COVID-19 update on ODSP Disability Determination Packages and Medical Reviews

We are still processing ODSP Disability Determination Packages. We can send the package directly to your healthcare professional to help avoid in-person visits.

If you are already on ODSP and receive a medical review package that your health care professional can’t complete in time, call us at 1-888-256-6758 to ask for an extension.

If you have any questions, call the Disability Adjudication Unit at Toll-free: 1-888-256-6758 or 416-326-5079.

Learn more about COVID-19

Overview

When you apply for ODSP or are receiving income support through the program, you need to keep us up to date so we can make sure you remain eligible and are getting the right amount of money. This is important since your situation may change over time.

To qualify for ODSP income support, you must:

  • be at least 18 years of age
  • be an Ontario resident
  • have assets no greater than the limits set out in the program
  • be in financial need
  • meet the program’s definition of a person with a disability or be a member of a prescribed class

If you’re under 18, you can start the application process up to six months before your 18th birthday.

To see if you are financially eligible, we will look at your circumstances including your income and assets, living expenses, family size and make-up, and shelter costs.

If you are financially eligible, you will also have to participate in a process to determine whether you meet the ODSP definition of a person with a disability, unless you are a member of a prescribed class.

Find out more about your rights and responsibilities under ODSP.

Eligibility as a person with a disability

To be eligible for ODSP as a person with disability you must meet the definition of disability under the Ontario Disability Support Program Act.

Being a person with a disability means:.

  • you have a substantial mental or physical impairment that is continuous or recurrent, and is expected to last one year or more
  • the direct and cumulative effect of your impairment results in a substantial restriction in your ability to work, care for yourself, or take part in community life
  • your impairment, its likely duration and restrictions have been verified by an approved health care professional

When you apply for ODSP, your caseworker will give you a Disability Determination Package for you and your health care professional(s) to complete.

You have 90 days to complete and return the package to the ministry’s Disability Adjudication Unit. If you don’t send it back within 90 days, we will consider your ODSP application withdrawn unless you make a written request for an extension and we approve it.

We will review your completed package to determine if you meet the program’s definition of a person with a disability. This is called the Disability Determination Process.

If you meet the definition of a person with a disability, your local ODSP office will confirm that you still qualify financially. If you still qualify, you will receive income support.

If your disability or medical condition may improve, we will also give you a date for a medical review.

Prescribed classes

Prescribed classes are specific categories of people who do not have to go through the disability adjudication process to qualify for ODSP income support.

Members of prescribed classes include:

  • A person who, on May 31, 1998, was a recipient, or the spouse of a recipient, of benefits under specific case classes under the Family Benefits Act, 1992
  • A person who is 65+ years old and not eligible for Old Age Security (OAS)
  • People who receive either of these disability pension benefits:
  • A person in receipt of an award under the English and Wabigoon River Systems Mercury Contamination Settlement Agreement Act, 1986
  • A person who was a former resident of a Schedule 1 facility under the former Development Service Act (DSA), who ceased to be resident of that facility on or after June 1, 1998
    • The Schedule 1 facilities under the former DSA include Huronia Regional Centre (Orillia), Rideau Regional Centre (Smith Falls) and Southwestern regional Centre (Blenheim)
  • A person who is already determined eligible for services and supports and funding under the Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA). This class includes:
    • persons living in the community as a renter, owner, a tenant or a border
    • persons living in an intensive support residence as defined under the SIPDDA
    • persons living in a supported group living residence as defined under SIPDDA
  • A person who currently resides in a home under the Homes for Special Care Act or a person who resided in a home under that Act on or after January 1, 2018, but has since left that home (for example, living in the community as a renter, owner, a tenant or a border)
  • A resident or former resident of homes that are part of the Community Homes for Opportunity program
  • Persons currently residing in:
    • a facility that was a Provincial Psychiatric Hospital
    • the Centre for Addiction and Mental Health (in Toronto)
    • the Homewood Health Centre (in Guelph)

If you are in one of these classes, you must still apply and meet all other ODSP eligibility requirements to continue receiving ODSP income support.

