Officers are the first decision-making level. They make decisions in OBVIOUS CASES, as defined in the list of disabling diagnoses. Physicians may use an ICD-9 (International Classification of Diseases) code to indicate the diagnosis. The officer checks that it corresponds to a diagnosis on the list of obvious cases (refer to 4.2.10)
The officer acts as follows, depending on the situation:
THE OFFICER RECOGNIZES a severely limited capacity for employment of an adult and grants the SLCE allowance in the following OBVIOUS CASES:
where the medical report contains a diagnosis that is IDENTICAL to one on the LIST OF DIAGNOSES, WHATEVER THE DURATION OF THE FUNCTIONAL LIMITATIONS indicated by the attending physician;
where the adult or one of the adult members of the family is receiving DISABILITY BENEFITS from the Quebec Pension Plan, the Canada Pension Plan, a U.S. social security plan or a private disability insurance plan. In the latter case, officers will ensure that the disability is a permanent one (long-term coverage) and not simply a temporary disability. The granting of a SLCE allowance is retroactive to the month following eligibility for a disability program, but cannot be before the date of the application for last resort financial assistance.
When a recipient loses his right to his disability pension (benefits from a private or public organization) after returning to work, his eligibility for the allowance for a severely limited capacity for employment must be reassessed as per the prescribed re-examination procedure (see section 4.2.14).
This adult or one of the members of his family is administered by the Public Curator. The allowance for a person with a severely limited capacity for employment is retroactive from the month the tutorship is instituted. However, this retroactivity cannot surpass 90 days and may not date back to prior to July 1, 2005.
When the tutorship or curatorship comes to an end, the person’s eligibility for the allowance for limited capacity for employment must be reassessed as per the prescribed re-examination procedure (see section 4.2.14).
This adult or one of the members of his family is administered by a tutor or a tutor assigned by the court. The advisor must make sure that the tutorship or curatorship was instituted for health reasons. The allowance for severely limited capacity for employment becomes retroactive when the decision is rendered. However, this retroactivity cannot surpass 90 days and may not date back to prior to July 1, 2005.
When the tutorship or curatorship comes to an end, eligibility for the allowance for limited capacity employment must be reassessed as per the prescribed re-examination procedure (see section 4.2.14).
THE OFFICER REFERS the case to a medical and socio-occupational assessment COMMITTEE for evaluation, after providing information on the employment-assistance program, if the medical report contains a NON-OBVIOUS diagnosis and the functional limitations are PERMANENT OR PROLONGED (at least 12 months).
If the medical report contains a non-obvious diagnosis and there are no functional limitations or the limitations are TEMPORARY (less than 12 months), the officer processes the file in accordance with the established rules and procedures.
When the file includes a medical report containing a NON-OBVIOUS diagnosis, the functional limitations are PERMANENT OR PROLONGED (at least 12 months) and the beneficiary REFUSES to be considered as having a severely limited capacity for employment, the officer sends the medical report to the departmental an evaluating physician for a consideration of whether the beneficiary has a severely limited capacity for employment.
If the beneficiary seems to HAVE SERIOUS PSYCHIATRIC PROBLEMS but refuses or neglects to meet with a physician to complete the medical report, the file is REFERRED TO HEALTH, who may, if he or she deems it appropriate, submit the file to the committee.
If an applicant has already been admitted to the Financial Support program (before October 1999) or has already been recognized as suffering from a severely limited capacity for employment (after October 1999), the officer readmits the applicant without having to again go through the usual process, if the reasons for the absence are the following:
- return to the labour market: the period of absence is 48 consecutive months following the month work was started;
- other situations: the period of absence is 24 consecutive months following the last month on assistance.