Area of Law: Government and The Justice System
Answer # 718
What if you are refused social assistance or disability benefits?Region: Ontario Answer # 718
People needing social assistance 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 OW, or the ODSP, 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 and request the Notice of Decision.
Requesting an Internal Review
If you disagree with the decision made about your benefits, you can request an ‘Internal Review.’ An Internal Review means that a different person in that office will review the original decision and decide whether to change it.
There is a 30-day time limit in which you must ask for the Review. Check your Notice of Decision letter for the exact deadline. This request must be made in writing and sent to the office that made the original decision. There are two ways you can do this: one, fill out a Request for Internal Review form (available from the Ministry of Community and Social Services website), or two, write a letter.
If you write a letter, make sure you state that you are asking for an Internal Review. Include your name, your member ID number (this is the number that is on your benefit statement or the letter you received from OW or ODSP), and your date of birth. Also be sure to include the date of the Notice of Decision and the date you received it.
It can be helpful to state the reasons you are requesting the review. Try to explain why you disagree with the decision that was made and include any additional information and/or a copy of documents that you think will help your case. Sign the letter and be sure to keep a copy for your files.
You can deliver your request in person, or fax or mail it. 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, such as you were in the hospital or had difficulty reading and responding to the letter, you may still get an Internal Review.
Internal Review decision
After the office conducts an Internal Review of your case, their decision must be sent to you in writing. If you do not receive a decision within 30 days of your Internal Review request, you can proceed directly to an appeal of the original decision. In the case where an Internal Review decision is made and is negative, you may be able to appeal it. 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.
When can you appeal
If you do not agree with the decision made at the Internal Review, you can appeal to the Social Benefits Tribunal (SBT), 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 for or the amount of assistance.
You cannot appeal a number of decisions, including those 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 can be appealed, you should contact a lawyer or a community legal clinic for information or advice.
How to appeal
If you decide that you are going to make an appeal to the SBT, you must use the official Appeal Form. You can obtain Appeal Forms from the SBT, from an OW or ODSP office, or from a community legal clinic.
An appeal to the SBT must be filed within 30 days of the Internal Review decision. If you did not receive an Internal Review decision within 30 days of your request for one, you can appeal the original decision. In this case, your appeal must be filed within 60 days of your original request. 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 OW, the ODSP office, or the Disability Adjudication Unit (DAU). 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. Within about two weeks of receiving your application, you will receive a confirmation letter from the SBT with your file number. You will need this file number for further communications with the SBT. A copy of your appeal will be sent to OW or ODSP or the DAU.
While you wait for the SBT to decide your case, you can apply for interim assistance. In order to receive interim assistance, the SBT must be satisfied that you will suffer financial hardship during the time it will take for the SBT to complete its review and issue a decision. The Application for Interim Assistance is part of the Appeal Form. If the SBT grants your request, 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 SBT hearing, you will have to repay the interim assistance. If your case gets settled, ask for 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.
Within 30 days of receiving a copy of your appeal from the SBT, the OW or ODSP office, or the DAU (whichever is applicable) must make a written submission if they wish to respond to the issues in your appeal. Their response must be provided to both you and the SBT. It should include reasons why they made the decision, and any evidence they are relying on.
Within approximately two months of receiving your appeal, the SBT will issue you a Notice of Hearing. The Notice will provide the date, time and whether your hearing will be held in person, by telephone, by videoconference or in writing.
You must be given at least 30 days notice before the hearing date. The hearing will take place about 10 months after you file your appeal.
If you have documents that you want to present as evidence at the hearing, you must file them with the SBT and the OW or ODSP office, or the DAU, at least 20 days before the hearing. If you are appealing a decision to refuse ODSP disability benefits and you have new medical evidence, it must be filed at least 30 days before the hearing.
If you do not file your documents within the time frame allowed before the hearing, the SBT 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 SBT might still agree to consider them.
The SBT will send you a decision regarding your appeal, in writing, within 60 days of when your hearing ends.
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 a decision to the SBT, you should consult a lawyer, contact a legal clinic or legal aid office.
More information about what to do if you disagree with a decision regarding your application for social assistance can be found from the Ministry of Children, Community and Social Services.
For more information about the SBT appeals and hearing process, and what to do if you do not agree with an SBT decision, visit the Social Benefit Tribunal website.
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