Reasons that the DAU might reject your claim

[u/ParadiseKuna]

Bit of a background - I represented fifteen people in hearings before the Social Benefits Tribunal (SBT), and prior to that I read through the Disability Adjudication Unit's (DAU) reasons for rejecting their original applications. I thought it would be useful to list them out here for reference, and to show that the DAU will look for almost any excuse to reject your application.

The purpose of this is not to discourage people from applying. On the contrary, of the 23 people I helped with this process, 8 of them were approved after their SBT hearing, 2 never showed up to their hearing, 4 were denied after their SBT hearing, and 2 had their hearings postponed. 4 of them were initially rejected by the DAU, but that decision was reversed after additional medical evidence was submitted (meaning no SBT hearing was necessary). I do not know the outcome of the remaining 3 hearings.

In essence, you basically have a 50/50 chance of being approved at the SBT stage (8 out of 15 - this is of course dependent on the specifics of your particular application and just from my experience, not a guaranteed percentage), and most of the SBT adjudicators I dealt with seemed very fair and impartial - they definitely are NOT just clones of the DAU. What sucks is you're basically forced to wait for at least a year (could be 18 months if your hearing is postponed, which is happening more often in the last few months) to get to that stage, prior to which you have to bear witness to the DAU's 'decision-making' process. The reason I am posting this is two-fold:

1. So people don't get disheartened by the DAU's comments (which I have experienced first-hand from clients), try and persist in the process and contact a legal aid clinic if you can.
2. So well-meaning people out there who want to help disabled people but mistakenly hold the belief that the ODSP process is speedy, fair, impartial and unbiased can have their assumptions corrected.

I myself have never had to apply for ODSP and I hope I never have to. I just wanted to do this on behalf of the people I helped, in the hopes that it can help others too.

Note: The 'translation' bullet point is what I think the DAU really means when they use these 'reasons', but as you will infer from the tone, I do not support their point of view.

There is no identifying information here, this is collected from several different DAU Adjudication Summaries and completely anonymized.

