An adult eligible for the employment-assistance program may be found to have a temporarily limited capacity for employment if, due to the adult’s physical or mental condition, the adult will be unable, for a period of at least one month, to engage in any activity that may be proposed as part of an Individualized Integration, Training and Employment Plan.
Usually this inability is demonstrated by providing a medical report which describes the nature and duration of the limitations.
Unless the content of the medical report is questionable, the temporary limitations found therein are recognized:
- when there are functional limitations and for the duration indicated, when the attending physician has checked NO in response to the question in Section A.
The Officer cannot reduce him/herself the duration requested by the attending physician. However, he/she refuses an application when the attending physician has checked YES in response to the question in Section A.
He or she refuses also an application when a beneficiary submits a new medical report which contains exactly the same information as the previous medical report, which was refused following its review by an evaluating physician.
If the medical report is questionable, the file is forwarded to an evaluating physician for a more comprehensive review.
An adult may be found to have a temporarily limited capacity for employment if a copy of an application for a disability pension under the Quebec Pension Plan, Canada Pension Plan, a U.S. social security plan or a private disability insurance plan and a medical certificate are submitted; in this case, a medical report is not required.
If the person cannot be found to have a temporarily limited capacity for employment for health reasons, an evaluation should be done to determine whether the person could be found to have a TLCE for some other reason as set out in the following sub-topics.
FOR EXAMPLE, a medical report IS QUESTIONABLE in the following cases:
- when, in the officer's opinion, there are grounds to question the information contained in the medical report (e.g. several diagnoses and several durations in the same report);
- when, in the officer's experience or after consulting the Guide of Medical Diagnoses, the length of time the person will be unable to participate in activities as part of a Plan does not seem to correspond to the duration of the health condition as noted in the medical report (e.g. eczema, duration 10 months; rupture - cerebral aneurysm, duration 1 month);
- A first medical report (non repetitive) which presents a duration exceeding the recommended duration in the Guide of Medical Diagnoses should not be referred to an evaluating physician unless it is questionable on other grounds. However, all medical reports must be referred when the duration entered in the Guide is 0 month.
- when, following a finding that the person does not have a severely limited capacity for employment, the assessment committee or the review committee has already decided on the duration of a temporarily limited capacity and, upon the expiry of that period, the beneficiary submits a new medical report with the same diagnosis in order to again be found to have a temporarily limited capacity for employment for health reasons;
- when a refusal to have a severely limited capacity for employment recognized is renewed by the officer following reapplication for a new decision regarding recognition of a temporarily limited capacity for employment for health reasons.
- when the beneficiary refuses to apply for recognition of a severely limited capacity for employment even though the medical report contains a diagnosis of permanent or prolonged functional limitations (at least 12 months).
- in any other situation considered ambiguous by the officer (e.g. diagnosis that cannot be found in the Guide of Medical Diagnoses or differing from the designation found in the List, cases that continue under a temporarily limited capacity for employment for health reasons that are lasting (12 months and more within the past 18 months, whatever the diagnoses), reports that are OVERLY repetitive).
Reports are deemed consecutive when there is a period of 3 months or less between each.
- where a disability is diagnosed, the officer may obtain support from a physician evaluation when, in his of her opinion, a diagnosis has similarities with one of the diagnoses on the list of disabling diagnoses but is not identical in all respects