Digest of Benefit Entitlement Principles - Chapter 23

previous | index | next

CHAPTER 23

COMPASSIONATE CARE BENEFITS

23.2  COMPASSIONATE CARE BENEFITS

23.2        Compassion Care Benefits
23.2.1     Definition
23.2.2     Entitlement Conditions
23.2.3     Proof of Gravely Ill Family Member
23.2.4     Care or Support of Gravely Ill Family Member
23.2.5     The number of Weeks for Which Compassionate Care Benefits May be Paid
23.2.6      Compassionate Care Window
23.2.7      Period during Which Compassionate Care Benefits are Payable
23.2.7.1   Compassionate Care Window Start
23.2.7.2   Medical Certificate Issued Before Compassionate Care Claimed
23.2.7.3   Medical Certificate Issued after Compassionate Care Claimed
23.2.8      End of Entitlement within the Window
23.2.9      Sharing Compassionate Care Benefits
23.2.10    Antedates
23.2.11    Waiting Period
23.2.12    Earnings

23.2  Compassionate Care Benefits

Compassionate care benefits are available to an eligible claimant for the purpose of providing care or support to a gravely ill family member with a significant risk of death within 26 weeks1.

  1. EIA 23.1(2)

23.2.1  Family Members Who Can Receive Compassionate Care Benefits

At the time Compassionate Care benefits were introduced, the term "family members" in relation to the individual who is gravely ill only applied to the following individuals:1

  • the claimant’s spouse2
  • Claimant's child, or the child of the claimant's spouse;
  • Claimant's parent, or the spouse of the claimant parent;
  • Any other person who is a member of a class of persons prescribed for the purposes of this definition.

A new regulatory provision expands the list of "family members" to include siblings, grandparents, grandchildren, in-laws, aunts, uncles, nieces, nephews, foster parents, guardians and wards. Other persons included as "family members" are3:

  • claimant's brother, sister, step-brother or step-sister;
  • grandparent of the claimant, claimant's spouse's grandparent, spouse of claimant's grandparent;
  • claimant's grandchild or the grandchild of the claimant's spouse, or the spouse of the claimant's grandchild;
  • claimant's child's spouse, the spouse of the child of the claimant's spouse;
  • claimant's father-in-law, mother-in-law, step-father-in-law, or step-mother-in-law;
  • the spouse of the claimant's brother, sister, step-brother, step-sister;
  • the brother, sister, step-brother or step-sister of the claimant's spouse;
  • the claimant's or the claimant's spouse's uncle or aunt, or the spouse of the claimant's uncle or aunt;
  • claimant's or the claimant's spouse's nephew or niece, or the spouse of the claimant's nephew or niece;
  • a current or former foster parent of the claimant or of their spouse;
  • a current or former foster child of the claimant, or the spouse of that child;
  • A current or former ward4 of the claimant or of their spouse;
  • A current or former guardian5 of the claimant or the spouse of that guardian;
  • A person considered a close relative by the patient for whom the claimant is caring, whether or not related by blood, adoption, marriage or common-law partnership; and
  • A person whom the claimant considers a close relative, whether or not related to the claimant by blood, adoption, marriage or common-law partnership.

[ July 2008 ]

  1. EIA 23.1(1);
  2. All references to "spouse" also includes common-law partner
  3. EIR 41.11(2);
  4. Ward means a person for who a guardian is appointed EIR 41.11(2);
  5. Guardian means a person having a legally recognized authority to act on behalf of a minor or disabled adult, and a mandatary in cases of incapacity, tutor and curator EIR 41.11(2);

23.2.2  Entitlement Conditions

The individual claiming compassionate care benefits must have experienced an interruption of earnings1 from employment, and be major attached2, that is, have 600 hours of insurable employment in the qualifying period. Although the entrance requirement for the new-entrant or re-entrant are 910 hours, there are provision which permit the claimant to qualify for compassionate care benefits with 600 hours of insurable employment in the qualifying period3.

In situations where a claimant has accumulated a violation, the claimant will require more than 600 hours of insurable employment during the qualifying period4 to be entitled to compassionate care benefits.

The individual claiming must also submit a medical certificate with regard to the gravely ill family member5.