Income

If you are applying for ODSP or receiving income support from the program, it is important that you tell your caseworker about all money you or your family receive from other sources.

We need to know about your income so that we can make sure you are getting the right amount of money. In general, any money you or your family receive is income, and may affect your income support.

Examples of income and other sources of funds

Income and other sources of funds you need to report include:

  • a job
  • tax benefits
  • Canada Pension Plan (CPP) or Québec Pension Plan (QPP) benefits
  • Workplace Safety and Insurance Board (WSIB) benefits
  • earnings from a job, training program
  • profit from a farm or business, including self-employment
  • spousal support
  • sponsorship support
  • Guaranteed Annual Income Supplement (GAINS)
  • Old Age Security (OAS) and Guaranteed Income Supplement (GIS)
  • Employment Insurance (EI)
  • other government programs
  • loans
  • any other money that you or your family receive or may be entitled to receive

Exempt income and other funds

Some types of income and other funds are exempt, which means they do not affect your eligibility or the amount of money you get for income support.

Here are some examples of what is exempt:

  • child support
  • certain federal tax benefits, like the Canada Child Tax Benefit
  • certain provincial tax benefits, like the Ontario Child Benefit
  • payments from a Registered Disability Savings Plan (RDSP)
  • Ontario Student Assistance Program (OSAP) loans and grants used for education costs

There are many rules about the treatment of other income while you are receiving income support. Your ODSP caseworker can help you figure out what income is exempt.

It is important that you report all the funds you receive.

Assets

You need to tell your caseworker about any assets you or your family own, if you are applying for ODSP or are receiving income support from the program. We consider your assets when we are reviewing your eligibility.

Examples of assets

Assets are property, possessions or money that belong to you or your family. Here are some examples:

  • cash
  • money you have in bank accounts
  • stocks and bonds
  • Registered Retirement Savings Plans (RRSP)
  • vehicles
  • property (for example, land or a house)
  • trust funds
  • any other assets that you or your family own

Exempt assets

Some assets are exempt, which means they do not affect your eligibility for income support. Here are some examples of exempt assets:

  • the home you own and live in
  • your primary vehicle (the one you use the most, if you have more than one)
  • trust funds derived from an inheritance or life insurance policy, up to allowable limits
  • the cash surrender value of life insurance policies, up to allowable limits
  • pre-paid funerals
  • Registered Education Savings Plans (RESP)
  • Registered Disability Savings Plans (RDSP)
  • necessary household and personal items, such as furniture and clothing

There are many rules about the treatment of assets while you are receiving income support. Your ODSP caseworker can help you figure out which of your assets are exempt.

It is important that you report all your assets to your caseworker.

Asset limits

There are limits to the amount of non-exempt assets you can have and still be eligible for income support. The asset limits are:

  • $40,000 for a single person
  • $50,000 for a couple

If you are over the limit

In some cases, you can get approval to save money and assets above the limit. For example, you may save money to buy an item or service that you need for your health or for your disability. Talk to your ODSP caseworker for details.

Buying disability-related items and services

If you are receiving ODSP income support, you may be allowed increased limits and flexibility for your assets and income to help you and your family save for or buy approved disability-related items and services.

Here are some examples of approved disability-related items and services:

  • assistive devices
  • health care and safety items, such as prosthetics or life-alert systems
  • disability-related support services, such as attendant care, sign-language interpreting or specialized equipment
  • renovations or alterations to your home to improve accessibility or to maintain health and safety standards
  • education and training costs related to a disability

Increased asset limits

We can increase your asset limits to help you save for an approved disability-related item or service.

Some exceptions to income and other money received

Some types of income and other money you receive may not affect your income support if you use the money to buy approved disability-related items and services.

Here are some examples:

  • gifts and voluntary payments
  • payments from a trust or life insurance policy
  • interest or dividends paid out from a life insurance policy
  • accident settlements
  • loans

If you earn money from working or profit from running your own business, you can use your earnings or profit to buy disability-related items and services you need for work without affecting your income support.

