more, and
    • Makes it hard for you to take care of yourself, take part in community life, or work
  • ODSP will also look at your immigration status
    • In general, visitors and tourists are not eligible for ODSP
    • If you live in Ontario but are not a permanent resident or a Canadian citizen, and would like to apply for ODSP, please contact a legal clinic for more information.

The financial need and disability criteria will be further explained.

Financial Eligibility

In determining whether an applicant is financially eligible, ODSP will first look at your household’s

entire financial situation.  To qualify, your family income and asset worth cannot be above a certain amount. These amounts depend on the size of your family.

Examples of income sources that the ODSP will look at include:

  • Employment income
  • Rental income
  • Private sickness or disability benefits
  • Old age security
  • EI benefits
  • Business income

Examples of assets include:

  • Cash
  • Bonds
  • Debentures
  • Stocks
  • Cash portions of life insurance proceeds, and
  • Other property which can be readily converted into cash.

Some income and assets are exempt. This means that ODSP does not count them when they calculate your income and assets.

Examples of exempted items include:

  • Part time income of dependent children in your household
  • Child tax benefits
  • The home that is your principal residence
  • Registered Disability Savings Plans (RDSPs)
  • Registered education saving plan (RESP)
  • Tools
  • Amounts received as compensation for pain and suffering, up to a maximum of $100,000

Disability Eligibility

If you meet the financial eligibility for ODSP, you will be given the Disability Determination Package to bring to an approved health professional who provides treatment to you in order to fill out.   You have 90 days from the date you get the forms to complete and send to the Disability Adjudication Unit (DAU).  The Disability Adjudication Unit (DAU) will assess your disability based on the information on these forms to determine if you meet the definition of a "person with a disability" as defined under the Ontario Disability Support Program Act

According to this definition, a person with a disability is someone who has a substantial mental or physical health problem that:

  1. Is continuous or recurrent
  2. Is expected to last for a year or more
  3. Significantly limits their ability to work, look after themselves, or do daily activities at home or in the community

An applicant must meet all three of these conditions in order to be eligible for ODSP. 

Some applicants do not require a disability assessment and automatically qualify for ODSP, provided that they are also found to be financially eligible. 

These exempted applicants include:

  • 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
  • Persons that live in certain types of institutions, such as a mental health facility or a home for people with developmental disabilities

The Disability Determination Package

The Disability Determination Package contains the following forms:

  • Health Status Report and Activities of Daily Living Index
    • Consent to Release Medical Information
    • Self-Report

Health Status Report and Activities of Daily Living Index

The Health Status Report and Activities of Daily Living Index must be filled out by an approved health professional. Your health professional has to confirm your disabilities and their impact on your ability to work, look after yourself or get out in the community.

The Health Status Report must be completed by a designated health professional such as:

  • Family doctor or specialist
  • Psychologist or psychological associate
  • Optometrist
  • Registered nurse (sometimes called a nurse practitioner)

Only one health professional may fill out a Health Status Report. Make sure you choose the one that knows about your disability the best. You should also talk to your health professional to ensure that all relevant conditions and symptoms are properly recorded on your Health Status Report and that nothing is left out.

The Activities of Daily Living Index must be completed by:

  • A family doctor or a specialist
  • A psychologist or psychological associate
  • An optometrist
  • An audiologist
  • An occupational therapist
  • A physiotherapist
  • A chiropractor
  • A speech language pathologist
  • A social worker
  • A nurse
  • A nurse practitioner

It is important that the health professional includes copies of medical and consultation reports with this form. Applicants are strongly encouraged to have their health care professional submit additional medical and supporting information with their application (e.g. specialist reports, psychological assessments, radiology reports, functional assessments etc.).

Consent to Release Medical Information and Self Report

The 2 forms that you fill out yourself are:

  • Consent to Release Medical Information
  • Self Report

The Consent to Release Medical Information gives your doctor or health professional permission to send the Disability Adjudication Unit all the medical information that supports your application.  This might include reports from specialists, psychological or other assessments, x-ray reports, and test results.

The Self-Report Form is optional. You do not have to complete this form, but it will help the DAU understand how your health situation affects your daily activity. Whether or not it is completed, you must sign and send this form with the rest of the package within 90 days from the date you get the package.

90 days deadline

Once all the forms in your Disability Determination Package are complete, you (or the health professional) must return them to the Disability Adjudication Unit of the Ministry of Community and Social Services at:

Ontario Disability Support Program
Disability Adjudication Unit
Box B18
Toronto, ON M7A 1R3
Fax: 416-326-3374

If you do not send the forms in within the 90 days, the ODSP office will close your file. This means that you will have to start again from the beginning to apply for ODSP.

