When a person has been found not to have a severely limited capacity, it must be determined whether this is an application for REVIEW or a NEW APPLICATION.
It is a NEW APPLICATION, and then the regular processing procedure begins with the submission of a medical report form, if:
- it is submitted after the 90-day period for requesting a review;
- it is submitted before this date but the person reports a deterioration in his or her physical or psychological condition;
- it is submitted at the same time as an application for review because the person would like both to challenge the decision before the review committee and to reapply to be recognized as having a severely limited capacity for employment. However, the resubmitted application is processed by the officer only if the application for review is rendered and is rejected.
In these cases, a refusal is renewed if the new medical report contains a non-obvious diagnosis identical to the preceding one and there have been no changes in the socio-occupational profile that would provide further entitlement to review. To check whether the client is entitled to the TLCE (temporarily limited capacity for employment) adult program category for health reasons, the officer forwards the file to the evaluating a physician for evaluation since it is a "questionable" case.
If an application is made within the review period, it is deemed to be an application for review that must follow the usual procedure.
Example 1
A recipient applies in the month of February to obtain recognition of a severely limited capacity for employment. The medical report, dated January 30, diagnosed a depressive psychosis with temporary functional limitations and a limited capacity to develop work skills for a period of 9 months.
His or her application was refused in the month of February, but he or she was recognized with a temporary limited capacity for employment for a period of 6 months, i.e. up to July 30 (the period of 6 months is calculated as of January 30).
In the month of July, the recipient provides a new medical report containing the same data than the previous one and his or her socio-occupational profile has not changed.
The officer may therefore notify him or her of the refusal to recognize his or her severely limited capacity for employment without referring the file to the committee, but forwards the file to the evaluating physician to check whether the client is entitled to an extension of the benefit for a temporary limited capacity for employment.
Notwithstanding the aforementioned, if an application is made within the review period, it is deemed to be an application for review that must follow the usual procedure.
Example 2:
If, in the previous example, the recipient had provided a new medical report within the review period, the officer should have notified the client of the refusal to recognize his or her severely limited capacity for employment, and consider as well that this is an application for review.