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Ontario|Government & Justice SystemGovernment & Justice System 718 What if you are refused social assistance or disability benefits? People needing social assistance, including single parents, must apply for Ontario Works (OW) also known as welfare. People who are considered "disabled" may receive benefits under the Ontario Disability Support Program (ODSP).
- Notice of decision
If you are refused assistance when you apply for Ontario Works, or the Ontario Disability Support Program, or your assistance is reduced or cut off, you should receive a letter from the government. This letter is called a 'notice of decision'.
The notice of decision should tell you:
- the effective date of the decision,
- reasons for the decision, and
- how much time you have to ask for an internal review.
If your assistance is refused, reduced or cut off and you do not receive a letter, contact the office that made the decision immediately. This will be the local Ontario Works or Social Services or Ontario Disability Support Program office, or the Disability Adjudication Unit (DAU) in Toronto. Ask for the notice of decision.
- Asking for an internal review
If you disagree with the decision made about your benefits, you can request an 'internal review'. You must request the internal review in writing and send it to the office that made the original decision. An internal review means that a different person in that office will review the original decision to refuse, reduce or cut off your benefits and decide whether to change it.
Your written request for an internal review must arrive at the office you are sending it to either:
o within 10 days of the day you received the notice of decision if it was given to you in person by a worker, or,
o if the notice was mailed to you, within 13 days from the date it was mailed.
Some social services offices or community legal clinics have form letters that you can use to request an internal review. You do not have to use a form letter, but if you write your own letter, be sure to include the date of the notice of decision and, the date you received it.
Say in the letter that you want an internal review. It can be helpful to state the reasons you are requesting the review. Sign the letter and include your case identification number, which is your date of birth, and be sure to keep a copy of your letter for your files.
You can deliver, fax, or mail your request for an internal review. If you deliver your request in person, ask for a receipt to prove the date you delivered it. Make sure you get it to the correct office within the time limit. If it is late, you could lose the right to a review and an appeal.
If the time for requesting an internal review has passed, you can still request one. Explain in your letter why your request is late. If you can show that you have a good reason, you may still get an internal review. Some good reasons why your request was late could be:
- you were in the hospital,
- you have difficulty reading and writing, or
- the mail took longer than 3 days to reach you.
- The internal review decision
After the office conducts an internal review of your case, their decision must me sent to you in writing. If the decision is negative, you can appeal. If you do not receive a decision within 10 days of your internal review request, you can proceed directly to an appeal of the original decision. However, not all decisions can be appealed. Also, if you withdraw your request for an internal review, you will not be able to appeal the decision.
- Appealing to the Social Benefits Tribunal (SBT)
You can appeal an internal review decision if it concerns any of the following:
- being refused or cut off financial assistance,
- the amount of assistance,
- the reduction of assistance to recover overpayment,
- community start-up benefits, employment and training start-up benefits,
- medically necessary transportation costs and certain health supplies,
- appointment of a trustee to receive your cheque if you are 18 or over, and
- employment assistance, including help with job searches, referral to education or training, community participation and employment placement, but only if it affects your eligibility or the amount of assistance.
You cannot appeal decisions that are about:
- discretionary benefits, such as dental services, moving costs, funerals or burials, eyeglasses, and prosthetic appliances,
- third party payments, such as having some or all of your assistance paid directly to a landlord or utility company,
- emergency assistance, and
- appointment of a trustee to receive your cheque if you are under 18.
If you are not sure if an internal review decision made by the Social Benefits Tribunal can be appealed, you should contact a lawyer or a community legal clinic for information or advice.
- How and when to appeal to the Social Benefits Tribunal (SBT)
If you decide that you are going to appeal a decision, you must use the official Appeal Form. You can get one from an Ontario Works or Ontario Disability Support Program office, a community legal clinic, or by calling the Social Benefits Tribunal office at 1-800-753-3895.
An appeal to the Social Benefits Tribunal must be filed within 30 days of the internal review decision. If you did not receive an internal review decision within 10 days of your request, you can appeal the original decision. In this case, your appeal must be filed within 40 days of your original request for an internal review. If you miss the time limit for appealing, you can ask for more time but you will have to explain why you missed the time limit.
When you file an appeal, along with the completed Appeal Form, include copies of any letters you have received from the Ontario Works or Ontario Disability Support Program office, or the Disability Adjudication Unit. Also include a copy of your letter requesting the internal review. If you do not have copies of these letters to send, you should explain why.
- Interim assistance
While you wait for the Social Benefits Tribunal to decide your case, you can apply for interim assistance. The Application for Interim Assistance is part of the Appeal Form. If the Social Benefits Tribunal orders it, the local office will have to pay your benefits while you wait for the appeal.
It is important to note that if you lose your appeal, or you do not attend your Social Benefits Tribunal hearing, you will have to repay the interim assistance. If your case gets settled, try to get an agreement in writing that says you will not have to repay the interim assistance. You may have to repay the interim assistance if you withdraw the appeal without such an agreement.
- The appeal hearing
Within 60 days of receiving your Appeal Form, the Social Benefits Tribunal must send a 'notice of hearing' to you and to the office that made the decision you are appealing. The notice will give the date, time, and place of the appeal. You must be given at least 30 days notice.
If the Ontario Works or Ontario Disability Support Program office, or the Disability Adjudication Unit, intends to file a report with the Social Benefits Tribunal, they must send you a copy within 30 days of receiving the notice of appeal. The report should include reasons why they made the decision, and any evidence they are relying on.
If you have documents that you want to present as evidence at the hearing, you must file them with the Social Benefits Tribunal and the Ontario Works or Ontario Disability Support Program office, or the Disability Adjudication Unit, at least 20 days before the hearing. New medical evidence in an Ontario Disability Support Program appeal must be filed with the Disability Adjudication Unit at least 20 days before the hearing.
If you do not file your documents within 20 days before the hearing, the Social Benefits Tribunal can refuse to consider them at the hearing or they could re-schedule the hearing. If you have documents to file but there are less than 20 days left before the hearing date, file them as soon as possible. The Social Benefits Tribunal might still agree to consider them.
You have the right to be represented at the hearing. It can be difficult to prepare and present your case. For advice and assistance when appealing an internal review decision, you should consult a lawyer or contact a legal clinic.
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