If you cannot send your forms in within the 90 days, you can ask the Disability Adjudication Unit to give you more time. You will have to prove to them that you have a good reason for the delay.  For example, if you could not complete the forms because you were in hospital or in jail, they should give you more time.

But if they refuse to give you more time, you will have to begin your application anew.

Meeting the Disability Test

Usually the most difficult part of obtaining ODSP is meeting the disability test. Not all people who are sick or have a disability will be able to meet all the requirements to be eligible for ODSP. It is important to understand all elements of the disability test to determine whether or not you may qualify for ODSP and to figure out what supporting documentation you may need to obtain.

  1. I.                 Substantial disability

In order to be eligible, an applicant must have serious health problems and or a substantial disability. This means that the impairment cannot be mild or just minor. Your impairment must result in a significant reduction of activity. For example, minor aches and pains, or occasional headaches generally would not considered substantial enough.

  1. II.               Continous or recurrent, expected to last for one year or more

Even if the disability is considered substantial, it must also be long-term and not merely temporary. For example, although someone had an arm fracture which could be substantially impaired for a few months, that person would not meet the requirements of being continuous or recurrent, and the condition would not be expected to last for one year or more. Your health professional should indicate whether or not the impairment is expected to last longer than one year on your Health Status Report.

  1. III.             Substantial restrictions in daily life

Just because you have a substantial long-term disability does not automatically qualify you for ODSP. That disability must also significantly restrict your ability in at least one of the following areas of life:

(1)            Your ability to attend to your own personal care;

(2)            Your ability to function in the workplace; and

(3)            Your ability to participate in the community.

Your health professional should indicate the severity of these restrictions in your Activities of Daily Living Index.

However, it must be noted that ODSP takes a cumulative approach to determining whether there is substantial restriction or substantial disability. This means that ODSP will look at all your circumstances in order to make a decision. For example, ODSP may look at factors like your previous work experience, education, language ability, and age, in order to determine whether there is substantial disability as well as substantial restriction.

  1. IV.            Proper dating of supporting evidence

You must meet all the elements of the disability test at the time of your application. This means that even you had a substantial disability that met all the elements of the test in the past; but the condition had improved at the time of application, your application may still be rejected if you do not meet the disability test at the time of application.

Therefore it is extremely important that your doctor or health professional indicate at what date you had your conditions and symptoms and that you continue to have them since then.

Furthermore, if you appeal a disability decision, any new medical documents that you  submit must specifically refer to your condition at a time which predates the rejection decision or they will not be considered at all in your appeal.

What do I get from ODSP?

ODSP monthly income support payments are separated into two parts: (1) basic needs and (2) shelter allowance.  The basic needs portion is intended to cover the cost of food, clothing, and other necessary personal items.  The shelter allowance is intended to cover the cost of rent or mortgage payment on your residence, heat, utilities (e.g. hydro, water), property taxes, home insurance, and condominium fees.  The benefit amount depends on the size of the household, the age of dependent children and the number of disabled people in the household.  Every one in your household also gets drug card coverage. 

In addition to income support, if you and your family member qualify, they may also qualify for certain benefits such as:

  • Special diet
  • Dental coverage
  • Vision care
  • Hearing aids
  • Diabetic supplies
  • Help with transportation costs to medical appointments
  • Wheelchair/mobility device repairs and batteries
  • Help to support your guide dog
  • Help with work-related expenses

Finally, if you qualify for ODSP and still wish to find work, ODSP provides employment supports to help you prepare for a new job or training program or even to start your own business.  Depending on the situation, ODSP may allow you to work and receive income support at the same time.

Special Diet allowance

If you or a member in your household has certain medical conditions you might be able to get a special diet allowance as part of the income support they get from ODSP.

The amount you get depends on the medical condition you have. You have to apply for it.

To apply for a special diet allowance, you must use the special diet allowance application form. You can ask your ODSP worker for this form and bring to your health professional to be completed and returned to your worker.

The approved health professional who could complete the special diet form could be:

•         a family doctor or a specialist
•         a dietitian
•         a nurse practitioner

The application form lists all the medical conditions that qualify for a special diet allowance. If a medical condition is not on the list, you cannot get an allowance for it.  The amount of special diet allowance is based on each medical condition on the form up to a maximum amount.

If ODSP refuses your application for a special diet allowance, you can appeal the decision.

How to Apply for ODSP

If you are already receiving financial assistance from Ontario Works (OW) and want to apply to ODSP, you do not have to complete a financial assessment.  Simply talk to your worker about an ODSP referral.  Your OW worker can give you the Disability Determination Package to apply for ODSPA.

