Digest of Benefit Entitlement Principles Chapter 22 - Section 2

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22.2.0 Family caregiver benefits

Family caregiver benefits are available to an eligible family member(s) for the purpose of providing care or support to a critically ill child Footnote 1 , or adult, also referred to in this chapter as “care recipient”.

22.2.1 Claimants who can receive family caregiver benefits

For the purposes of entitlement to family caregiver benefits, the term "family member" in relation to the care recipient, means any one of the following Footnote 2 :

  • 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

22.2.2 Qualifying and entitlement conditions

The individual claiming family caregiver 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 Footnote 5 .

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 6 , to be eligible for family caregiver benefits Footnote 7 .

Individuals who are unemployed and already receiving EI benefits can also apply and may be entitled to family caregiver benefits.

The individual claiming family caregiver benefits must submit a medical certificate with regard to the critically ill child or adult Footnote 8 . The critically ill child must be under the age of 18 years. The critically ill adult must be 18 years old or older.

Family caregiver benefits are accessible to self-employed persons Footnote 9 who have voluntarily registered into the EI program Footnote 10 .

22.2.3 Proof of critically ill or injured child or adult

An eligible claimant must submit a medical certificate, which must be completed and signed by a medical doctor or nurse practitioner Footnote 11 .

Nurse Practitioner is defined as a registered nurse who, under the laws of a province, is entitled to practice as a nurse practitioner — or under an equivalent designation — and to autonomously make diagnoses, order and interpret diagnostic tests, prescribe substances and treat patients.

The medical doctor or nurse practitioner must issue a medical certificate that indicates:

  • The patient’s life is at risk as a result of an illness or injury
  • There has been a significant change in the patient’s baseline state of health; and
  • The patient requires the care or support of one or more family members

For cases in which the critically ill child or adult resides outside Canada, it will be necessary for the claimant to submit a medical certificate completed by a medical doctor or nurse practitioner who is recognized by the appropriate government authority with similar qualifications to a medical doctor Footnote 12 .

The certificate will identify the critically ill child or adult - the medical doctor's 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 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 separate form must be signed by the patient, to authorize the medical doctor or nurse practitioner to release medical information on the patient, to the Commission. If the patient is incapable of consenting to the release of medical information for reasons of his/her age or a physical or mental condition, the authorization form must be completed by the patient’s legally authorized or appointed representative. If a medical certificate is not accompanied by the authorization to release medical information for the patient, the claimant will be disentitled from benefits.

22.2.4 Care or support of critically ill or injured child or adult

Care Footnote 13 is defined as: all care that is required because of a care recipient’s state of health, other than the care provided by a health care professional.

Support Footnote 14 is defined as: all psychological or emotional support that is required because of a care recipient’s state of health.

The definition of care or support may also include situations where the claimant simply spends time each day with the critically ill care recipient in the home, a hospice or a medical facility.

It is recognized that an individual claiming this type of benefits may require a short break from providing care or support for the critically ill care recipient. Therefore benefits would not be automatically denied when the claimant does not actually provide care for only a few days. The determination of whether a claimant continues to prove entitled to benefits will be considered based on the merits of each individual case.

In any situation, if it becomes apparent that the claimant is not providing care or support, based on the definitions above, the claimant will be disentitled from benefits.

22.2.5 The number of weeks for which family caregiver benefits may be paid

22.2.5.1 Family caregiver benefits for children

The legislation provides two caps to the maximum number of weeks payable for family caregiver benefits for children.

  1. A maximum of 35 weeks of family caregiver benefits for children is payable within a benefit period Footnote 15
  2. A maximum of 35 weeks of family caregiver benefits for children payable within the 52 week family caregiver window, in relation to a critically ill child Footnote 16

These limitations apply whether the benefits are claimed by one individual or shared with the child’s other family members.

22.2.5.2 Family caregiver benefits for adults

The new legislation provides two caps to the maximum number of weeks payable for family caregiver benefits for adults.

  1. A maximum of 15 weeks of family caregiver benefits for adults is payable within a benefit period
  2. A maximum of 15 weeks of family caregiver benefits for adults is payable within the 52 week family caregiver window Footnote 16 .

These limitations apply whether these benefits are claimed by one individual or shared with other family members.

22.2.6 Family caregiver window

Family caregiver benefits are available within a 52 week window, to eligible claimants to provide care or support to a critically ill care recipient. This 52 week window during which the 35 weeks of family caregiver benefits for children or 15 weeks for family caregiver benefits for adults may be paid is determined by both the issuance of a medical certificate and a first request for these benefits by a family member of the critically ill care recipient.