  1. EIR 14(2);
  2. EIA 6(1);
  3. EIR 93;
  4. EIA 7.1(1); 7.1(2);
  5. see 23.2.3 “Proof of Gravely ill Family Member”.

23.2.3  Proof of Gravely Ill Family Member

An eligible claimant must submit a medical certificate signed by a medical doctor1 or other prescribed medical practitioner2 treating the gravely ill family member. The medical doctor or practitioner will attest to the fact that his or her patient, the gravely ill family member, has the following two conditions. The patient

  1. has a serious medical condition with a significant risk of death within 26 weeks, and
  2. requires the care or support of one or more family members

A medical certificate issued by a medical practitioner, as prescribed by Regulation, will be acceptable in situations where the patient resides in a geographical area without access to treatment by a medical doctor and where the medical practitioner is treating the patient under the direction of a medical doctor3, for example, a nurse practitioner in a remote northern community in Canada.

Where the gravely ill family member resides outside of Canada, a medical certificate issued by a medical doctor or practitioner recognized by the appropriate government authority with similar qualifications to a medical doctor inis acceptable.

The certificate will identify the gravely ill family member - the doctor's patient - by providing the complete name, address and date of birth of the patient. When more than one claimant will share the compassionate benefits, only one certificate is required. If more than one medical is submitted, it is the first valid certificate that will determine the 26 week window4.

The medical profession is not authorized to release medical information without the patient's consent or unless required by law.   A section was included on the medical certificate to authorize doctors to release medical information on the patient to family members claiming compassionate care benefits and to the Commission.  This section of the certificate is signed by the patient authorizing the release of medical information or a parent or legal representative where the patient is unable to sign due to a physical or mental condition.

A medical certificate without the patient or representative signature to authorize the release of medical information will nevertheless be accepted where the patient information is completed and the doctor has attested to the two conditions of entitlement.

  1. EIA 23.1(2);
  2. EIA 23.1(3);
  3. EIR 41(2);
  4. EIA 23.1(4)(a); 23.1(6)

23.2.4  Care or Support of Gravely Ill Family Member

Care or support of a gravely ill family member includes1;

  1. directly providing or participating in the care of the family member, or
  2. providing psychological and emotional support to the family member, or
  3. arranging for care of the family member by a third party care provider .

The definition of care or support includes direct as well as indirect care and support. It also includes situations where the claimant simply spends time each day with the gravely ill family member in the home, a hospice or a medical facility.

Any period during which an individual is claiming this type of benefit is a time of great personal stress and the claimant may require a short break from providing care or support for the gravely ill family member in order to deal with this stress. Therefore benefits should not be denied where the claimant does not actually deliver care for a few days. A reasonable approach should be taken and each case should be decided on its own merit.

There will be situations where the claimant resides in a different geographical area than the gravely ill family member and may arrange for the delivery of care or may provide psychological and emotional support from wherever he or she resides. The legislation provides the opportunity to respond to these situations.

In any situation where it becomes apparent that the claimant is not providing care or support, based on the definition above, the claimant would be disentitled from benefits. This would apply whether the claimant is in the same geographical area as the gravely ill family member or not.

  1. EIR 41.1

23.2.5  The Number of weeks for Which Compassionate Care Benefits May Be Paid 

The legislation provides two limits to the maximum number of weeks payable for compassionate care benefits.

  1. The first is a maximum of six weeks of compassionate care benefits payable within a benefit period1
  2. The second is that this maximum of 6 weeks within relation to a 26 week window for the gravely ill family member.

These limitations apply whether the benefits are claimed by one individual or shared with another family member2 

  1. EIA 12(3)(d);
  2. EIA 12(4.1)

23.2.6  Compassionate Care Window

Compassionate care benefits are available to eligible workers to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. This 26 week window during which 6 weeks of compassionate care benefits are payable is determined by both the issuance of a medical certificate and a first request for these benefits by a family member.

23.2.7  Period during Which Compassionate Care Benefits are Payable

Compassionate care benefits are payable at any time during the benefit period and claimants have a 26 week window to receive these benefits1. The first valid medical certificate provided for the gravely ill family member will be used to identify the 26 week period during which compassionate care benefits can be claimed for the gravely ill family member.

Payment of compassionate care benefits cannot begin before

  • the day of issuance of the first valid medical certificate which is filed with the Commission or
  • in the case of a claim that is made before the day the certificate is issued, the day from which the medical doctor certifies the patient’s medical condition.

The 6 weeks of compassionate care benefits do not have to be consecutive and can be taken intermittently over the 26 week period in a manner that is most convenient for the claimant. Of course, even when the claimant is within this window, no benefits can be paid if the claim has expired, if the maximum entitlement on the claim has been reached or the 6 weeks payable for the gravely ill family member has been paid.

In situations where the gravely ill family member dies before the end of the 26 week window or before the 6 weeks of compassionate care benefits have been paid, benefits would cease to be payable at the end of the week in which the gravely ill family member dies.