There are three ways to apply for ODSP:

I.                 Online

The Online Application for Social Assistance allows residents of Ontario to find out if they might be eligible for ODSP Income Support, and start the application process. You may apply at the following link:

http://www.mcss.gov.on.ca/en/mcss/programs/social/apply_online.aspx

II.               Applying by phone

Call your local office to complete the application over the phone. To find your local ODSP office, you can check the following website for an office listing:

http://www.mcss.gov.on.ca/en/mcss/programs/social/odsp/contacts/index.aspx

III.             In Person

To begin the application process, contact your local Ontario Disability Support Program office and ask to set up a meeting. If you can't get to the local office for the appointment, ODSP can arrange to meet with you at another location.

If you have special needs, such as language interpretation, let ODSP know and they will arrange to have an interpreter at the initial meeting.

Before your appointment, the office will send you a letter confirming the date and time of the appointment. They will also include a list of all the things you need to bring to the appointment.

The purpose of the initial meeting is to look at your financial situation. You should bring the following documents (as applicable) for you and your family members:

  • Birth certificates;
  • Immigration papers (such as Canadian Citizenship, Record of Landing, Sponsorship Agreement or Permanent Resident Card);
  • Social insurance numbers;
  • Ontario health card numbers (OHIP);
  • Information about your housing costs (such as rent receipts, mortgage statements, or utility and heating bills);
  • Information about your assets (such as bank books or statements);
  • Information about your income (such as pay stubs or support orders);
  • Information about your job or training program;
  • Evidence of trusteeship or power of attorney.

The officer will also take into account various other factors to determine ODSP financial eligibility:

  • How many people there are in your family;
  • How many children you have and how old they are;
  • If you have a spouse or adult defendants;
  • Your household income and assets;
  • If you are entitled to other sources of income; and
  • Where you live.

The meeting will take about 1 hour and an hour and a half. After the meeting, your caseworker will tell you whether or not you qualify financially for ODSP.

If you qualify financially you will then go on to part two of the application process: the Disability Determination Process.

This involves looking at your disability status to see if you meet the definition of "a person with a disability" as defined in the Ontario Disability Support Program Act.

After submitting the forms

The DAU will decide whether you meet the ODSP definition of a person with a disability and therefore qualify for ODSP benefits. They will let you know their decision by mail. If the DAU decides that you do qualify, they will let your local ODSP office know so that they can start paying you income support.

Please note that even if the DAU decides that the applicant qualifies, if they think your impairment may improve in the future, they may give you a medical review date.

Medical reviews

If you qualify and receive ODSP benefits, the Disability Adjudication Unit may give you a medical review date. This means that they want to check your disability or health status in the future to see if you still qualify for ODSP. They do this if they think your health may improve over time.

As of March 2016, ODSP has instituted a new, simpler medical review process and a two-step form.

In the first part of the form, if the client's health care professional can indicate that the client's medical condition, impairments and restrictions have not improved, the second part of the form, which requires additional medical information to be provided, would not need to be completed.

If the health care professional does indicate there is an improvement, then the second part of the form would give an opportunity for the health professional to put in updated medical information. There will also be an opportunity for the health care professional to advise on relevant new conditions that arose since the last  determination.

The Disability Adjudication Unit decides if you still qualify as "a person with a disability" based on the forms and any medical evidence that you send in for the review.

You will continue to get income support while the Disability Adjudication Unit does its review. If they decide that you no longer have a disability, you will be cut off after 3 more months of income support. This new decision can be appealed.

Participation requirement

All non-disabled adults who get income support from the ODSPA (often spouses of disabled persons on ODSP) will be referred to Ontario Works employment services, as a condition of eligibility, to complete a Participation Agreement to participate in Ontario Works employment assistance activities to help them become and stay employed. 

If the family members have not been doing the activities in the Agreement, the income support could be cut off or reduced.

In some situations, you can ask for a deferral to participate if you:

  • are a single parent and there is no publicly-funded education available for your child who lives with you, or
  • you have a letter from someone, such as a doctor, saying that you cannot participate because you are the caregiver for a family member who needs your ongoing physical help every day because they are disabled or  ill

In some other situations, your OW worker give you a Temporary Waiver from doing the activities in the Agreement, but only if you can show that it is very difficult for you to do any of the activities. For example, you might be excused if:

  • you are a foster parent,
  • you are on workers' compensation benefits,
  • you are on pregnancy or parental leave,
  • you are under house arrest,
  • you are a victim of family violence, or
  • you are taking family medical leave for up to 8 weeks to care for or support a family member who is gravely ill and has a serious risk of dying within 26 weeks.

You will need to provide the OW office with documents or other evidence to support your request for Temporary Waiver.

If your circumstances change, you are expected to tell your OW worker. A change in your circumstances might mean that you have to start doing the activities in your Agreement.

