Ontario ends intimidating review process for disabilities; Simplified approach focuses solely on determining whether initial medical condition has improved

Laurie Monsebraaten, The Toronto Star , Apr. 6, 2017

Two years after the Star highlighted problems with Ontario’s onerous and intimidating medical review process for disabled people on welfare, Social Services Minister Helena Jaczek has introduced a more simple and streamlined approach.

Beginning this month, those whose medical conditions have not improved will no longer be required to fill out the same forms they completed for their initial application for benefits under the Ontario Disability Support Program (ODSP).

“Our government is committed to a more client-friendly and efficient adjudication process,” Jaczek said Wednesday. “These changes will reduce the burden on clients, health-care professionals, stakeholders and staff, while maintaining a process that is fair and accountable.”

The new, simplified medical review package is focused solely on determining whether the medical condition that caused the person to require support in the first place has improved. If there is no improvement, or expected improvement, a statement from the patient’s health-care provider will suffice, cutting the need for costly medical tests and referrals to specialists that had been required in the past. “Only in cases where improvement is reported or prognosis is unknown will the health-care professional be asked to provide further information,” an advisory posted on the social services ministry website says.

ODSP recipient Kimberly Sturge, 31, says she is “relieved” she won’t have to endure another medical review under the old system. The Toronto single mother, who developed severe vertigo, an anxiety disorder and chronic depression in 2012 after a head injury left her unable to continue working as a legal assistant, suffered a mental-health setback when her ODSP medical review was rejected twice in 2014. “I no longer feel anxious about my next review in two years,” she said Wednesday. “It makes me feel good to have been able to tell my story and make a difference.”

Legal clinic case workers, who say most of their work involves helping people navigate access to ODSP benefits, were pleased by the government’s willingness to address the long-standing issue. “This is the first minister who has acknowledged there was a problem with how they are adjudicating disability,” said Mary Marrone, legal director of the Income Security Advocacy Centre, a legal-aid clinic that advocates on behalf of people on social assistance.

“The new forms are much simpler and focus on the legal test, which is: Has the client improved?” said Marrone, who has been pressing the government to reform the process since 2010. “The process is clear, so doctors know why they are filling out these forms, and there isn’t the same demand for massive amounts of information,” she added.

Due to rising ODSP caseloads, a backlog of more than 60,000 medical reviews prompted the province in the spring of 2015 to more than triple the number of forms issued each month, from 600 to 1,900. An outcry by legal clinics and medical professionals, highlighted by the Star, prompted Jaczek to re-examine the process.

“People, especially with mental-health issues, find (the current process) particularly difficult and intimidating,” Jaczek told the Star a year ago when she gathered a working group of medical professionals, social workers, lawyers and community advocates to solve the problem. “What we’re trying to do is lessen the burden on families and individuals and the health-care providers and the legal clinics . . . who often end up appealing decisions made,” Jaczek said at the time.

Almost one-third of about 350,000 households with a person receiving support under the program have disabilities that are expected to improve, such as cancer, depression or an addiction. Thus, the government conducts medical reviews every two to five years to see if the person is still legally eligible for support.
Until now, the 21-page review form doctors and other health-care providers were required to complete was the same one they fill out when patients first apply for benefits.

Doctors said it is costly for the medical system to repeat tests they don’t feel are necessary. And legal clinics say appeals for clients who have been denied benefits are a waste of time and money, as half of the cases are upheld. Social workers say the small number of people on ODSP who are difficult to reach, due to homelessness or a medical condition that makes it hard for them to keep appointments, risk being cut off if they don’t complete the forms.

Dr. Fatima Uddin, who works at the Regent Park Community Health Clinic, said many of her patients rely on ODSP and are overwhelmed by the medical review process. “It is quite stressful for patients who have already been approved for ODSP to go through that harrowing process all over again just to prove they continue to be as unwell as they were before,” she said.

“The new process is simple, efficient and reduces a lot of the stress for patients and (medical) providers,” Uddin said. “And it is going to save the health care and social service system a lot of unnecessary costs.”

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