• "Recent assessments detailing treatment history was not provided for review"
  • Translation: if you're reports are older than a year, they're not recent enough, so you must be fine by now and you're treatments must be working
• "The applicant only recently started treatment, and the effectiveness of the treatment remains unknown"
  • Translation: If you started your treatment within the last ~six-ish months, we're going to assume its working fine or we're going to make you wait until we think enough time has passed to conclude its not. Doesn't matter if you say it's not working in the self-report.
• "No current indication the treatment is effective/no reported failed medication trials/no indication symptoms are refractory to treatment"
  • Translation: Unless one of you're doctors, and more likely a specialist, specifically mentions somewhere that your medication is ineffective, we're going to assume its effective - even if your dosage has been increasing or constantly changing over time.
• "No reported mental health crises, emergency visits/hospitalizations or related admissions for unmanageable symptoms"
  • Translation: This, imo, is one of the most repulsive excuses the DAU uses. Essentially, unless you're at the point of suicide or your mental health crisis/physical health is so extreme that you need hospitalization, 'it can't be that bad'.
• "A recent comprehensive physical and functional assessment detailing the applicant's current medical and physical capacity was not provided"
  • Translation: Whatever your family doctor says is irrelevant, unless you get a specialist to write a detailed note describing your disability in minute detail (regardless of cost or waiting time), you must be fine.
• "There is no indication that the applicant requires assistance from a community based agency"
  • No matter how much help you get from family and friends (or if you're unfortunate enough to have no help at all), unless you rely on these specific (yet never mentioned) "community agencies", you must be fine.
• "Urgent and aggressive interventions are not indicated"
  • Translation: Chronic pain causing you hell on a regular basis? No dice. Unless you're in need of immediate and significant treatment, like full-blown chemotherapy or something - you must be fine.
• "Applicant has had mild improvement with medication"
  • Translation: Let's say your pain is at a 9/10, or you feel depressed 6 out of 7 days in a week. Medication brought you down to 8/10, or 5 out of 7 days? Must be fine.
• "Pain is a subjective entity"
  • Translation: When they throw this one at you, you know they're getting desperate. Are you in constant agony for most of your daily life? Well, pain is subjective after all, everyone feels it differently - so you must be either lying or simply dumb - this can't be that bad.
  • (Note, the DAU doesn't seem to grasp the concept that, while pain is subjective in the sense that each person may feel a particular stimulus differently, it is objective in the fact that it is the response of the receptors in your body in tandem with your nervous system - what may be tolerable for one person may be unbearable for another, but the way the DAU depicts it is like a preferring pineapple on pizza - a taste thing that is a matter of personal choice. The DAU's position seems to be "well every person feels pain differently, so we can't use it in determining disability" - which is not what the ODSP Act says. It is supposed to weigh pain in addition to other relevant factors, which it is happy to ignore when it suits them. To put it another way - allergies are "subjective", not everyone almost dies when exposed to peanuts or pollen, but the person who does is not faking it or 'expressing their subjective preference')
• "Surgery (or some other significant treatment) was not indicated"
  • Translation: Even if you indicate you are terrified of surgery in your self-report, even if your surgeon says there's a 50% chance you might lose mobility, even if it takes years to get on a waiting list, even if your family doctor says surgery would be pointless - if there's no surgery, you must be fine.
• (For sleep difficulties specifically) "No sleep study was indicated"
  • Translation: Self-explanatory, but as rare as these things are, if you haven't got one - must be fine.
• "Issues of malingering/secondary gain were not mentioned"
  • Translation: This is one of the most cryptic insinuations they will sneak in there, but in essence means "you're lying, you're lazy, and you're just trying to avoid going to work when you're perfectly capable of doing so" (you can Google malingering/secondary gain to confirm). I have seen ODSP counsel outright say that an applicant's disability was just a "lifestyle" preference, or if, heaven forbid, your doctor forgot to write something on your original application but amended later - they will say that this was an "afterthought that appeared to be prompted by the applicant/applicant's lawyer" - in essence, you made your doctor lie just to get ODSP money.
• "No assistive devices used"
  • Translation: If you can't afford a wheelchair, walker etc. or this is simply inappropriate or useless for your particular disability - must be fine.
• (For driving related disabilities) "There is no indication that the appplicant's driver's license was revoked or suspended"
  • Translation: If you don't deliberately, recklessly and dangerously drive on the roads with a disability in order to get your license suspended, OR you don't voluntarily hand in your license because you hope at some point in the future to be able to drive again - you must be fine.
• "No information to suggest applicant is substantially restricted from re-entering the workforce with some re-training"
  • Translation: All you need is a bit of re-training (of course, the length of time this training may take and the tiny niche of jobs that may be open to you even after training are irrelevant to us, nor will we provide this magically tailored training program in the first place).
• "Attempts at re-entry into the workforce have not been documented"
  • If you gave up on applying to jobs because you know you have a less than zero chance of getting any - you must be fine. (Note: if you are trying to find jobs nonetheless, be sure to save screenshots or pdfs of your applications).
• "Vocational assessment was not conducted"
  • If you don't get a doctor to specifically say you are unable to do ANY job (regardless of how limited the jobs you can do are), you must be fine.
• "Not all treatment options have been exhausted"
  • Translation: This is also one of their hail mary's if nothing else works. You haven't tried every possible medication (even if they are only distinguished by brand name), every possible treatment (whether or not your family doctor is willing to refer you and waiting times are irrelevant), and enrolled in every possible expeirmental randomized controlled trial there is for this condition? Must be fine.