22.2.7 Start of the family caregiver window

Subsection 23.2 (3) and Subsection 23.3(3) of the EI Act, states that family caregiver benefits can be paid in the period that begins in the week in which either of the following falls:

  • the day of issuance of the first valid medical certificate that is submitted to the Commission, or
  • in the case of a claim that is made before the day on which the medical certificate is issued, the day from which the medical doctor or nurse practitioner certifies that the care recipient is critically ill

The first medical certificate submitted that meets the requirements of the legislation, will determine the start of the 52 week window. A subsequent medical certificate that indicates an earlier date on which the critically ill care recipient became ill will not be accepted to change the start of the window when:

  • all benefits 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 critically ill care recipient, and the certificate would have the effect of moving the beginning of that period to an earlier date

This provision will ensure that a subsequent certificate submitted will not impact any family caregiver benefits already paid to another eligible claimant, for the same critically ill care recipient.

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 family caregiver benefits legislation.

22.2.7.1 Medical certificate issued before family caregiver benefits claimed

Where the medical certificate is issued before the family caregiver benefits claim is made, the 52 week window starts with either:

  • the date of examination of the critically ill family member where the doctor or nurse practitioner certifies that the two conditions exist: the patient has a serious medical condition where life is at risk and the patient requires the care of support of one or more family members, or
  • the date which the medical doctor or nurse practitioner attests that the two conditions applied at an earlier period of time

Where benefits are requested for weeks prior to the week of signature of the medical certificate, information that the conditions for family caregiver benefits applied to an earlier date may be present. This can be the date of the last medical examination or an earlier date on which the conditions applied, as indicated in the medical, rather than the date of signature. The date which will be used to start the 52 week window should be the one which will accommodate the weeks the claimant is requesting.

22.2.7.2 Medical certificate issued after family caregiver benefits are claimed

Where the medical certificate is issued after family caregiver benefits are claimed, the 52 week window starts with either:

  • the date the certificate is signed by the medical doctor or nurse practitioner, or
  • the date of examination of the critically ill family member where the doctor or nurse practitioner certifies that the two conditions exist: the patient has a serious medical condition where life is at risk and the patient requires the care or support of one or more family members, or
  • the date which the medical doctor or nurse practitioner attests that the two conditions applied at an earlier period of time

Where benefits are requested for weeks prior to the week of signature of the medical certificate, information that the conditions for family caregiver benefits applied to an earlier date may be present. This can be the date of the last medical examination or an earlier date on which the conditions applied, as indicated in the medical, rather than the date of signature. The date which will be used to start the 52 week window should be the one which will accommodate the weeks the claimant is requesting.

22.2.8 End of entitlement

The family caregiver window is established for a specific period of 52 weeks Footnote 17 . Once established, the claimant is entitled to a maximum of 35 weeks of family caregiver benefits for children or 15 weeks of family caregiver benefits for adults within that window. The weeks of family caregiver benefits do not have to be paid consecutively and can be paid intermittently during the benefit period or the 52 week window, in a manner that is most convenient to the claimant, provided the required medical proof supports the care recipient’s critical illness during the weeks claimed.

Legislation provides that no further family caregiver benefits can be paid after the end of the week in which any of the following occur:

  • the benefit period has expired;
  • the maximum number of weeks of benefits payable on the claim has been reached;
  • the 52 week window has expired;
  • the maximum weeks payable for family caregiver benefits for children (35) or adults (15) has been paid (either to one individual or shared);
  • the critically ill care recipient no longer requires care or support

In situations where the critically ill care recipient dies before the 52 week window ends, family caregiver benefits would cease at the end of the week in which the critically ill care recipient died. While entitlement to family caregiver benefits would cease at the end of this week, claimants may require additional time off to attend the funeral. The existing adjudication principles 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.

When a critically ill care recipient recovers, or the illness goes into remission, entitlement to family caregiver benefits ceases at the end of the week in which the claimant is no longer required to provide care or support to the critically ill care recipient.

There will also be situations where the critically ill care recipient 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 family caregiver benefits may be paid. However, it must be kept in mind that a claimant can only receive maximum weeks of family caregiver benefits for children (35) or adults (15) in a benefit period.

For example: The 52-week family caregiver window closes, but only 25 weeks of family caregiver benefits for children were paid in the claimant’s benefit period. If the child is still critically ill, a subsequent medical could establish a new 52-week family caregiver window, which would start in the same benefit period. An additional 10 weeks of family caregiver benefits for children could be paid to this claimant, as only 25 weeks of these benefits were paid within the first family caregiver window in the current benefit period. Continuing the example above, if the claimant then qualifies to establish a new benefit period for family caregiver benefits for children, the remaining 25 weeks payable in the second window could be paid on the new benefit period. These benefits could also be shared with other family members, based on their individual entitlement.

