Digest of Benefit Entitlement Principles Chapter 23 - Section 2

23.2.0 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 weeks ^Footnote1 .

23.2.1 Family members who can receive compassionate care benefits

For the purpose of entitlement to compassionate care benefits, the term "family members" in relation to the individual who is gravely ill, applies to the following individuals: ^Footnote2

• the claimant's spouse ^Footnote3 , including common law partner;
• 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 regulatory provision further 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" are ^Footnote4 :

• 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 ward ^Footnote5 of the claimant or of their spouse;
• a current or former guardian ^Footnote6 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 ]

23.2.2 Qualifying and entitlement conditions

The individual claiming compassionate care benefits must have experienced an interruption of earnings ^Footnote7 from employment, and be major attached ^Footnote8 , that is, have 600 hours of insurable employment in their qualifying period.

In situations where a claimant has accumulated a violation, the claimant will require more than 600 hours of insurable employment during the qualifying period ^Footnote9 to be entitled to compassionate care benefits.

Individuals who are unemployed and already receiving EI benefits can also apply for and be entitled to compassionate care benefits.

The individual claiming compassionate care benefits must submit a medical certificate with regard to the gravely ill family member ^Footnote10 .

Compassionate care benefits are accessible to self-employed persons ^Footnote11 who have voluntarily registered into the EI program.

23.2.3 Proof of gravely ill family member

An eligible claimant must submit a medical certificate signed by a medical doctor ^Footnote12 or other prescribed medical practitioner ^Footnote13 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, meets 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 doctor ^Footnote14 , 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 in Canada is 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.

Medical professionals are not authorized to release medical information without the patient's consent or unless required by law. A section is 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.

23.2.4 Care or support of gravely ill family member

Care or support of a gravely ill family member includes ^Footnote15 ;

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 would not be automatically denied when the claimant does not actually provide care for only a few days. The determination of whether the claimant continues to prove entitlement to these benefits will be based on the merits of each individual case.

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

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 of compassionate care benefits payable.

1. The first is a maximum of 26 weeks of compassionate care benefits payable within a benefit period ^Footnote16
2. The second is a maximum of 26 weeks in a 52 week window in relation to the gravely ill family member.

These limitations apply whether the benefits are claimed by one individual or shared with another family member ^Footnote17

23.2.6 Compassionate care window

Compassionate care benefits are available to eligible claimants within a 52 week window, to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. This 52 week window during which 26 weeks of compassionate care benefits may be 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 Start of the compassionate care window

Subsection 23.1 (4) of the EI Act states that compassionate care benefits can be paid in the period that begins in the week in which the following falls:

• the day of issuance of the first valid medical certificate that is submitted to the Commission,
• in the case of a claim that is made before the day the medical certificate is issued, the day from which the medical doctor certifies the family member’s medical condition, or
• in the case of a request to consider that the claim is made at an earlier date ^Footnote18 , at that earlier day.

The first medical certificate submitted that meets the requirements of the legislation will determine the start of the 52 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 when ^Footnote19 :

• 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 52 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 are no Regulations 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 cases 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.

23.2.8 End of entitlement

The compassionate care window is established for a specific period of 52 weeks ^Footnote21 . Once established, the claimant is entitled to a maximum of 26 weeks of benefits payable within that window. The 26 weeks of compassionate care benefits do not have to be paid consecutively and can be taken intermittently during the benefit period or the 52 week window, in a manner that is most convenient for the claimant, provided the required medical proof supports the patient’s illness during the weeks claimed.

Legislation provides that no further compassionate care benefits can be paid after the end of the week in which any of the following occur ^Footnote22 :

• the benefit period has expired;
• the maximum number of weeks of benefits payable on that claim has been reached;
• the 52 week window has expired;
• the 26 weeks of compassionate care have been paid (either to one individual or shared); or
• the gravely ill family member dies.

In situations where the gravely ill family member dies before the 52 week window ends, compassionate care benefits would cease at the end of the week in which the gravely ill family member died. 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 principles ^Footnote23 should be applied in these situations, to determine if the claimant could be entitled to regular benefits, whether the funeral is in Canada or outside Canada ^Footnote24 .

