Ontario Rethinks Complex Disability Reviews; Advocates Say Unwieldy System Wastes Public Funds and Puts Vulnerable at Risk

Laurie Monsebraaten
The Toronto Star, May 17, 2015

Queen’s Park is reversing an aggressive plan to clear a backlog of more than 60,000 medical reviews for people on disability welfare after advocates warned it would be a waste of public funds and put vulnerable Ontarians at risk.

“While we remain committed to eliminating the backlog of medical reviews, we want to take the time to get the process right,” said a spokeswoman for Helena Jaczek, the minister of community and social services. The government has been working with advocates to improve the medical review process, Meaghan Coker added in an email.

Physicians and community legal clinics were alarmed when they heard last fall that the ministry was planning this spring to increase the number of medical reviews being done monthly from 600 to 1,900.

Last month, they urged the ministry to hold off until it developed a better process to ensure that people with medical conditions that could improve still need financial help.

“The process is so flawed. It’s wasteful in terms of the public funds that are going into both the health and legal clinic resources. And it’s careless with people’s lives,” said Mary Marrone of the Income Security Advocacy Centre, a legal aid clinic that supports people on social assistance.

“We are very pleased that we have been heard and that the ministry is holding off increasing the number of medical reviews. We look forward to working with them,” she added.

However, Marrone said advocates remain worried about the 600 people a month who are still going through the current process.

“We’re concerned there is an ongoing risk that the most vulnerable people will lose their benefits as a result of a poor process,” she said. “The ministry needs to act quickly to prevent that from happening.”

Advocates say the biggest problem with the current process is that the detailed, 21-page review form doctors and other health care providers are required to complete is the same one they fill out when patients first apply for benefits under the Ontario Disability Support Program (ODSP).

The application is so complicated and the initial rejection rate so high that more than half of legal clinic cases now involve ODSP appeals, Marrone said. And yet more than half of appeals heard before the Social Benefits Tribunal are approved.

“We understand some conditions are time limited,” said Dr. Fatima Uddin of the Regent Park Community Health Clinic. “Health is a dynamic thing. It can improve, and there may be the need for review. But it should be a review – not a complete re-application.”

Uddin is one of seven physicians, three nurse practitioners and numerous social workers at the centre who have helped residents such as Lillian complete ODSP medical reviews.

The 29-year-old single mother, who didn’t want her full name published for fear of government reprisals, developed severe vertigo, an anxiety disorder and chronic depression three years ago, after a head injury left her unable to continue working as a legal assistant.

Uddin said Lillian’s recovery was going well until her medical review forms arrived last fall. After two rejections and six months of medical, social work and legal clinic advocacy on her behalf, Lillian’s case was finally approved last month. But the stress has compromised her fragile mental health. “It has been a setback. But if I didn’t have the support, I’d be in the hospital freaking out,” Lillian said. “But I have that support. Not everybody has that support or knows how to get it.”

In addition to jeopardizing people’s health, filling out the lengthy medical forms puts pressure on already time-pressed medical and legal clinics as well as on social agencies that work with this vulnerable population, advocates add.

“The current medical review process is difficult for both service providers and clients to navigate,” said Camille Quenneville of the Canadian Mental Health Association, Ontario. “As nearly half of all ODSP recipients have a mental health issue, receiving notice of medical review could be disruptive to their recovery. Improving the process would be of benefit for both service providers and clients alike.”