Digest of Benefit Entitlement Principles   Chapter 22 - Section 2

22.2.0 Parents of critically ill children benefits

Benefits for parents of critically ill children are available to an eligible claimant for the purpose of providing care or support to a critically ill child ^{Footnote 1} .

22.2.1 Claimants who can receive parents of critically ill children benefits

For the purposes of entitlement to parents of critically ill children benefits, the term "parent" in relation to the child who is critically ill, is defined as ^{Footnote 2} :

• A person who, in law, is a parent (including an adoptive parent) of a critically ill child; or
• A person who, in law, has custody of or, in Quebec, parental authority over the child; or
• A person who, in law, is the guardian of the child, or, in Quebec, the tutor to the person of the child; or
• A person with whom the child is placed for the purposes of adoption under the laws governing adoption in the province in which the person reside.

22.2.2 Qualifying and entitlement conditions

The individual claiming parents of critically ill children 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 to parents of critically ill children benefits ^{Footnote 7} .

Individuals who are unemployed and already receiving EI benefits can also apply and may be entitled to parents critically ill children benefits.

The individual claiming parents of critically ill children benefits must submit a medical certificate with regard to the critically ill child ^{Footnote 8} . The critically ill child must be under the age of 18 years.

Parents of critically ill children 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

An eligible claimant must submit a medical certificate, which must be completed and signed by a specialist medical doctor. A medical signed by a general practitioner is not sufficient. A specialist medical doctor, for the purpose of entitlement to parents of critically ill children benefits, is defined as:

• a medical doctor who is licensed to practice medicine in Canada as a specialist ^{Footnote 11} .

The specialist medical doctor must issue a medical certificate that:

• states the child is a critically ill child and requires the care or support of one or more of their parents; and
• sets out the period during which the child requires that care or support.

For cases in which the critically ill child resides outside Canada, it will be necessary for the claimant to submit a medical certificate completed by a specialist medical doctor licensed to practice medicine as a specialist in Canada, as defined in Regulation 41.4(2) (b) ^{Footnote 12} .

The certificate will identify the critically ill child - the specialist medical doctor'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 critically ill child’s parent, to authorize the child’s specialist medical doctor to release medical information on the patient, to the Commission. 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

Care ^{Footnote 13} is defined as:

• All care that is required because of a critically ill child’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 critically ill child’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 child 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 child. 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 parents of critically ill children benefits may be paid

The legislation provides two limitations to the maximum number of weeks of parents of critically ill children benefits payable.

1. The first is a maximum of 35 weeks of parents of critically ill children benefits within a benefit period ^{Footnote 15} .
2. The second is a maximum of 35 weeks in a 52 week parents of critically ill children window, in relation to a critically ill child or children ^{Footnote 16} .

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

22.2.6 Parents of critically ill children window

Parents of critically ill children benefits are available within a 52 week window, to eligible claimants to provide care or support to a critically ill child. This 52 week window during which 35 weeks of parents of critically ill children benefits may be paid is determined by both the issuance of a medical certificate and a first request for these benefits by a parent of the critically ill child.

22.2.7 Start of the parents of critically ill children window

Subsection 23.2 (3) of the EI Act, states that parents of critically ill children 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 specialist medical doctor certifies that the child 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 child 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 child, 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 parents of critically ill children benefits already paid to another eligible claimant, for the same critically ill child.

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 parents of critically ill children benefits legislation.

22.2.8 End of entitlement

The parents of critically ill children 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 benefits within that window. The 35 weeks of parents of critically ill children 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 child’s critical illness during the weeks claimed.

Legislation provides that no further parents of critically ill children 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 35 weeks payable for parents of critically ill children has been paid (either to one individual or shared);
• the critically ill child dies.

In situations where the critically ill child dies before the 52 week window ends, parents of critically ill children benefits would cease at the end of the week in which the critically ill child died. While entitlement to parents of critically ill children 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 child recovers, or the illness goes into remission, entitlement to parents of critically ill children 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 child.

There will also be situations where the critically ill child 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 35 weeks of parents of critically ill children benefits may be paid. However, it must be kept in mind that a claimant can only receive a maximum of 35 weeks of parents of critically ill children benefits in a benefit period.

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

22.2.9 Sharing parents of critically ill children benefits

The legislation provides that the 35 weeks of parents of critically ill children benefits in relation to a critically ill child 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 35 weeks of benefits can be claimed anywhere within the 52 week parents of critically ill children 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 parent is claiming or has claimed parents of critically ill children benefits to care for the same critically ill child, and the number of weeks being claimed by the other parent.

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 parents of critically ill children 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 parents of critically ill children benefits.

22.2.10 More than one critically ill child

If more than one child is critically ill as a result of the same event, only one 52 week window may be established, and a maximum of 35 weeks of parents of critically ill children benefits may be paid during that 52 week period, and benefit period ^{Footnote 20} .

If more than one child is critically ill as a result of unrelated events, a separate 52 week window may be established for each of the critically ill children. However, the maximum number of weeks of parents of critically ill children benefits payable is 35 per child during the related 52 week period, as well as a maximum of 35 weeks during a benefit period. This means that two parents could each establish a benefit period, one in respect of one child, and the other parent in respect of the other child, and be payable a maximum of 35 weeks each. Neither parent can collect benefits in relation to both children simultaneously.

22.2.11 Access to compassionate care benefits

Once a parents of critically ill children window has been established, compassionate care benefits are not payable in respect of the critically ill child. This means that neither the parents, nor any other family member, can access compassionate care benefits in relation to the critically ill child, until all related parents of critically ill children benefits are exhausted, or until the 52 week period has expired ^{Footnote 21} .

Compassionate care benefits may be paid for the child, after parents of critically ill children 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 parents of critically ill children benefits. However, the legislation provides that, when an antedate is requested for parents of critically ill children benefits, the benefit period cannot be antedated if, at the time the claim is made:

• 35 weeks of parents of critically ill children benefits have been paid; or,
• the 52-week parents of critically ill children 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 parents of critically ill children benefits by one claimant, will not affect the previous entitlement of the other claimant ^{Footnote 22} .

Taking into account the nature of parents of critically ill children 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 child, 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 parents of critically ill children benefits ^{Footnote 24} . However, solely when the parents of critically ill children benefits are shared between the parents will one waiting period have to be served in relation to each critically ill child 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 parent sharing these benefits, provided that a waiting period has been served by one of the parents in relation to that critically ill child and for the same 52 week window ^{Footnote 25} .

Where two eligible parents make a claim for parents of critically ill children benefits at the same time, in relation to the same critically ill child, 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 parents of critically ill children benefits must serve a one-week waiting period in its entirety, in order for the other parent 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 parents of critically ill children benefits, the second person establishing an initial benefit period for the same critically ill child 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

The current allowable earnings provisions applicable to regular, parental and compassionate care benefits also apply to parents of critically ill children benefits.

Normally, claimants may earn up to 25% of their weekly benefit rate or $50.00 where the benefit rate is less than $200, without any deduction from benefits. Earnings in excess of the 25% or $50 will be deducted dollar for dollar ^{Footnote 27} .

Detailed information on the rules currently applicable regarding the deduction of earnings while receiving benefits can be found on the Working While on Claim pilot projects web page on the Service Canada website ^{Footnote 28} .