  1. EIA 23.1(4)

23.2.7.1  Compassionate Care Window Start

The start week of the compassionate care window is the week in which the medical doctor or practitioner signed the certificate if it is equal to the first week compassionate care benefits are claimed.

The first certificate submitted that meets the requirements of the legislation will determine the start of the 26 week window. Once the start week of the window has been established, it cannot be changed. The legislation provides that a subsequent certificate which indicates that the conditions of entitlement applied to the gravely ill family member on an earlier date will not be accepted to change the start of the window when1

  • all benefits that may otherwise have been payable in relation to that claim have already been paid at the time the certificate is filed with the Commission, or
  • the start of the 26 week window has already been determined regarding the gravely ill family member, and the certificate would have the effect of moving the beginning of that period to an earlier date; or
  • the claim is made in any other circumstances set out in the Regulations.

N.B. At present there is no Regulation defining any other circumstances.

This provision will ensure that a subsequent certificate submitted will not impact any compassionate care benefits already paid to another claimant for the same gravely ill family member.

There may be rare occurrences where a medical certificate is received with an amendment to the information provided on a previous medical certificate. As in any other situation where amended information is received, the claim may be reconsidered, keeping in mind the provisions of the compassionate care legislation.

  1. EIA 23.1(6)

23.2.7.2  Medical Certificate Issued Before Compassionate Care Claimed

Where the medical certificate is issued before the compassionate claim is made, the 26 week window starts with the earlier of:

  • the date of examination of the gravely ill family member where the doctor certifies that the two conditions exist: the patient has a serious medical condition and a significant risk of death within the next 26 weeks and the patient requires the care of support of one or more family members, or
  • the date which the medical doctor or practitioner attests that the two conditions applied at an earlier period of time.

23.2.7.3  Medical Certificate Issued After Compassionate Care Claimed

Where the medical certificate is issued after compassionate care benefits are claimed, the 26 week window starts with the earlier of:

  • the date the certificate is signed by the medical doctor or practitioner, or
  • the date of examination of the gravely ill family member where the doctor certifies that the two conditions exist: the patient has a serious medical condition and a significant risk of death within the next 26 weeks and the patient requires the care of support of one or more family members, or
  • the date which the medical doctor or practitioner attests that the two conditions applied at an earlier period of time.

Where benefits are requested for weeks prior to the week of signature of the medical certificate, information that the conditions for compassionate care benefits applied to an earlier date may be present.   This can be the date of last medical examination or date that the conditions applied earlier as indicated in the medical rather than the date of signature1. The date which will be used to start the 26 week window should be the one which will accommodate the weeks the claimant is requesting.

The week the medical doctor or practitioner signed the certificate can also be used as the start week of the window where the date of signature is prior to the compassionate care weeks being claimed.

  1. EIA 23.1(2)(a)(ii); 23.1(4)(a)(ii)

23.2.8  End of Entitlement within the Window

The compassionate care window is established for a specific period of 26 weeks1. Once established, the claimant is entitled to a maximum of 6 weeks of benefits. Legislation provides that the entitlement period ends at the end of the week when any of the following occur2:

  • All benefits payable in respect of the gravely ill family member are exhausted (6 weeks of benefits have been paid either to one individual or shared);
  • the gravely ill family member dies; or,
  • the 26 week window has expired.

In situations where the gravely ill family member dies before the 26 week window ends, compassionate care benefits would cease at the end of the week in which the gravely ill family member dies.  While entitlement to compassionate care benefits would cease at the end of this week, claimants may require additional time off to attend the funeral. The existing adjudication principles3 should be applied in these situations to determine if entitled to regular benefits, whether the funeral is in Canada or out of Canada4.

When the gravely ill family member recovers or the illness goes into remission and the claimant is no longer required to provide care or support, entitlement ceases the week the claimant advises of this change in the condition of the gravely ill family member.

There will also be situations where the gravely ill family member remains in the same condition after the initial 26 week window or later experiences a recurrence of the illness. When this occurs, an additional medical certificate could open a new 26 week window during which compassionate care benefits may be paid for 6 weeks. However, it must be kept in mind that a claimant can only receive a maximum of 6 weeks of compassionate care benefits in a benefit period.

Therefore, this new window will simply provide a new window during which compassionate care benefits could be payable to a family member. For example, if in the first 26 week window of a benefit period, only 4 weeks of benefits were paid to a claimant and a second window is set up on the same benefit period, an additional 2 weeks of benefits are potentially payable within the second 26 week window to that claimant.