Before buying disability-related items and services

Contact your local ODSP office. Your caseworker can help you figure out what disability-related items and services are approved and how the program can help you save for or buy these items and services.

Gifts and voluntary payments

If you are receiving ODSP income support, you and your family can receive gifts or voluntary payments for any reason without affecting your income support.

You and each family member are allowed to receive a total of up to $10,000 in a 12-month period, including money from:

  • gifts
  • voluntary payments
  • payments from trusts (including interest earned)
  • payments from life insurance policies (including interest and dividends earned)
  • inheritances
  • honorariums
  • windfalls, such as lottery winnings

You may receive donations from religious and charitable organizations without affecting your income support.

If you receive a gift or voluntary payment and use it to help pay for disability-related items and services that have been approved in advance (such as interpreter services), it will be exempt as income. This means it does not affect your eligibility or the amount you get for income support, and it does not count against your $10,000 limit.

If you or a family member receives more than $10,000 per family member in total in a 12-month period, we will consider the extra amount above the limit as income in the month you receive it. This extra amount may affect your eligibility or the amount of money you get for income support.

For example: If you receive a gift for $11,000 in August and you have not received any gifts or voluntary payments before, we will consider $10,000 exempt and the other $1,000 as income when we calculate your income support for August.

However, this income may not affect your income support if you use it to buy a disability-related item or service that has been approved in advance.

If you have any money left in the next month (September in the previous example), we will treat it as an asset. Asset rules may apply that could affect your eligibility for income support.

Your ODSP caseworker can help you figure out how these rules can benefit you.

Life insurance policies

There are different types of life insurance policies. Under ODSP rules, life insurance includes:

  • annuities
  • deferred annuities
  • segregated funds

For you and each family member, up to $100,000 of the cash surrender value of a life insurance policy is exempt as an asset under ODSP. This means it does not affect your eligibility for income support.

"Cash surrender value" refers to the money an insurance company will pay when the insurance policy is terminated by the insurer or the policyholder cancels a life insurance policy early.

If you or a family member has a trust and a life insurance policy, up to $100,000 of the combined value of the trust and the cash surrender value may be exempt as an asset.

If a life insurance policy does not have a cash surrender value, we do not consider it an asset.

Your ODSP caseworker can help you figure out how your life insurance policy could affect your eligibility for income support.

Income earned on a life insurance policy

Dividends or interest earned from a life insurance policy is exempt as income if:

  • it is reinvested in the policy
  • the cash surrender value of the policy is still within the allowable limits

You must report any dividends or interest earned from your life insurance policy and the changes to your policy to your worker.

Payments from a life insurance policy

You must report any payments you receive from a life insurance policy to your worker. This includes dividends or interest earned that are paid out.

Generally, we consider payments from a life insurance policy as income when you receive them.

There are some exceptions. Up to $10,000 of the total value of all gifts, voluntary payments and payments from a life insurance policy or trust you receive in a 12-month period is exempt as income.

Also, if you use the payment for a disability-related item or service that has been approved in advance (such as attendant services), it may be exempt as income and may not count against your $10,000 limit.

Inheritances

Money, property or possessions you inherit could affect your eligibility or the amount of money you get for ODSP income support.

It is possible that all or part of your inheritance may be exempt. This means it does not affect your eligibility or the amount you get for income support.

Your ODSP caseworker can help you figure out how an inheritance may affect your income support.

It is important to report any inheritances you receive or expect to receive to your caseworker.

If you inherit money

If you inherit money or assets, some of your inheritance may be exempt under the rules for gifts and voluntary payments.

Up to $10,000 of the total value of all gifts, voluntary payments and payments from a life insurance policy or trust you receive in a 12-month period, is exempt as income.

Generally, we will treat the money you inherit as income when we calculate your eligibility for income support in the month you receive it. For example, if you inherit money in August, we will consider it when we calculate your income support for August.

If you have any money left from your inheritance in the next month (September in the previous example), we will treat it as an asset in that month. Asset rules may apply that could affect your eligibility for income support.