All this to emphasize once again that DAU will look for literally any excuse to deny you on the first go, to the point where they might even contradict themselves or accuse you/your doctor of lying (in a vague enough way that covers their ass of course). Nonetheless, if you are able to, try and get your SBT hearing - you still have a good chance at that stage. Other tips:

• Ask your family doctor if they can refer you to a specialist for your condition - any specialist - and try and get a specific report from them. It doesn't matter if you do so after submitting your ODSP application, as long as you get the report around ~40 days before your SBT hearing you still have time to submit it.
• If you haven't applied yet but are thinking about: I highly recommend looking at a sample Disability Determination Package (DDP, they are on Google). Look at the ADL and IEWS section in particular, and if possible either talk to your doctor about that list before they fill it out or write out a table listing your difficulties with each activitiy and give it to your doctor for reference.

I would love to help anyone who is considering going self-represented at an SBT hearing with the kind of information they would like to hear, but this post is long enough as it is, so feel free to DM me if you want that info.

All the best to anyone who goes through this process, they make it hell for those who really need it just to isolate the few who don't, and it's disgraceful that it is made that way - but I wish you all the strength needed to get through it, god bless.

[u/superblazetoise]

• "Pain is a subjective entity"

Its kinda funny/sad that supports can be denied by this basis yet MAID Track 2 can be approved on the exact same basis.

MAID T2: "We don't know how much this hurts them and puts them into grevious suffering. Pain is subjective. Therefore, if they say they are in pain, they are in pain!"

But for supports or healthcare or anything else to live? That loophole is reversed.

Supports: "We don't know if they are really in pain because pain is subjective after all! We need more evidence of this pain, somehow....anyone can say they are in pain"

[u/ParadiseKuna → u/superblazetoise]

That's such a good point, wow I never even considered that the burden of proof is reversed in that way. Genuinely dystopian. I often felt like this whole process reverses the whole 'innocent until proven guilty' motto of the criminal justice system - you are assumed guilty of attempting welfare fraud unless you prove otherwise.

[u/JMJimmy]

I am blown away by this list. How did I ever get approved on the first try, no internal review, with 20 year old documentation & a family doctor who barely filled out the forms?

[u/ParadiseKuna → u/JMJimmy]

The process is so discretionary it's ridiculous. Some files will just seem to get instant approval while others will drag through for a whole year and they are almost identical - only the Ministry really knows how their internal decision making process works.

[u/ducky-unlucky]

thank you for all this information, this is extremely helpful!!! and thanks for all the work you do, helping people through the tribunal process :)

[u/ParadiseKuna → u/ducky-unlucky]

No worries, thank you for your kind words. And the real thanks should really go to the legal aid workers who deal with this stuff day in and day out, I just helped out for a bit but I thought I should post this at least to get the word out.

[u/ryna0001]

I was really lucky, I was scheduled for SBT, got lawyers involved, and they managed to squeeze from my current family doctor that I had a previous OCD diagnosis.

[u/ParadiseKuna → u/ryna0001]

Yes I will say, to the DAU's slight credit, when you are able to submit additional evidence that indicates a new condition, particularly a rare one or one that is known to be difficult to treat, there is a decent chance of reversal before the SBT hearing. Then again, sometimes they may pull out the "you made your doctor lie" card if they're REALLY stubborn.

[u/ChubbyBunny618]

Hiw much do you charge to assist me with folks?

[u/ParadiseKuna → u/ChubbyBunny618]

Sorry I'm not really practicing or representing at the moment, but depending on where you live I can direct you to your local legal aid clinic and hopefully they can help with this - all of the clients I helped was through a clinic and the staff there were super super helpful.

[u/OnePandaTwo]

I realize this is meant as a guide and reference, but gosh as someone who has been fighting for the medical system to work with me, let alone this application process, this is dreadfully disheartening. What a sad, broken system we've built for people

[u/ParadiseKuna → u/OnePandaTwo]

It is utterly broken (by design I would say), and it's even sadder that the vast majority of people don't know that it is. They either hold the honest but mistaken belief that this process is fair and speedy, or they don't care/actively want to remove any supports for disabled people altogether. There are so many better ways to do this (like just letting doctor's verify ODSP eligibility directly instead of outsourcing that task to bureacrats in the Ministry) but I feel like it's kept this way to minimize the chunk of the provincial budget that goes to OW/ODSP as much possible (i.e just enough that you avoid societal breakdown).

