Digest of Benefit Entitlement Principles   Chapter 11 - Section 5

11.5.0  Provisions regarding payment of sickness benefits

Once the entitlement conditions^{Footnote 1} for sickness benefits are met, although such benefits may certainly be paid at any time during the benefit period, there is a limit to the number of weeks sickness benefits are payable within a benefit period.

There are other provisions in the Act that may have an effect on the payment of sickness benefits^{Footnote 2}.

11.5.1  The number of weeks for which sickness benefits may be paid

A person who meets the qualifying and entitlement conditions to sickness benefits^{Footnote 3} can be paid such benefits at any time during the benefit period. However, the Act has placed a specific limit to the maximum number of weeks of sickness benefits payable within a benefit period.

A first limit is defined in the following passage^{Footnote 4}:

… the maximum number of weeks for which benefits may be paid in a benefit period
… (c) because of a prescribed illness, injury or quarantine is 26^{Footnote 5}.

However, this limit of 26 weeks is not a maximum that is guaranteed in all cases even if a person proves that he or she is unable to work for a longer period of time.

11.5.2  Antedate

Standard adjudication principles will apply when a claimant requests an antedate of a claim for sickness benefits. However, a lenient approach will be applied, in the same manner as for other special benefits.

11.5.3  Waiting period

A one week waiting period must be served when an initial benefit period is established for sickness benefits^{Footnote 6}. However, this waiting period can be waived^{Footnote 7} when a claim for sickness benefits is made and the claimant qualifies to receive sickness and after the claimant ceased to work, allowances, payments or other moneys are payable to the claimant by the claimant's employer or former employer as sick leave pay.

11.5.4  Earnings

Any earnings received while in receipt of EI sickness 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 8} [EI Act 19(2)].

The sole exception to this provision is for wage loss indemnity (WLI) or paid sick leave (PSL) payments paid by an employer who is registered in the Premium Reduction Program (PRP). WLI or PSL payments paid though a registered plan and for which the employer has been granted a premium reduction continue to be deducted dollar- for- dollar during the benefit period; this ensures that employers registered in the PRP remain first payers [EI Act 21(3)].

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.

If a claimant in receipt of sickness benefits works a full work week, no sickness benefits will be payable for that week, regardless of the amount earned.

11.5.5  Sickness benefits as a part of special benefits

Under the EI program, sickness benefits, together with maternity benefits (because of pregnancy), parental benefits (to care for a new born or a child placed for the purpose of adoption), compassionate care benefits (to care for a seriously ill family member with a significant risk of death within 26 weeks) and family caregiver benefits (to care for or support a critically ill or injured family member) are known collectively as special benefits and have specific requirements for payment^{Footnote 9} as well as limits to the number of weeks payable.

The maximum number of weeks for which combined special benefits may be paid has been set by legislation. These parameters are explained in the following section.

[ October 2013 ]

11.5.6  Limits to the number of weeks special benefits are payable

Each type of special benefits has an individual maximum number of weeks payable in one benefit period^{Footnote 10}. Individual maximums are: 26^{Footnote 5} weeks for sickness benefits; 15 weeks for maternity benefits; 35 weeks for standard parental benefits or 61 weeks for extended parental benefits; 26 weeks for compassionate care benefits; 35 weeks for family caregiver benefits for children and 15 weeks for family caregiver benefits for adults.

Special benefits may be paid in any combination during a benefit period, provided the claimant proves entitlement for each type of benefit claimed.

A maximum of 50 weeks of benefits can be paid in the initial benefit period, when regular and special benefits are combined. The only exception is when regular benefits and extended parental benefits were paid in the initial benefit period. Refer to Chapter 13 – Parental benefits, for more information on combining regular and extended parental benefits and the maximum number of weeks that can be paid under these circumstances.

A maximum of 102 weeks of combined special benefits may be payable, and the initial benefit period extended to a maximum of 104 weeks, if, during the initial benefit period^{Footnote 11}:

• No regular benefits have been paid during the initial benefit period; and
• More than one type of special benefits was paid; and at least one of these special benefits was paid for fewer than the applicable maximum number of weeks payable for these special benefits, and
• The maximum total number of weeks payable for the types of special benefits requested is greater than 50.

If a specific type of special benefits was not paid during the initial benefit period, it cannot be paid during the extended benefit period.

The initial benefit period ends on the earlier of:

• When 50 weeks of special benefits have been paid; or
• Benefit period start date plus 51 weeks plus any weeks of extension due to work-sharing or for one of the following reasons
  1. Confined in a jail, penitentiary or other similar institution and was not found guilty of the offence for which the claimant was being held or any other offence arising out of the same transaction;
  2. In receipt of earnings paid because of the complete severance of their relationship with their former employer;
  3. In receipt of workers’ compensation payments for an illness or injury;
     or
  4. In receipt of payments under a provincial law on the basis of having ceased to work because continuing to work would have resulted in danger to the claimant, her unborn child or a child whom she was breast-feeding.

It is important to note that for the purpose of the extension of the benefit period, when reference is made to “benefits paid for a pregnancy or caring for a child”, this also refers to the provincial benefits that have been paid to the claimant for the same reasons^{Footnote 12}. This means that Québec Parental Insurance Plan benefits can be used to extend the EI benefit period^{Footnote 13} to allow the claimant to receive the maximum number of special benefits weeks under the EI Act, other than maternity or parental, to which he/she is entitled.

A claimant who does not qualify for regular benefits under the EI Act ^{Footnote 14}, but qualifies for special benefits because of a regulatory exception^{Footnote 15} can only receive special benefits.

The limit to the number of weeks of special benefits payable also includes benefits paid under the Québec Parental Insurance Plan. According to a specific regulatory provision^{Footnote 16}, each week of Quebec Parental Insurance Plan benefits paid is considered as a week for which benefits are paid under the EI program, and is taken into consideration in calculating the overall maximum number of weeks of EI maternity or parental benefits to be paid per benefit period, and the maximum number of weeks of EI benefits to be paid regarding a birth or an adoption.