You can still use the money towards assets that do not affect your eligibility for income support, such as:

  • investing in a Registered Education Savings Plan (RESP) for your children
  • investing in a Registered Disability Savings Plan (RDSP),
  • buying a home to live in

Inheritance and trusts

If you inherit some money and you place it in a trust within six months of receiving it, up to $100,000 of your trust may be exempt as an asset.

If you inherit a trust that has been set up in a will, the inherited trust is not considered income and up to $100,000 of your trust may be exempt as an asset.

If you have a trust and a life insurance policy, up to $100,000 of the combined value of the trust and the cash surrender value of the life insurance policy may be exempt as an asset.

"Cash surrender value" refers to the money an insurance company will pay when the insurance policy is terminated by the insurer or the policyholder cancels a life insurance policy early.

If you inherit property or possessions

We will treat property or other possessions you inherit as assets. Asset rules may apply which could affect your eligibility for income support.

There are some situations when the property or possessions you inherit may be considered exempt. For example, there may be an exemption if:

  • you inherit a house and live in it
  • you inherit a car and use it as your primary vehicle

Tell your case worker if you receive and inheritance to see if some or all of it can be exempt.

Trusts

When we assess your eligibility for ODSP income support, we consider any money held in a trust for you and your family.

It is possible that all or part of the money held in a trust for you or a family member may be exempt as an asset. This means it does not affect your eligibility for Income Support.

For you and each family member, up to $100,000 of a trust may be exempt as an asset if the money to set up the trust came from either:

  • an inheritance
  • the proceeds of a life insurance policy

If you or a family member has a trust and a life insurance policy, up to $100,000 of the combined value of the trust and the cash surrender value of the life insurance policy may be exempt as an asset.

"Cash surrender value" refers to the money an insurance company will pay when the insurance policy is terminated by the insurer or the policyholder cancels a life insurance policy early.

There are different types of trusts and the impact on a person's Income Support depends on the details of the trust. Your ODSP caseworker can help you figure out how a trust could affect your eligibility for income support.

Interest earned in a trust

Any interest earned from the money held in trust for you is exempt as income if:

  • it is reinvested in the trust
  • the value of the trust is still within the allowable limits

You must report any interest you earn from the trust and any changes to the value of your trust to your worker.

Payments from a trust

If you receive any payments from your trust, you need to tell your worker. This includes any interest earned that is paid out.

Generally, we consider payments from a trust as income when you receive them.

There are some exceptions. Up to $10,000 of the total value of all gifts, voluntary payments and payments from a life insurance policy or trust you receive in a 12-month period, is exempt as income.

Also, if you use the payment for a disability-related item or service that has been approved in advance (such as attendant services), it may be exempt as income and may not count against your $10,000 limit.

Discretionary trusts

In some cases, your inheritance may be in a discretionary trust that has been set up in a will. A discretionary trust is one where the trustee has absolute discretion over how the trust is used to help the beneficiary. These types of trusts are treated differently under ODSP. If you are named in such a trust, you must speak to you caseworker about how it may affect your case.

Medical reviews

A medical review of your disability allows us to determine whether you continue to meet the ODSP definition of a person with a disability. A medical review date is set when a person's condition may improve over time.

If you were not assigned a medical review at the time you originally qualified for the program, medical review dates do not apply to you.

You will continue to receive your income support and other benefits if you continue to meet all other eligibility requirements of the program.

How the medical review process works

When it is time for your medical review, you will be notified and sent a Medical Review Package.

An approved health care professional, such as your doctor, must fill out the medical review forms.

You will have 90 days to send in your forms. If you need more time to complete your forms, you can ask the Disability Adjudication Unit for an extension.

After we receive your completed forms, we will:

  • review the information you gave us
  • decide if you continue to meet the program’s definition of disability
  • send you a letter to tell you what our decision is

Internal reviews and appeals

If you disagree with a decision, you can ask to have the decision reviewed. This is the first step in the appeal process and is called an internal review.

If you don't agree with the decision from the Internal Review, you may be able to appeal the decision to the Social Benefits Tribunal.

If your income support has stopped, you can apply to Ontario Works if you still need financial help.