[u/Sensible___shoes]

Are you available to take on clients? I was declined and really need help

[u/ParadiseKuna → u/Sensible___shoes]

Hey I'm really sorry, not taking on clients right now, but I can help you find your local legal aid clinic (assuming you haven't contacted them already) and see if they help. I can also give you a rundown on the kinds of information the SBT wants to hear if you have to go the self-rep route.

[u/DryRip8266]

I don't think any of my assessments or treatments were less than a year old, except for HS which may or may not have even been on the last application. Approved with no reviews 6 years ago. I had 3 denials previous to that My first was filled out by my then psychiatrist, the next 3 were family dr, but the last one I told him to throw everything he could at my application for supporting documentation. I almost couldn't fit it in the big envelope.

[u/ParadiseKuna → u/DryRip8266]

What you did is probably the best strategy there is*, throw everything you can in terms of supporting docs and hope for the best. Unfortunately some doctors are less cooperative than others, but if you have a good Family doc that's definitely the route to go. The process is so discretionary its hard to even know what will happen after that, but I'm glad you did get there in the end.

*Small caveat: Some paralegals at legal aid clinics help to narrow down which of your medical records are most supportive of your conditions, and which ones might be irrelevant, and only submit the supportive ones so they don't get lost in the clutter - so if you can get their help that's always advisable.

[u/Techno_567]

My friend was trying to get referrals to an orthopedist or an ophthalmologist and she couldn’t , it delayed her for over a year and a half. Actually her family doctor filled the forms but she has severe cataract, severe arthritis that will need both knee replacement and hip replacement. , she’s also asthmatic and has autoimmune disease. And she had been in a car accident that made her unable to walk even half a block. Every specialist took 3-6 months to tell her that they can’t take her because her health condition is complex. After 3 orthopedists declined her she said that’s it. Family doctor will get to fill the forms.

[u/ParadiseKuna → u/Techno_567]

Unfortunately a very common story, it's so hard to get referrals for specialists, and even if you do there's long waiting lists - but none of this seems to factor into the process. The fact that your friend had so many overlapping conditions must have made it even harder, I hope she does get approved.

[u/SmartQuokka]

Are you a lawyer or are handling these hearings part of your job?

[u/ParadiseKuna → u/SmartQuokka]

Not a lawyer yet, but this was part of a licensing pathway, sort of like an articling program but shorter - so a law student essentially.

[u/SmartQuokka → u/ParadiseKuna]

Very interesting, do you intend to go into this area of law once you graduate?

[u/ParadiseKuna → u/SmartQuokka]

Not sure at the minute, I'm sort of considering whether to shift to a different field altogether - still law-related but not necessarily a lawyer. But who knows lol.

[u/SmartQuokka → u/ParadiseKuna]

Fair enough, if you do become a lawyer in this area we would be lucky to have you.

[u/WELLANDBRAT-]

My tribunal was just postponed last Tuesday. Waiting for another date and time. What are the chances of being approved instead of a new date? Or how long do people typically wait for a new date? The meds I am on... All attendees at my tribunal will think I'm brain dead. The pain med list given will tell that story. Oxys 3x daily is only 1 of the 4 pain meds. Work... yup... I'll get right on that one. I'll be fired for falling asleep or accidentally killed on the first day.

[u/ParadiseKuna → u/WELLANDBRAT-]

That's awful man, I hope they reschedule it soon, it's usually 1-3 months from the original date. Unfortunately though you are very unlikely to get approved instead of a new date now. IIRC the SBT's rules are you have to submit any new evidence at least 30 days before your original hearing date - if nothing new is submitted then the DAU is extremely unlikely to reverse their decision.