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Digest of Benefit Entitlement Principles Chapter 24 - Section 13

24.13.0 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.

The legislative authority to pay compassionate care benefits is contained in subsection 152.06(1) of the Employment Insurance Act:

"…benefits are payable to a self-employed person if a medical doctor has issued a certificate stating that

  • a family member of the self-employed person has a serious medical condition with a significant risk of death within 26 weeks
    • from the day on which the certificate is issued, or
    • in the case of a claim that is made before the day on which the certificate is issued, from the day from which the medical doctor or nurse practitioner certifies the family member's medical condition; and
  • the family member requires the care or support of one or more other family members."

24.13.1 Definition of family member

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 (EIR 1(3)):

  • 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 (ward means a person for whom a guardian is appointed (EIR 1(4))
  • current or former ward of spouse or common-law partner
  • current or former guardian, their spouse or common-law partner (guardian means a person who is legally authorized to act on behalf of a minor or incapable adult and includes a tutor, curator, mandatary acting under a protection mandate or any person who is appointed to act in a similar capacity (EIR 1(4))
  • a person who is considered to be like a close relative, whether or not related by blood, adoption, marriage or common-law partnership

24.13.2 Sharing compassionate care benefits

The legislation provides up to 26 weeks of compassionate care benefits in relation to the seriously ill family member.  These can be shared by one or more claimants, and divided as agreed to by those claimants (EIA 152.14(1)(d), EIA 152.06(7)).

The 26 weeks of benefits can be claimed anywhere within the 52-week compassionate care benefits window (section 24.12.5 of the Digest), subject to medical proof, and can be received concurrently by eligible family members.

When these benefits are shared, it must be determined whether any other family member is claiming or has claimed compassionate care benefits to care for the same seriously ill family member and, if so, for how many weeks.

When eligible family members cannot agree, the remaining weeks will be divided based on the prescribed rules in the following manner (EIR 41.6):

  • When the number of weeks left to be paid can be divided equally between the family members, 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 compassionate care 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 latter made their claim for compassionate care benefits.

24.13.3 First entitlement condition: Proof of seriously ill family member

Claimants must submit a medical certificate signed by a medical doctor or nurse practitioner (EIR 1(3)) treating the seriously ill family member (EIA 152.06(2)).

The medical doctor or nurse practitioner will attest to the fact that their 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, it will be necessary to submit a medical certificate completed by a medical doctor or nurse practitioner who is authorized by the appropriate government authority to perform such work and who has similar qualifications to a medical professional practicing in Canada (EIR 41.2).

The certificate will identify the seriously ill family member - the medical 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 care 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. The patient must sign a separate form authorizing the medical doctor or nurse practitioner to release medical information for the patient to the Canada Employment Insurance Commission (the Commission). If the patient is incapable of consenting to the release of medical information for reasons of their 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.

24.13.4 Second entitlement condition: Care or support of seriously ill family member

Care or support of a seriously ill family member includes (EIR 1(5)):

  • directly providing or participating in the care of the family member;
  • providing psychological and emotional support to the family member; or
  • arranging for care of the family member by a third party care provider

The individual may provide direct or indirect care or support to the family member. For example, the claimant may simply spend 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 should not be denied where the claimant does not actually deliver care for a few days. A reasonable approach should be taken and each case should be decided on its own merit.

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 where it becomes apparent that the claimant is not providing care or support, based on the definition above, the claimant would be disentitled from benefits (section 24.6.1 of the Digest). This would apply whether the claimant is in the same geographical area as the seriously ill family member or not (EIA 152.062(1).

24.13.5 Compassionate care window

Compassionate care benefits are available within a 52-week window to eligible claimants to provide care or support to a seriously ill family member with a significant risk of death within 26 weeks (EIA 152.06(3)(b)(iii)). This 52-week window during which the 26 weeks of compassionate care benefits 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 seriously ill care recipient.

The weeks of compassionate care benefits do not have to be paid consecutively and can be paid intermittently over the 52-week period in a manner that is most convenient for the claimant, provided the required medical proof supports the care recipient's serious illness during the weeks claimed.

