Patient Support Programs for the Seriously Injured

If you or a loved one has been injured or involved in a car crash, you’re probably overwhelmed.  And worried about how you will support yourself and your family.

At Campisi, we understand. We make it easy. We’ve been through this before for our injured clients. That’s why we know about a whole list of support programs that help you and your family. 

Here are some that might help you.

Ontario Disability Support Program (ODSP)

What Is It?

ODSP is a great program that offers monthly financial assistance monthly to help with the costs of basic needs, like food, clothing, and shelter. 

It also offers income support and includes benefits like drug coverage and vision care, for clients and their eligible family members.

Eligibility:

To qualify for ODSP income support, you must:

• be at least 18 years old (start application up to 6mos prior to 18th birthday);
• be an Ontario resident;
• be in financial need as determined by your ODSP caseworker; and
• meet the program’s definition of a person with a disability or be a member of a prescribed class.

How to Apply:

If you require immediate financial assistance, please contact your local Ontario Works office (you can also still apply for ODSP). If you’re an Ontario Works client, your financial need has already been established. Speak to your caseworker if you want to apply for ODSP income support.

Employment Insurance (EI) Sickness Benefit

What it is:

This EI program offers temporary financial assistance to sick or injured workers. Once it runs out, you can then apply for regular EI benefits. You could be eligible to receive up to a maximum of 15 weeks of EI sickness benefits and then Regular EI benefits.

Eligibility:

You may be entitled to receive EI sickness benefits if:

• you are employed in insurable employment;
• you meet the specific criteria for receiving EI sickness benefits;
• your normal weekly earnings have been reduced by more than 40%; and
• you have accumulated at least 600 hours of insurable employment during the qualifying period, being the shorter of:
• the 52-week period immediately before the start date of your EI claim; or
• the period from the start of a previous EI benefit period to the start of your new EI benefit period, if you applied for benefits earlier and your  the application was approved in the last 52 weeks.

How to Apply:

You should apply as soon as possible after you stop working. You may be required to use all your available sick leave before applying. If you delay applying for benefits later than four weeks after your last day of work, you risk losing benefits unless you have a good explanation for the delay.  To find out if you are eligible to receive EI benefits, you must submit an application online through Service Canada.

Short-Term Disability

What Is It?

Short-term disability (STD) coverage provides benefits while you are sick or injured. To qualify for short-term disability, you will need to have insurance either through your employer or personally.  If your employer has a short-term disability plan, you must claim through your disability plan. If you do not have short-term disability coverage and your employer does not offer one, you may be eligible for EI sickness benefits. Sometimes, the EI sickness benefits work with any STD coverage you have and your insurance company will guide you through the application process and tell you what needs to be claimed and when.

Eligibility

Typically, an insurance company will assign a case manager for your claim. During the evaluation of your claim for eligibility benefits, the case manager finds out if you satisfy the criteria for total disability.

In the case of a short-term disability claim, the definition of disability generally revolves around your capability to perform the essential duties of your current occupation or a similar one. The case manager carefully examines medical evidence that proves the symptoms, limitations, and restrictions you have reported.

Long Term Disability

What is it?

Long-term disability insurance benefits generally begin when the following benefits end: short-term disability insurance, sick leave benefits from your employer, or EI benefits. Most long-term disability plans will replace 60% to 70% of your normal income. The benefit can be taxable or not taxable. 

Some may provide disability benefits for up to two years if you’re unable to return to the job you had before becoming disabled. After two years, you may continue to receive benefits only if you are no longer able to work at all. 

There is often a list of exclusions and limitations within the disability policy, so you will need to check the details of your policy. For example, if you had pre-existing conditions and you have a group policy, your pre-existing condition might exclude you from the policy. 

Eligibility

The definition of disability during the initial part of an LTD claim is typically the same as short term disability; concerning your ability to work in your own occupation.

Considering recent legal cases, you must submit an application for long-term disability (LTD) benefits to your insurance company to safeguard your entitlement to benefits. Otherwise, if you wait, you might be disentitled. 

If the end of the waiting period is approaching and you have not yet received the LTD forms from the insurance company, it is advisable to request an LTD application package (if the provider is different from your short-term disability insurer) or an LTD transition package (if it is the same insurer). 

Sometimes, your employer or union is the one that must give you these forms. Make sure you ask!

You must promptly submit your Member's Statement and Attending Physician's Statement in accordance with the timelines specified in your policy. To determine the application deadline, it is imperative that you thoroughly review your policy.

Canada Pension Plan Disability (CPPD)

What Is It?

Canada Pension Plan (CPP) provides disability benefits (disability pension and postretirement disability benefit) to people who have made enough contributions to the CPP and who are disabled and cannot work at any job on a regular basis. Benefits may also be available to dependent children.

Eligibility:

To qualify for a Canada Pension Plan (CPP) disability benefit, you must:

• have a severe and prolonged disability;
• be under the age of 65; and
• meet the CPP contribution requirements, meaning you must have contributed to the CPP in four of the last six years; or three of the last six years if you have contributed for at least 25 years.

How to Apply:

You must apply in writing. The online application kit for Canada Pension Plan Disability benefits includes the application form and the medical report to be completed by your doctor or nurse practitioner. A hard copy of the application must be mailed to the nearest Service Canada office with certified copies of any required documents.

Get your application in as soon as possible. The reason: retroactive benefits can be paid from the date you submit your portion of the application. Do not wait for your doctor to submit their portion of the application. 

Trillium Drug Benefit

What it is:

The Trillium Drug Program helps Ontarians pay for their high prescription-drug costs by covering the cost of more than 4,400 prescription drugs that are currently available through the Ontario Drug Benefit program.

Eligibility:

You should apply if:

• live in Ontario;
• have a valid Ontario health card number;
• do not already qualify for the Ontario Drug Benefit program (for example, you are not enrolled in a program such as Ontario Works)
• do not have an insurance plan that  pays for 100% of your drugs; and  spend about 4% or more of your after-tax household income on prescription drug costs.

How to Apply:

The Trillium Drug Program year is from August 1 to July 31. Make sure you apply by September 30 to be reimbursed for any eligible drug you received in the previous program year (August 1-July 31). You must apply for the Trillium Drug Program as a household. Your household’s enrolment will be renewed automatically every year and you will receive an annual confirmation letter. You can find the application form online or by calling.

Home and Community Care Support Services (HCCSS)

Formerly Local Health Integration Networks (LHINs)

What it is:

Home and Community Care Support Services (HCCSS, to reflect a focused service delivery mandate to deliver patient care.

HCCSS plan, integrate, and fund home and community care services for Ontarians and coordinate admission to long-term care facilities. Available services may include nursing, physiotherapy, occupational therapy, speech-language therapy, dietitian services, pharmacy services, diagnostic and laboratory services, respiratory therapy, social work, social service work, personal support and homemaking.

Eligibility:

Anyone can make a referral to an HCCSS- an individual requiring service, a family member, caregiver, friend, physician or other health care professional.

How to Apply:

The first step is to call the main HCCSS phone number, 1–866–532–3161, which will automatically direct your call to your local home and community care office . Let them know that you are making a referral for services. If your healthcare provider has already made the referral for you, you can expect a phone call from HCCSS once the referral has been processed to ask some questions to better understand your needs. Then, you will either be connected with a Care Coordinator, or HCCSS will refer you to the program or service that may be right for your needs.

For a free copy of this information, you can download a copy of our Personal Injury Resource Guide.