22.2.9 Sharing family caregiver benefits

The legislation provides that the 35 weeks of family caregiver benefits for children and 15 weeks of family caregiver benefits for adults in relation to a critically ill care recipient can be shared by one or more eligible claimants, and that the weeks are to be divided as agreed to by those claimants Footnote 18 . The weeks of benefits can be claimed anywhere within the 52 week family caregiver window, subject to medical proof, and can be received concurrently by eligible claimants.

When these benefits are shared, it must be determined whether the other family member is claiming or has claimed family caregiver benefits to care for the same critically ill care recipient, and the number of weeks being claimed by the other family member.

When eligible claimants cannot come to an agreement, the remaining weeks will be divided based on the prescribed rules Footnote 19 in the following manner:

  • When the number of weeks left to be paid can be divided equally between the eligible claimants, each claimant will be paid an equal number of weeks.
  • When the number of weeks left to be paid cannot be divided equally (odd number of weeks remaining) between the eligible claimants, the remaining weeks will be divided equally to the extent possible, and the extra week will be assigned to the eligible claimant who made their claim for family caregiver benefits first.
  • When the number of weeks left to be paid is less than the number of eligible claimants, the weeks will be distributed in the order in which the eligible claimants made their claim for family caregiver benefits

22.2.10 More than one critically ill care recipient

If more than one care recipient is critically ill as a result of the same event or unrelated events, a separate 52 week window may be established for each of the care recipients. However, the maximum number of weeks of family caregiver benefits payable is 35 per child, or 15 per adult, during the related 52 week window, as well as during a benefit period Footnote 20 .
This means that two family members could each establish a benefit period, one in respect of one care recipient, and the other in respect of the other care recipient, and be payable the maximum weeks each. Neither family member can collect benefits in relation to both care recipients simultaneously.

22.2.11 Access to compassionate care benefits

Once a family caregiver window has been established, compassionate care benefits are not payable in respect of the critically ill care recipient. This means that no other family member can access compassionate care benefits in relation to the critically ill care recipient, until all related family caregiver benefits are exhausted, or until the 52 week period has expired Footnote 21 .

Compassionate care benefits may be paid for the care recipient, after family caregiver benefits have exhausted, provided all other qualifying and entitlement conditions for compassionate care benefits are met.

22.2.12 Antedates

Standard adjudication principles will apply when a claimant requests an antedate of a claim for family caregiver benefits. However, the legislation provides that, when an antedate is requested for family caregiver benefits, the benefit period cannot be antedated if, at the time the claim is made:

  • 35 weeks of family caregiver benefits for children have been paid; or,
  • 15 weeks of family caregiver benefits for adults have been paid; or,
  • the 52-week family caregiver window has already been established by another claimant, and establishing the claim on the earlier date would move the start date of the window to an earlier date

This provision ensures that a request to antedate a claim for family caregiver benefits by one claimant will not affect the previous entitlement of the other claimant Footnote 22 .

Taking into account the nature of family caregiver 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 critically ill care recipient, a lenient approach will be applied, in the same manner as for other special benefits, keeping in mind the specific provisions mentioned above Footnote 23

22.2.13 Waiting period

A one week waiting period must be served when an initial benefit period is established for family caregiver benefits Footnote 24 . However, when the family caregiver benefits are shared between family members only one waiting period has to be served in relation to each care recipient and to each 52 week window.

When these benefits are shared, the first eligible claimant making an initial claim for benefits is required to serve the waiting period. The waiting period may be deferred for the other family members sharing these benefits, provided that a waiting period has been served by one of the family members in relation to that care recipient and for the same 52 week window Footnote 25 .

Where two eligible family members make a claim for family caregiver benefits at the same time, in relation to the same care recipient, the claimants will be required to choose which one will serve the waiting period.

It should be noted that, based on the wording of the legislation, the first claimant claiming family caregiver benefits must serve a one-week waiting period in its entirety, in order for the other family member(s) to have the waiting period deferred.

The current policy on waiving the waiting period continues to apply Footnote 26 . In situations where the waiting period was waived for the first person claiming family caregiver benefits, the second person establishing an initial benefit period for the same care recipient 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.

22.2.14 Earnings

Any earnings received while in receipt of EI family caregiver 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 Footnote 27 .

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 Footnote 28 .

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