24.13.5.1 Start of compassionate care window

Paragraph 152.06(3)(a) of the Employment Insurance Act states that compassionate care 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 which is filed with the Commission; or
  • in the case of a claim that is made before the day the certificate is issued, the day from which the medical doctor or nurse practitioner certifies the patient's medical condition.

Based on 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 because of providing care or support to a seriously ill family member, a lenient approach will be applied, keeping in mind the provisions of the compassionate care legislation (section 3.3.5 of the Digest). Therefore, if a request is made asking the Commission to consider that the claim was made at an earlier date, and this request is approved, the period could begin at that earlier day (Chapter 3 of the Digest).

The first medical certificate submitted that meets the requirements of the legislation determines the start of the 52-week window. A subsequent medical certificate that indicates an earlier date will not be accepted to change the start of the window when (EIA 152.06(5)):

  • 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 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 (at present there is no Regulation defining any other circumstances)

This provision will ensure that a subsequent certificate submitted will not impact compassionate care benefits already paid to another eligible 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.

24.13.5.2 Medical certificate issued before compassionate care benefits are claimed

Where the medical certificate is issued before the compassionate care benefit claim is made, the 52-week window starts with either:

  • the date of examination of the seriously ill family member where the doctor or nurse practitioner certifies that the two conditions exist:
    • the patient has a serious medical condition with a significant risk of death within the next 26 weeks; 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

24.13.5.3 Medical certificate issued after compassionate care benefits are claimed

Where the medical certificate is issued after compassionate care benefits are claimed, the 52-week window starts no earlier than:

  • the date the certificate is signed by the medical doctor or nurse practitioner; or
  • the date of examination of the seriously ill family member where the doctor or nurse practitioner certifies that the two conditions exist: the patient has a serious medical condition and a significant risk of death within the next 26 weeks 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 before the week of signature of the medical certificate, information that the conditions for compassionate care 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.

24.13.5.4 End of entitlement

Legislation provides that no further compassionate care benefits can be paid after the end of the week when any of the following occur (EIA 152.06(3)(b)):

  • the benefit period has expired;
  • the maximum number of weeks of benefits payable on the claim has been reached;
  • the 26 weeks have been paid (either to one individual or shared);
  • the seriously ill family member no longer requires care or support; or,
  • the 52-week window has expired

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.

When the seriously ill family member recovers or the illness goes into remission, entitlement to compassionate caregiver 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 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, a new claim may need to be established (section 24.3.0 of the Digest).

24.13.6 Access to family caregiver benefits

If a compassionate care window 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 (EIA 152.061(10), EIA 152.062(8)). Compassionate care benefits may then become payable, provided all other qualifying and entitlement conditions for compassionate care benefits are met.

24.13.7 Payment of compassionate care benefits

24.13.7.1 Waiting period

A one-week waiting period must be served when an initial benefit period is established and before compassionate care benefits can be paid (EIA 152.15).

The waiting period may be waived if, after having ceased work, the claimant received sick leave pay from their employer (EIR 40(6)).When the claimant works for more than one employer, if they were paid sick leave pay after ceasing work from one of these employers and had an interruption of earnings for the same employer, the conditions have been met to waive the waiting period.

When 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. The first eligible person making a claim for benefits serves the waiting period and the other family member has their waiting period deferred (EIA 152.06(6)).

Where two eligible family members 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. The other family member may then have the waiting period deferred.

If a waiting period is deferred, it must eventually be served before a person can receive other types of special benefits on the same claim.

If the waiting period was waived for the first family member making a claim for benefits, the second family member establishing an initial benefit period for the same seriously ill family member within the same window, will be required to serve the waiting period, unless the latter also meets the conditions to have the waiting period waived.

24.13.7.2 When out of Canada

A claimant who is outside Canada temporarily or permanently is entitled to compassionate care benefits for the purpose of providing care or support to a gravely ill family member with a significant risk of death within 26 weeks, unless their social insurance number has expired. A claimant receiving these benefits is not required to prove availability for work, and will not be disentitled for the sole reason of being out of the country (EIR 55.01(3)).

[November 2023]

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