Digest of Benefit Entitlement Principles Chapter 24 - Section 12

24.12.0 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 or injured child or adult, also referred to in this chapter as "care recipient" (EIA 152.061, EIA 152.062).

24.12.1 Definitions

24.12.1.1 Family member

For the purposes of entitlement to family caregiver benefits, the term "family member" in relation to the care recipient, 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

24.12.1.2 Critically ill child

The Employment Insurance Regulations define a critically ill child as a person who is under the age of 18 on the first day of the period set out by the doctor or nurse practitioner, whose baseline state of health has significantly changed and whose life is at risk because of an illness or injury (EIR 1(6)).

24.12.1.3 Critically ill adult

The Regulations define a critically ill adult as a person who is 18 or over on the first day of the period set out by the doctor or nurse practitioner, whose baseline state of health has significantly changed and whose life is at risk because of an illness or injury (EIR 1(7)).

24.12.2 Sharing family caregiver benefits

The legislation provides up to 35 weeks of family caregiver benefits for children and 15 weeks of family caregiver benefits for adults in relation to a care recipient. These can be shared by one or more eligible claimants, and divided as agreed to by those claimants (EIA 152.14(1)(e),(f), EIA 152.061(8), EIA 152.062(6)).

The weeks of benefits can be claimed anywhere within the 52-week family caregiver window (section 24.13.5 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 the other family member is claiming or has claimed family caregiver benefits to care for the same critically ill care recipient, 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 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 latter made their claim for family caregiver benefits

24.12.3 First entitlement condition: Proof of critically ill family member

Claimants must submit a medical certificate signed by a medical doctor or nurse practitioner (EIR 1(3)) treating the care recipient (EIA 152.061(1), EIA 152.062(2)).

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

• the care recipient's life is at risk as a result of an illness or injury; and
• there has been a significant change in the care recipient's baseline state of health; and
• the care recipient requires the care or support of one or more family members; and
• the period during which the care recipient is expected to require care or support

Where the care recipient 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 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 critically ill child or adult - 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 benefits, only one certificate is required.

One medical certificate may underestimate the initial time required to care and support a critically ill or injured care recipient. In these circumstances a second (subsequent) signed medical certificate containing the same information as the first, will be required in order to revise the dates during which the care recipient requires care or support.

Medical professionals are not authorized to release medical information without the care recipient's consent, or unless required by law. The care recipient must sign a separate form authorizing the medical doctor or nurse practitioner to release medical information on the care recipient to the Canada Employment Insurance Commission (the Commission). If the care recipient 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 care recipient's legally authorized or appointed representative. If a medical certificate is not accompanied by the authorization to release medical information for the care recipient, the claimant will be disentitled from benefits.

24.12.4 Second entitlement condition: Care or support of critically ill family member

Care of a critically ill or injured care recipient is defined as all care that is required because of the care recipient's state of health, other than the care provided by a health care professional (EIR 1(5)).

Support is defined as the psychological or emotional support that is required because of a care recipient's state of health (EIR 1(5)).

Care or support of a critically ill or injured child or adult includes (EIR 1(5)):

• directly providing or participating in the care; or
• providing psychological and emotional support; or
• arranging for care of the critically ill or injured child or adult by a third party care provider

The individual may provide direct or indirect care or support to the care recipient. For example, the claimant may simply spend time each day with the care recipient 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 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 critically 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 24.6.0 of the Digest). This would apply whether the claimant is in the same geographical area as the critically ill family member or not (EIA 152.062(1)).

24.12.5 Family caregiver window

Family caregiver benefits are available within a 52-week window to eligible claimants to provide care or support to a care recipient (EIA 152.061(3)(b)(iii), EIA 152.062(3)(b)(iii)). This 52-week window during which the 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 care recipient.

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.

24.12.5.1 Start of the family caregiver window

Subsections 152.061(3)(a) and 152.062(3)(a) of the Employment Insurance Act state 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; or

Based on 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 because of providing care or support to a care recipient, a lenient approach will be applied, keeping in mind the provisions of family caregiver 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 152.11(6.1), EIA 152.11(6.2)):

• 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 care recipient, 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 any family caregiver benefits already paid to another eligible claimant, for the same 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.

24.12.5.2 Medical certificate issued before family caregiver benefits are 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 care recipient has a serious medical condition where life is at risk; and,
• the care recipient 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

24.12.5.3 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 care recipient has a serious medical condition where life is at risk; and,
• the care recipient 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 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.

24.12.5.4 End of entitlement

Legislation provides that no further family caregiver benefits can be paid after the end of the week in which any of the following occur (EIA 152.061(3)(b), EIA 152.062(3)(b)):

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

In situations where the care recipient dies before the 52-week window ends, family caregiver benefits would cease at the end of the week in which the care recipient died.

When a 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 care recipient.

There will also be situations where the 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. If the maximum has been paid, a new claim may need to be established.

24.12.6 Access to family caregiver benefits

Once a family caregiver window has been established, compassionate care benefits are not payable in respect of the care recipient. This means that no other family member can access compassionate care benefits in relation to the care recipient, until all related family caregiver benefits are exhausted, or until the 52-week period has expired (EIA 152.061(10), EIA 152.062(8)).

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.

24.12.7 More than one critically ill care recipient

If more than one care recipient is critically ill because 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.

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.

24.12.8 Payment of family caregiver benefits

24.12.8.1 Waiting period

A one-week waiting period must be served when an initial benefit period is established and before family caregiver 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 family caregiver benefits are shared between family members, only one waiting period must be served in relation to the same care recipient for family caregiver benefits 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 152.061(6), EIA 152.062(5)).

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. 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 critically ill family member will be required to serve the waiting period, unless the latter also meets the conditions to have the waiting period waived.  

24.12.8.2 Limits to the number of weeks payable

The following limitations apply whether the benefits are claimed by one individual or shared with the care recipient's other family members.

Family caregiver benefits for children

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

• a maximum of 35 weeks of family caregiver benefits for children is payable within a benefit period (EIA 152.14(1)(e)); and
• 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 (EIA 152.14(5.1))

Family caregiver benefits for adults

The legislation provides 2 limits to the maximum number of weeks payable for family caregiver benefits for adults.

• a maximum of 15 weeks of family caregiver benefits for adults is payable within a benefit period (EIA 152.14(1)(f)); and
• a maximum of 15 weeks of family caregiver benefits for adults is payable within the 52 week family caregiver window (EIA 152.14(5.2)).

 24.12.8.3 When out of Canada

A claimant who is outside Canada temporarily or permanently is entitled to family caregiver benefits for the purpose of providing care or support to a critically ill family member, 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]