OW reviews Participation Agreements regularly. Even if you were excused from doing the activities in your Agreement for some time, the OW worker who reviews your Agreement could decide that you have to start doing the activities.

Appeal

You can appeal if the Disability Adjudication Unit decides that you do not qualify financially or meet the definition of a person with a disability or your benefit was reduced or cut off. 

Before you file the appeal, you must first ask ODSP in writing to have the decision reviewed. This is called an Internal Review.

You have 30 days from the day you receive the decision to ask for an internal review. Check the letter that told you about the decision for the exact deadline.

If you miss the deadline, you can still ask for an Internal Review, but you will need to explain why you needed more time. In some cases, you can do an Internal Review even if the deadline has passed.

There are two ways you can request an Internal Review

(1)  Fill out a Request for Internal Review form; or

(2)  Write a letter.

If you write a letter, make sure you say that you are asking for an Internal Review and include your name, member ID number (this will befound on your ODSP decision letter), and date of birth.

In the letter, you should also try to explain why you disagree with the decision that was made.  If your appeal is based on medical reasons, you should include any additional medical information that you think would help with the Internal Review (e.g. consultation reports, X-ray reports).

Mail or fax your Internal Review request to:

Disability Adjudication Unit
Social Assistance and Municipal Operations Branch
Ministry of Community and Social Services
P.O. Box B18
Toronto ON M7A 1R3
Fax: (416) 326-3374

If your Internal Review has been refused

If you do not agree with the decision of your Internal Review, you may be able to appeal your decision to the Social Benefits Tribunal (SBT). The SBT is a decision making body that is independent of ODSP and DAU.

At this point, it is highly recommended that you go seek legal help with your appeal from Legal Aid Ontario or a community legal clinic.

You have to request the appeal within 30 days of receiving the Internal Review decision by filling out the appeal form to SBT.  If you need interpreter for the hearing, you should request for an interpreter on this form and SBT will provide an interpreter at the hearing.

You can file your appeal in person, by mail, or by fax. There is no fee to file an appeal with the SBT. The Appeal (Form 1) is available online, from the SBT office, at any OW or ODSP office, and at community legal clinics. If you need help to understand the form you can contact SBT at:

Social Benefits Tribunal
1075, Bay Street, 7th Floor
Toronto, Ontario M5S 2B1
416-326-0978
Toll-free: 1-800-753-3895

About 2 weeks after you file your appeal form you will receive a letter with your SBT file number. Keep your file number in a safe place – you will need it whenever you contact the SBT.

The SBT will issue a Notice of Hearing that tells you when and where your hearing will take place. This usually happens 4-8 weeks after you file the appeal. The Notice of Hearing will tell you whether  your  hearing will be held in person, by telephone, by video conference or in writing.

A hearing is a meeting held by the Tribunal where you can explain why you disagree with the decision that was made. A representative from the Ontario Disability Support Program office that made the original decision may also be there. A Tribunal member will listen to both sides and then make a decision on your case.

You will receive a written decision within 60 days of when your hearing ends. If you have not received the decision within 60 days, contact the SBT.

If you win the appeal, The SBT will order the ODSP or OW office to correct what the SBT found was wrong with its decision. For example:

  • If your assistance was cancelled, it will be restored.
  • If you are found “to be a person with a disability”, the Disability Adjudication Unit (DAU) will send you a letter to let you know. The letter also tells you that the local ODSP office will contact you.
  • If the SBT decides that an overpayment was assessed incorrectly, the amount you owe will be reduced or reversed.

The ODSP or OW office must implement the decision even if it plans to ask the SBT to reconsider the decision or to appeal the decision to the Divisional Court.

If you lose your appeal, the SBT will not order any changes to the ODSP or OW office’s decision.

If you received interim assistance during the appeal period, the money you received will be treated as an overpayment and you may have to pay it back.

Interim Assistance

If you are experiencing financial hardship while you wait for your appeal to be decided you can ask the SBT for interim assistance by completing Section 4 of the Appeal (Form 1). Interim assistance is financial help for the period of your appeal.

The SBT can order that you receive interim assistance if you will experience financial hardship as a result of the decision made by the social assistance office. To help the SBT determine whether you are eligible for interim assistance, you need to provide information about your income and your expenses, the  requests for interim assistance are normally processed quickly. If your appeal is denied, the interim assistance you have received will be assessed as an overpayment by your local office and you will have to pay it back.

Being granted interim assistance does not mean you have won your appeal.

Where to get help?

For legal advice and representation, you can contact a lawyer or a community legal clinic.  To find the community legal clinic in your area, you can phone Legal Aid Ontario, their toll free outside Toronto number is 1-800-668-8258, in Toronto, call 416-979-1446 or check their web site at www.legalaid.on.ca