Andrea Hatala lives with a visual impairment. But all her life, she says, people have told her, “Oh come on, you can really see.”

So it was hard for the 52-year-old Toronto resident, who receives income from the Ontario Disability Support Program, when Ontario auditor general Bonnie Lysyk said last month that some people are likely receiving benefits to which they are not entitled.

“I wish that people would trust that we have to go to the doctors to get ODSP,” says Hatala. “We have to get doctors to sign the forms.”

According to the auditor general’s annual report, tabled in the legislature on December 4, the average number of ODSP recipients increased 50 per cent over the past decade (in 2018-19, more than half a million people received income support); during that time, Ontario’s population rose by just 12 per cent. It also found that more than 40 per cent of applicants to the $5.4 billion program “were confirmed as disabled by the Ministry after a cursory review of their application” and that 80 per cent of applicants found to be disabled “were approved for benefits for life without setting a future medical review to confirm they still meet the definition of a person with a disability.”

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The ministry’s systems and processes, the report concludes, “are not effective to ensure that only eligible applicants qualify for the program and receive income support.”

But Hatala and other advocates say that the report is based on problematic and incomplete assumptions — and reinforces troubling misconceptions about what it means to be a person living with a disability.

The ODSP process was simplified in 2017: individuals whose medical conditions haven’t improved since their initial application are no longer required to fill out the same forms again, although their medical provider needs to confirm that their condition has not improved for them to continue to qualify for income support.

Vanessa Emery, a lawyer at West Scarborough Community Legal Services, says that the system now better reflects the realities of certain types of disabilities. “Medical reviews are now being applied in a fairer and reasonable, thoughtful way,” says Emery, noting that the change could account for the decrease in the number of reviews. Some medical conditions, she adds, may improve with the right treatments, but if a client presents with an established pattern of mental health and substance abuse, for example, a medical review may not be appropriate.

And unnecessary medical reviews mean unnecessary costs, she says. Ordering tests and specialist reports, particularly for conditions that are not expected to improve, places a burden on the health-care system, as well as causing stress for recipients. “There is no certainty for people who deal with the stress of a review in two or five years,” Emery says. “People are constantly worried — it contributes to your mental health. We’ve had clients who were unsuccessful at a medical review, and it caused a relapse in their condition.”

Scott Guzman lives in an urban area, but it still takes him two hours to reach his doctor for a medical review. He worries about those who face even bigger logistical barriers. “At least I had a family doctor who has known me for half of my life,” he says. “I have these advantages, but if you don’t have those things, you could get cut off right there.”

Joel Harden, the NDP’s critic for accessibility and persons with disabilities, says that he doesn’t dispute that the number of recipients and the costs of ODSP have gone up but that it’s vital that we focus on the underlying reason for the rise: increasing poverty. “The increases in costs are driven by the fact that we haven’t made substantial efforts at poverty reduction in the province,” he says, adding that he would like to see the auditor general examine other costs to the province of “legislating poverty.”

Windsor West NDP MPP Lisa Gretzky says that changes to the Workplace Safety and Insurance Board process have compounded the problem: “There has been an increase to the number of WSIB claims being denied to injured workers. And what’s happening is, when this happens, they’re ending up on ODSP, when, really, they should be WSIB.”

Advocates are concerned about how the provincial government will act on the report’s findings. In November 2018, then-minister of community and social services, Lisa MacLeod, announced plans to change the definition of disability to align with the more restrictive federal definition used to qualify for the Canada Pension Plan, which requires a condition to be severe and prolonged. Critics worry that the auditor general’s report will be used to speed up those proposed changes, making it harder for people with disabilities to qualify. ”People live in fear that [changing the definition] is going to happen, and it is going to kick a lot of people off the rolls, and they will have to rely on Ontario Works,” says Karin Baqi, a lawyer at the Income Security and Advocacy Centre, a legal clinic in Toronto. “This report lays the groundwork to restrict [the definition] of disability.”

Following the release of the auditor general’s report, Toronto city council and Ottawa city council in December passed motions requesting that the Ontario Minister of Children, Community and Social Services maintain the definition of disability for recipients of ODSP.

MacLeod’s successor, Todd Smith, has not yet said whether he intends to make any changes to the definition of disability. He told TVO.org via email that the government is responding to Lysyk’s report: “We know social assistance in Ontario is broken. The Auditor’s report on ODSP makes that fact abundantly clear.” He also said that the province will develop “smarter ways” to identify and prioritize cases for review and confirm ODSP eligibility.

Hatala worries about the implications of people not qualifying for ODSP — which provides individuals with a monthly maximum of $1,169 — and about the possible risks of their having to rely on Ontario Works instead. “I’m afraid of people being forced to live on $750 a month,” she says. “Because when you’re sick or depressed, and you have no money, it just adds to your condition.”