Continuing the example above, if the claimant then qualifies to establish a new benefit period for compassionate care benefits, the balance of the week’s payable for the second window could be claimed on the new benefit period, an additional 4 weeks. Conversely, these benefits could be shared with other family members based on their individual entitlement5.

  1. EIA 23.1(4);
  2. EIA 23.1(4)(b);
  3. see 10.11.4, “Sickness or Death in Family”; see 10.11.8 “Out of Canada,”
  4. see 23.8.2, Other Out of Canada Situations and Compassionate Care Benefits.”
  5. see 23.2.9, “Sharing Compassionate Care Benefits.”

23.2.9 Sharing Compassionate Care Benefits

The legislation provides that the 6 weeks of compassionate care benefits in relation to the gravely ill family member can be shared by one or more claimants and that the weeks are to be divided as agreed to by those claimants1.

The 6 weeks of benefits can be claimed anywhere within the 26 week window2 and can be received concurrently by family members.

When these benefits are shared, the Commission staff must be able to determine whether any other family member is claiming or has claimed compassionate care benefits to care for the gravely ill family member and also the number of weeks being claimed by other family members.

However, when family members cannot come to an agreement, the remaining weeks will be divided by the Commission based on the prescribed rules in the following manner3:

  • When the number of weeks left to be paid can be divided equally between the family members claiming the benefits.
  • When the number of weeks is greater than the number of eligible family members, each family member will be assigned one week. The weeks will be assigned in the order in which the family members made their claim for compassionate care benefits, starting with the first eligible family member to make his or her claim, until no further week of benefits remains.
  • When the number of weeks is less than the number of eligible family members, the weeks will be assigned in the order in which the family members made their claim for benefits, starting with the first eligible family member to make the claim, until no week of entitlement remains.

This decision will be made by the Commission staff when family members are unable to come to an agreement on this issue.

  1. EIA 23.1(8);
  2. EIA 12(4.1);
  3. EIA 23.1(9); EIR 41.3

23.2.10  Antedates

Usual adjudication principles will apply when a claimant requests an antedate of a claim for compassionate care benefits. However, the legislation provides that, when an antedate is requested for compassionate care benefits, the antedate will be denied if at the time the claim is made1:

  • 6 weeks of compassionate care benefits have been paid; or,
  • the period of entitlement to compassionate care benefits has already been established by another claimant and the request to antedate would move the start week of the 26-week window to an earlier date.

This provision ensures that a request to antedate a claim for compassionate care benefits by one claimant will not affect the previous entitlement of another claimant.

Based on the nature of compassionate care benefits, there will be occasions where individuals may delay in making a claim for benefits. When a claimant is prevented from making a claim by reason of providing care or support to a gravely ill family member, a lenient approach will be applied in the same manner as for other special benefits2, keeping in mind the specific provisions mentioned above.

  1. EIA 10(5.1);
  2. see 3.3.5, “Prevented from Applying.”

23.2.11  Waiting Period

A two week waiting period must be served when an initial benefit period is established for compassionate care benefits1. However, only one waiting period must be served in relation to each gravely ill family member and 26 week window, regardless of the number of claimants making a claim for benefits.

When these benefits are shared, the first eligible person making an initial claim for benefits is required to serve the waiting period. The waiting period may be deferred for the other family members sharing this new benefit, provided that a waiting period has been served by another claimant in relation to that gravely ill family member and during the same 26 week window2.

Where two claimants make a claim for compassionate care benefits at the same time in relation to the same gravely ill family member, the claimants will be required to choose which one will serve the waiting period3.

It should be noted that based on the wording of the legislation the first claimant claiming compassionate care benefits must serve a 2 week waiting period in its entirety in order that another family member can have the waiting period deferred.

The current policy on waiving the waiting period continues to apply4. In situations where the waiting period was waived for the first person claiming compassionate care benefits, the second person establishing an initial benefit period for the same gravely ill family member within the same window, will be required to serve the waiting period. However, if the second claimant also qualifies to have the waiting period waived, this will be done.

  1. EIA 13;
  2. EIA 23.1(7);
  3. EIA 23.1(7)(b);
  4. EIR 40(6)

23.2.12  Earnings

The current allowable earnings provision applicable to regular and parental benefits also apply to compassionate care benefits.

Thus, claimants may earn up to 25% of their weekly benefit rate or $50.00 where the benefit rate is less than $200, without any deduction from benefits1.  Earnings in excess of the 25% or $50 will be deducted dollar for dollar.

[ January 2006 ]

  1. EIA 19(2)
previous | index | next