Digest of Benefit Entitlement Principles Chapter 24 - Section 6

24.6.0 Entitlement to benefits

When a self-employed person successfully establishes a claim for Employment Insurance (EI) self-employment special benefits, it does not mean that payment of the requested benefit type(s) is automatic. While specific qualifying conditions are required to establish a benefit period, for each week of benefits claimed, claimants must also satisfy the entitlement conditions required for the type of special benefits requested.

Unlike the requirements necessary to establish a benefit period, where the qualifying conditions are the same regardless of the type of benefits requested, entitlement conditions vary depending on the specific type of special benefits.  For example, while a medical note must be obtained covering each week of sickness benefit payment claimed (section 24.9.0 of the Digest), this requirement does not apply to maternity benefits.

The determination of entitlement, although based on legislation, also requires consideration of a claimant's unique situation. In adjudicating a self-employed person's entitlement to special benefits, the legislation provides the legal tests; while jurisprudence provides the guiding principles. Each claimant's specific circumstances is considered in rendering any decision.

24.6.1 Disentitlement

Under the EI legislation, the term disentitlement has a specific meaning and refers to the situations described in the legislation that result in the non-payment of benefits as a result of one or more required conditions not being met (EIA 152.01(1)). Period of disentitlement

Benefits are not paid for any day to which a disentitlement is applied. When it is determined that a claimant should be disentitled, the disentitlement is applied for a minimum of one day. There are no partial-day disentitlements. Extenuating circumstances cannot reduce a period of disentitlement.

A one-day disentitlement, therefore, carries a value of one-fifth (1/5) the weekly rate of benefits as EI is payable from Monday to Friday of any given week (EIA 152.19(1)).

When a disentitlement covers a full week, it does not reduce the maximum number of weeks payable. However, once the benefit period ends, no further entitlement to benefits from that period remains (section of the Digest; jurisprudence), even if there are entitlement weeks remaining.

A disentitlement may be imposed indefinitely from any working day of the week, and continues as long as the situation remains unchanged. Whenever a change occurs, a decision is made as to whether it warrants terminating the disentitlement or rescinding it completely (section 1.4.4 of the Digest, section 1.4.6 of the Digest).

A disentitlement from benefits may be brought about by several concurrent reasons; creating several disentitlements where no benefits can be paid as long as one of them continues.

24.6.2 Grounds for disentitlement

There are 4 circumstances where a disentitlement could apply regardless of the type of special benefits sought:

The following disentitlements relate specifically to the special benefit type requested. They are addressed in this chapter under the relevant special benefit type:

  • failure to prove incapacity for work in the case of sickness benefits (EIR 40(1))
  • failure to prove one would be otherwise working in the case of sickness benefits (EIA 152.03(4))
  • not entitled to compassionate care benefits (EIA 152.06)
  • not entitled to parental benefits (EIA 152.05(1))
  • not entitled to family caregiver benefits (EIA 152.061(1), EIA 152.062(1))
  • having received or being entitled to receive provincial benefits in respect of the birth (EIA 152.04(3)) or the adoption of a child under a provincial plan (EIA 152.05(11))

[November 2023]

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