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Reasons and decision
Persons in attendance
The Appellant attended the hearing.
Introduction
[1] The Appellant filed an initial claim for employment insurance benefits (benefits) on April 22, 2013 (Exhibit GD3-12). The Appellant was sent a decision from the Canada Employment Insurance Commission (Commission), dated September 23, 2015, denying her benefits because it was determined by the Commission that no medical certificate was submitted attesting to her medical condition (Exhibits GD3-68 and GD3-6). The Appellant requested a reconsideration of this decision, which was received on October 6, 2015 (Exhibit GD3-70). The Appellant was sent a reconsideration decision, dated October 28, 2015, which upheld the modified decision denying her benefits from July 3, 2013 to July 12, 2013 (Exhibits GD3-84 and GD3-85). The Appellant appealed this decision to the Social Security Tribunal (Tribunal) on November 12, 2015, 2015 (Exhibits GD2-1 to GD2-5).
[2] The hearing was held by Teleconference for the following reasons:
- a) The complexity of the issue under appeal.
- b) The information in the file, including the need for additional information.
- c) The form of hearing respects the requirement under the Social Security Tribunal Regulations to proceed as informally and quickly as circumstances, fairness and natural justice permit.
Issue
[3] Whether the disentitlement of sickness benefits imposed on the Appellant, pursuant to subsection 18(1) of the Employment Insurance Act (Act) and subsection 40 (1) of the Employment Insurance Regulations (Regulations) for failing to prove she was not available for work due to illness, should be upheld.
The law
[4] Subsection 18 (b) of the Act states, “ A claimant is not entitled to be paid benefits for a working day in a benefit period for which the claimant fails to prove that on that day the claimant was unable to work because of a prescribed illness, injury or quarantine, and that the claimant would otherwise be available for work”
[5] Section 40 (1) of the regulations states, “The information and evidence to be provided to the Commission by a claimant in order to prove inability to work because of illness, injury or quarantine under paragraph 18(1) (b) or subsection 152.03(1) of the Act, is a medical certificate completed by a medical doctor or other medical professional attesting to the claimant’s inability to work and stating the probable duration of the illness, injury or quarantine.”
Evidence
[6] The Appellant worked for at Compass Group Canada Ltd from November 1, 2012 to April 9, 2013 (Exhibit GD3-15).
[7] The Appellant applied for sickness benefits on April 22, 2013 (Exhibit GD3-12).
[8] The Appellant declared she ready and able to work for the period April 14, 2013 to April 27, 2013.
[9] However because the Appellant was claiming sickness benefits, she subsequently amended these reports after contacting Service Canada on May 6, 2013 (Exhibits GD3-25 and GD3-26).
[10] The Appellant used the Telephone Reporting System to complete the remainder of her reports for the weeks of April 28, 2013 to July 20, 2013. She indicated that she was not available for work due to sickness (Exhibits GD3-30 to GD3-66).
[11] The Appellant received a notice from the Commission indicating that her claim was under review. The Commission requested that the Appellant provide a medical certificate to support her illness claim. When she did not respond to this notice, the Commission disentitled her from receiving benefits (Exhibits GD3-67 to GD3-69).
[12] The disentitlement of sickness benefits established an overpayment of $3,224.00 (Exhibit GD3-86).
[13] The Appellant asked for a reconsideration of this decision and explained that she did not respond to the request for a medical certificate because she did not receive the letter. Attached to this request were copies of the appropriate medical certificates, which were requested by the Commission (Exhibits GD3-70 to GD3-78).
[14] A Commission agent spoke with the Appellant on October 27, 2015 and explained that she had provided proof of illness up to April 25, 2013 (Exhibit GD3-79).
[15] The Appellant submitted an additional medical certificate indicating that she was unable to work until July 2, 2013 (Exhibit GD3-81).
[16] The Appellant advised that she went to her employer to begin working again on July 3, 2013. However, her job was not available until July 8, 2013. The Appellant continued to collect benefits for this extra week.
[17] Based upon the medical certificate submitted in October 2013, the overpayment was reduced from $3,224.00 to $496.00 (Exhibit GD4-3).
Submissions
[18] The Appellant submitted that she should be paid benefits for the one week that she had to wait until her job became available and she could resume her job.
[19] The Appellant submitted that she is in a difficult financial position and could really use the benefit money for that week (Exhibit GD2-40.
[20] The Respondent submitted that her medical certificate only advised that she was ill and could not work, until July 2, 2013, thus she was not eligible for benefits after that date.
Analysis
[21] CUB 63860 upheld the principle that sickness benefits may be payable upon submission of appropriate medical certificates attesting to the illness.
[22] The Appellant subsequently submitted the appropriate medical documents attesting that she was unable to work because of her sickness and medical condition. When the Commission received this information, it reduced the overpayment incurred by the Appellant, accordingly.
[23] The Appellant was not able to produce any medical documentation that she was prevented from working due to sickness, after July 2, 2013. She was paid sickness benefits after this date, but she was not eligible to receive benefits after that date. Because she was not eligible to receive these benefits, a $496.00 overpayment was incurred.
[24] The Tribunal finds that the Appellant did not meet the legislative requirements to receive sickness benefits after July 2, 2013.
Conclusion
[25] The appeal is dismissed