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 support from the province after 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 occurs 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 conceal his identity because he fears reprisal from his doctor and from agents with Quebec's social assistance program. 

Relying solely on his physical strength for employment and with no other work experience, George fell on hard times when his employment insurance coverage expired in 2018. He said he was diagnosed with serious symptomatic 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 sickness, but also the system — both at the same time," he said.

Temporary work limitations — for years

At first, George only received the basic amount of money from the province's social assistance program, which is intended for people without any severe limitations 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-Rioux became his counsellor. 

"I noticed he had significant health issues, and he had no [work limitations] related to social assistance at all," Nadeau-Rioux said.

In his eyes, George qualified for Quebec's social solidarity program, which offers increased financial assistance for people who have severely limited capacity for employment.

To qualify for this program, Nadeau-Rioux said, recipients must submit a medical report from their doctor diagnosing them with a severe health issue that prevents them from working for at least a year.

However, when George began the application process in 2020, he said his orthopedic surgeon refused to complete and sign a medical report for him to apply for it. 

"You perform surgeries on me, you know about the illness but you refuse to give me the medical reports. This has made my life very difficult," he said. 

LISTEN | Reporter Sandra Hercegova breaks down George's situation:

In the end, George had a family doctor and a psychiatrist who filled out the medical form for him.

However, social assistance refused to recognize his long-term disability. 

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

He explained the final decision relies on the evaluating physician from the Quebec Ministry of Labour, Employment and Social Solidarity, who reviews the requests and decides whether the applicant has a severe work limitation or not.

Nadeau-Rioux said the ministry repeatedly granted George temporary work limitations lasting three to six months over the course of four years. While recipients do get higher financial aid with these limitations, it's only 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 benefits required him to submit requests every three to six months with updated medical reports.

Missing appointments or failing to submit timely applications meant George could lose approximately $400 from his monthly social assistance.

'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 Montréal, 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 assistance 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 Quebec," said Barbeau.

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

Barbeau said it is also complex to evaluate if a specific health condition can lead to a permanent disability. He says sometimes, doctors fear that by diagnosing a permanent disability, they will make a patient less motivated to return to work.

That's why, he says, some doctors diagnose social assistance recipients with temporary 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 evaluation, but at one point they have to decide," he said.

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

Giguère, a researcher for CREMIS and an associate professor in the department of family medicine at the Université de Montréal, says in addition to the reluctance of some doctors to participate in the process, the administrative burden on recipients themselves also creates a barrier to accessing support. 

Applying to be recognized as having permanent work limitations involves the applicant filling out a 15-page document with their employment history and medical reports, she said, adding it can be difficult to fill out correctly, especially if the applicant does not have the appropriate level of literacy.

"It should be a program giving social assistance to the most vulnerable, but if they want to get through this process, 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 Social Solidarity why a recipient of social assistance may be denied benefits related to having permanent work limitations, despite medical reports from their doctor diagnosing them with a long-term disability that affects their ability to work. 

In a statement, the ministry said that in addition to the doctor's medical form, "other medical and socio-professional information or documents may be deemed necessary to demonstrate" the person's eligibility for permanent work disability. 

It also said factors affecting employability and work limitation assessment include age, education, work experience and psychosocial adaptation. 

"The evaluation is conducted by a specialized centre of medical and socio-professional experts, considering the person's overall situation and physician's recommendation," it said. 

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

Permanent work limitation finally accepted

After four years of reassessment demands and submitting medical reports, social assistance finally recognized 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 bills, I have a bit of a budget for groceries.- George

George's counsellor Nadeau-Rioux filed a review requesting George receive retroactive benefits, but social assistance rejected this request.

The case will be brought to the Administrative Tribunal of Quebec this year. 

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

"The people on social assistance 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.