Archived - 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 seriously 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 member" in relation to the individual who is seriously ill, applies to the following individuals: ^Footnote2

• spouse or common-law partner
• child, their spouse or common-law partner
• child of spouse or common-law partner, their spouse or common-law partner
• parent, their spouse or common-law partner
• parent of spouse or common-law partner, their spouse or common-law partner
• sibling, step-sibling, their spouse or common-law partner
• sibling, step-sibling of spouse or common-law partner
• grandparent, their spouse or common-law partner
• grandparent of spouse or common-law partner
• grandchild, their spouse or common-law partner
• grandchild of spouse or common-law partner
• uncle, aunt, their spouse or common-law partner
• uncle, aunt of spouse or common-law partner
• nephew, niece, their spouse or common-law partner
• nephew, niece of spouse or common-law partner
• current or former foster parent
• current or former foster parent of spouse or common-law partner
• current or former foster child, their spouse or common-law partner
• current or former ward
• current or former ward of spouse or common-law partner
• current or former guardian, their spouse or common-law partner or
• a person who is considered to be like a close relative, whether or not related by blood, adoption, marriage or common-law partnership

23.2.2 Qualifying and entitlement conditions

The individual claiming compassionate care benefits must have experienced an interruption of earnings^{Footnote 3} from employment, and be major attached^{Footnote 4}, 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^{Footnote 5}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 seriously ill family member^{Footnote 6}.

Compassionate care benefits are accessible to self-employed persons^{Footnote 7} who have voluntarily registered into the EI program.

23.2.3 Proof of seriously ill family member

An eligible claimant must submit a medical certificate signed by a medical doctor^{Footnote 8} or nurse practitioner^{Footnote 9} treating the seriously ill family member. The medical doctor or nurse practitioner will attest to the fact that his or her patient, the seriously ill family member, meets the following 2 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

Where the seriously ill family member resides outside of Canada, a medical certificate issued by a medical doctor or nurse practitioner recognized by the appropriate government authority with similar qualifications to a medical doctor or nurse practitioner in Canada is acceptable.

The certificate will identify the seriously ill family member - the doctor or nurse practitioner'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 or nurse practitioners 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 or nurse practitioner has attested to the 2 conditions of entitlement.

[June 2020]

23.2.4 Care or support of seriously ill family member

Care or support of a seriously ill family member includes^{Footnote 10};

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 seriously 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 seriously 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 seriously 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 seriously 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^{Footnote 11}
2. The second is a maximum of 26 weeks in a 52 week window in relation to the seriously ill family member.

These limitations apply whether the benefits are claimed by one individual or shared with another family member^{Footnote 12}.

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 seriously 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^{Footnote 13}, 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 seriously ill family member on an earlier date will not be accepted to change the start of the window when^{Footnote 14}:

• 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 seriously 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 seriously 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^{Footnote 16}. 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^{Footnote 17}:

• 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 seriously ill family member dies.

In situations where the seriously ill family member dies before the 52 week window ends, compassionate care benefits would cease at the end of the week in which the seriously 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^{Footnote 18} 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^{Footnote 19}.

If the seriously 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 seriously ill family member.

There will also be situations where the seriously 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 seriously 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 seriously 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^{Footnote 20}.

The 26 weeks of benefits can be claimed anywhere within the 52 week window^{Footnote 21}, 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 seriously 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^{Footnote 22}:

• 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 family caregiver benefits

If a compassionate care window^{Footnote 23} has been established, a window for family caregiver benefits can also be established for the same patient, and family caregiver benefits can be paid in respect of that critically ill or injured family member. However, once a family caregiver window is established, neither the parents, nor any other family member, can receive compassionate care benefits in relation to the critically ill patient, until all family caregiver benefits for that patient, are exhausted, or until the 52 week period has expired.

Compassionate care benefits may become payable for the family member, after family caregiver 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^{Footnote 24}:

• 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 seriously ill family member, a lenient approach will be applied, in the same manner as for other special benefits^{Footnote 25}, keeping in mind the specific provisions mentioned above.

23.2.12 Waiting period

A one week waiting period must be served when an initial benefit period is established for compassionate care benefits^{Footnote 26}. However, when the compassionate care benefits are shared between family members, only one waiting period must be served in relation to the same seriously 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 seriously ill family member, and during the same 52 week window^{Footnote 27}.

Where two claimants make a claim for compassionate care benefits at the same time in relation to the same seriously ill family member, the claimants will be required to choose which one will serve the waiting period^{Footnote 28}.

It should be noted that, based on the wording of the legislation, the first claimant claiming compassionate care benefits must serve a one 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^{Footnote 29}. 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 seriously 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

Any earnings received while in receipt of EI compassionate care benefits must be declared and will be deducted from benefits at a rate of 50 cents of EI benefits for every dollar earned or received while on claim, up to a maximum of 90 percent of the weekly earnings used to establish their EI benefit rate. Any earnings above this threshold are deducted dollar for dollar from benefits [EI Act 19(2)].

Detailed information on the rules regarding the deduction of earnings while receiving benefits can be found in Digest Chapter 1.9.8 – Earnings while on claim and on the Government of Canada website.