He fought years for financial aid for his long-term disability. He says system must change

A Quebec man with serious health issues is calling for changes to the way people with long-term disabilities are provided financial sup‐ port from the province af‐ ter spending four years fighting for adequate help.

George was diagnosed in 2013 with a synovial sarcoma in his left knee, which is a rare type of cancer that oc‐ curs near large joints.

In the following years, he had surgery to remove the tumour and underwent two total knee replacements one due to arthritis - that left him unable to stand for long hours.

This resulted in him losing his longtime job as a security guard - where he socialized and made friends.

"Ever since I arrived in Canada, I have worked all the time. Even if I was sick or had trouble walking, I went to work," George said.

CBC is not using his real name and has agreed to con‐ ceal his identity because he fears reprisal from his doctor and from agents with Que‐ bec's social assistance pro‐ gram.

Relying solely on his phys‐ ical strength for employment and with no other work expe‐ rience, George fell on hard times when his employment insurance coverage expired in 2018. He said he was diag‐ nosed with serious sympto‐ matic depression.

George said he had no choice but to apply for social assistance from Quebec - a move he said led to years of fighting to get his long-term disability recognized.

"We have to fight our sick‐ ness, but also the system both at the same time," he said.

Temporary work limita‐ tions - for years

At first, George only re‐ ceived the basic amount of money from the province's social assistance program, which is intended for people without any severe limita‐ tions to work.

He said the money wasn't enough for him to survive.

George was referred to the Organisation populaire des droits sociaux (OPDS), a community organization that defends the rights of people receiving social assistance, where Christophe Nadeau-Ri‐ oux became his counsellor.

"I noticed he had signifi‐ cant health issues, and he had no [work limitations] re‐ lated to social assistance at all," Nadeau-Rioux said.

In his eyes, George quali‐ fied for Quebec's social soli‐ darity program, which offers increased financial assistance for people who have severely limited capacity for employ‐ ment.

To qualify for this pro‐ gram, Nadeau-Rioux said, re‐ cipients must submit a med‐ ical report from their doctor diagnosing them with a se‐ vere health issue that pre‐ vents them from working for at least a year.

However, when George began the application pro‐ cess in 2020, he said his or‐ thopedic surgeon refused to complete and sign a medical report for him to apply for it.

"You perform surgeries on me, you know about the ill‐ ness but you refuse to give me the medical reports. This has made my life very diffi‐ cult," he said.

LISTEN | Reporter San‐ dra Hercegova breaks down George's situation:

In the end, George had a family doctor and a psychia‐ trist who filled out the med‐ ical form for him.

However, social assistance refused to recognize his longterm disability.

"Even when he provided a well-filled medical report from his family doctor indi‐ cating a diagnosis for severe work limitations … it was so‐ cial assistance that refused," said Nadeau-Rioux.

He explained the final de‐ cision relies on the evaluating physician from the Quebec Ministry of Labour, Employ‐ ment and Social Solidarity, who reviews the requests and decides whether the ap‐ plicant has a severe work lim‐ itation or not.

Nadeau-Rioux said the ministry repeatedly granted George temporary work limi‐ tations lasting three to six months over the course of four years. While recipients do get higher financial aid with these limitations, it's on‐ ly temporary.

In Quebec, 77 per cent of people with temporary work limitations have them for more than 12 months while 50 per cent have them for over four years, according to recent research from the Centre de recherche sur les inégalités sociales à Montréal (CREMIS).

George's temporary bene‐ fits required him to submit requests every three to six months with updated med‐ ical reports.

Missing appointments or failing to submit timely appli‐ cations meant George could lose approximately $400 from his monthly social assis‐ tance.

'At one point they have to decide'

David Barbeau, a family doctor for over 20 years and a clinical teaching associate at the Université de Mon‐ tréal, has spent 15 years as a researcher for CREMIS.

He said one of the main issues with getting doctors to complete medical forms for people applying for social as‐ sistance is a lack of training.

"We are not trained at all … about this aspect, which is quite important as it touches half a million people of Que‐ bec," said Barbeau.

"I had to learn [to com‐ plete these medical reports] when I was already a doctor."

Barbeau said it is also complex to evaluate if a spe‐ cific health condition can lead to a permanent disabil‐ ity. He says sometimes, doc‐ tors fear that by diagnosing a permanent disability, they will make a patient less moti‐ vated to return to work.

That's why, he says, some doctors diagnose social assis‐ tance recipients with tempo‐ rary work limitations over the course of several years.

"Doctors should not sign these temporary forms repetitively for years and years," said Barbeau.

"They can sign it once or twice for three months or six months to pursue their eval‐ uation, but at one point they have to decide," he said.

Barbeau co-created training course alongside his colleague Nadia Giguère for doctors to learn more about their role within the social as‐ sistance system.

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Giguère, a researcher for CREMIS and an associate pro‐ fessor in the department of family medicine at the Uni‐ versité de Montréal, says in addition to the reluctance of some doctors to participate in the process, the adminis‐ trative burden on recipients themselves also creates a barrier to accessing support.

Applying to be recognized as having permanent work limitations involves the appli‐ cant filling out a 15-page doc‐ ument with their employ‐ ment history and medical re‐ ports, she said, adding it can be difficult to fill out cor‐ rectly, especially if the appli‐ cant does not have the ap‐ propriate level of literacy.

"It should be a program giving social assistance to the most vulnerable, but if they want to get through this pro‐ cess, they need help from a third party or else they will not receive help from the ministry," Giguère said.

"In terms of access to rights, this raises a lot of questions."

Ministry explains denial of permanent benefits

CBC asked the Ministry of Labour, Employment, and So‐ cial Solidarity why a recipient of social assistance may be denied benefits related to having permanent work limi‐ tations, despite medical re‐ ports from their doctor diag‐ nosing them with a long-term disability that affects their ability to work.

In a statement, the min‐ istry said that in addition to the doctor's medical form, "other medical and socio-pro‐ fessional information or doc‐ uments may be deemed nec‐ essary to demonstrate" the person's eligibility for perma‐ nent work disability.

It also said factors affect‐ ing employability and work limitation assessment in‐ clude age, education, work experience and psychosocial adaptation.

"The evaluation is con‐ ducted by a specialized cen‐ tre of medical and socio-pro‐ fessional experts, consider‐ ing the person's overall situa‐ tion and physician's recom‐ mendation," it said.

The ministry said it eased up some measures in May 2022, allowing the required medical form to be com‐ pleted by a specialized nurse practitioner instead of the person's family doctor.

Permanent work limita‐ tion finally accepted

After four years of re‐ assessment demands and submitting medical reports, social assistance finally ac‐ cepted George's disability as long term in 2023 and granted him permanent work limitations in 2023.

"Now I can start to breathe. I can pay my rent, my bills, I have a bit of a budget for groceries. I live a normal life," George said.

But his fight isn't over yet.

I can start to breathe. I can pay my rent, my bil‐ ls, I have a bit of a budget for groceries. George

George's counsellor NadeauRioux filed a review re‐ questing George receive retroactive benefits, but soci‐ al assistance rejected this re‐ quest.

The case will be brought to the Administrative Tri‐ bunal of Quebec this year.

George says he could have ended up on the street if it weren't for Nadeau-Ri‐ oux. He says that shouldn't happen and he wants the rights of people who are sick and vulnerable to be re‐ spected.

"The people on social as‐ sistance see you as someone who takes advantage of the system, but I am sick. It's not me who chooses the illness, it's the illness that chose me," he said.