If the gravely ill family member recovers, or the illness goes into remission, entitlement to compassionate care benefits ceases at the end of the week in which the claimant is no longer required to provide care or support to the gravely ill family member.

There will also be situations where the gravely ill family member remains in the same condition after the initial 52 week window, or later experiences a recurrence of the illness. When this occurs, an additional medical certificate could open a new 52 week window during which compassionate care benefits may be paid for up to 26 weeks. However, it must be kept in mind that a claimant can only receive a maximum of 26 weeks of compassionate care benefits in a benefit period. If the maximum has been paid this case, a new claim would may need to be established.

For example, John has a benefit period in effect from January 3, 2016 to December 31, 2016.

He applies for CCB to care for his gravely ill mother, and a CCB window is established from August 14, 2016 to August 12, 2017. John collects 20 weeks of CCB from August 14 to December 31, 2016, at which time his benefit period ends.

Tammie, John’s sister, establishes a claim for CCB. Her benefit period is in effect from June 18, 2017 to June 16, 2018. She collects the remaining six weeks in the CCB window John established. Tammie’s mother again becomes critically ill, and Tammie requests CCB benefits as of October 8, 2017. A second CCB window is established for the same patient (proper medical and authorization are submitted), from October 8, 2017 to October 6, 2018. As Tammie has already received six weeks of CCB within her benefit period, she may be eligible for up to 20 additional weeks, between October 8, 2017 and June 16, 2018, when her benefit period will end.

23.2.9 Sharing compassionate care benefits

The legislation provides that the 26 weeks of compassionate care benefits in relation to a 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 claimants ^Footnote25 .

The 26 weeks of benefits can be claimed anywhere within the 52 week window ^Footnote26 , subject to medical proof, and can be received concurrently by eligible family members.

When these benefits are shared, it must be determined how many other family members are claiming or have claimed compassionate care benefits to care for the same gravely ill family member, and the number of weeks being claimed by the other family members.

When eligible family members cannot come to an agreement, the remaining weeks will be divided based on the prescribed rules, in the following manner ^Footnote27 :

• When the number of weeks left to be paid can be divided equally between the family members claiming the benefits, each claimant will be paid an equal number of weeks.
• 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.

23.2.10 Access to parents of critically ill children benefits

If a compassionate care window ^Footnote28 has been established, a window for parents of critically ill children benefits can also be established for the same patient/child, and parents of critically ill children benefits can be paid in respect of that critically ill child. However, once a PCIC window is established, neither the parents, nor any other family member, can receive compassionate care benefits in relation to the critically ill child, until all parents of critically ill children benefits for that child, are exhausted, or until the 52 week period has expired.

Compassionate care benefits may become payable for the child, after parents of critically ill children benefits have exhausted, provided all other qualifying and entitlement conditions for compassionate care benefits are met.

23.2.11 Antedates

Standard 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 made ^Footnote29 :

• 26 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 establishing the claim on the earlier date would move the start date of the 52-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.

Taking into consideration the nature of compassionate care benefits, there may be occasions where individuals 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 benefits ^Footnote30 , keeping in mind the specific provisions mentioned above.

23.2.12 Waiting period

A two week waiting period must be served when an initial benefit period is established for compassionate care benefits ^Footnote31 . However, when the compassionate care benefits are shared between family members, only one waiting period must be served in relation to the same gravely ill family member and for each 52 week window.

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 other family members sharing these benefits, provided that a waiting period has already been or is being served by another claimant in relation to the same gravely ill family member, and during the same 52 week window ^Footnote32 .

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 period ^Footnote33 .

It should be noted that, based on the wording of the legislation, the first claimant claiming compassionate care benefits must serve a two 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 apply ^Footnote34 . 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 meets the conditions to have the waiting period waived, this can be done.

23.2.13 Earnings

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

The legislation provides that 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 benefits. Earnings in excess of the 25% or $50 will be deducted dollar for dollar ^{Footnote 35} .

Detailed information on the current rules applicable regarding the deduction of earnings while receiving benefits can be found on the Working While on Claim pilot project web page, on the Service Canada website ^Footnote36 .

[ January 2006 ]