Employment Insurance (EI)

Decision

[1] I am dismissing the Claimant’s appeal.

Overview

[2] The Claimant applied for employment insurance sickness benefits in April 2015. He submitted three doctors’ notes in support of his application and collected 15 weeks of sickness benefits. The Canada Employment Insurance Commission (Commission) conducted an investigation into the doctors who signed the notes. The Commission decided that the Claimant’s doctors’ notes were not genuine. The Commission decided that the Claimant had not proven his entitlement to sickness benefits and asked the Claimant to repay benefits. The Claimant asked the Commission to reconsider its decision. The Commission did not change its decisions. The Claimant appealed to the Tribunal.

[3] I am dismissing the Claimant’s appeal. The Commission had a reasonable basis to believe that someone had made a false statement about the Claimant’s entitlement to employment insurance benefits. The Commission had the authority to extend the reconsideration period to 72 months. The Claimant does not have evidence proving his entitlement to sickness benefits. He received benefits that he was not entitled to receive. He must repay the benefits.

Issues

[4] Issue 1: Does the Commission have the authority to reconsider the Claimant’s sickness benefits?

[5] Issue 2: Does the Claimant have evidence proving his entitlement to medical benefits?

[6] Issue 3: Does the Claimant have to repay benefits?

Analysis

Issue 1: Does the Commission have the authority to reconsider the Claimant’s sickness benefits?  

[7] The Commission has the authority to reconsider the Claimant’s sickness benefits. The Commission believed that someone had made false or misleading statements about the Claimant’s benefits. It was reasonable for the Commission to have this opinion.

[8] The Commission can reconsider any claim for employment insurance benefits. However, the Commission must obey time limits. Usually, the Commission has 36 months to reconsider a claim for benefits.^{Footnote 1} If the Commission decides that a claimant has received benefits they were not entitled to receive, the claimant has to repay those benefits.^{Footnote 2}

[9] If the Commission has the opinion that someone has made false or misleading statements about a claim for benefits, then the Commission can extend the reconsideration period. The Commission can take up to 72 months to reconsider a claim if the Commission has the opinion that someone made a false or misleading statement about a claim.^{Footnote 3}

[10] The Commission’s power to extend the reconsideration period to 72 months is an exceptional power. The Commission must exercise this power carefully. The Commission has to prove that it has a reasonable basis for its opinion that someone made a false or misleading statement. The Commission should tell a claimant why it thinks there is a false statement.^{Footnote 4}

[11] The Claimant applied for employment insurance sickness benefits on April 13, 2015. In support of his claim, he provided three doctor’s notes:

• One dated February 7, 2015. This note is signed by Dr. Mark Tao.
• One dated August 24, 2015. This note is signed by Dr. Mark Tao.
• One dated January 6, 2016. This note is signed by Dr. Landy Wu.

[12] All three of the notes are on a similar prescription pad. The three notes have the same office address and clinic name.

[13] The Commission could find no record of Dr. Mark Tao in the provincial physicians’ registry. An internet search did not show any links related to a Dr. Mark Tao.

[14] On December 16, 2015, and June 9, 2016, the Commission visited the clinic address listed on the doctors’ notes. On the first visit, the Commission spoke with Dr. Landy Wu, the tenant of the office suite. He told the Commission that there was no doctor named Dr. Mark Tao working at the office.  He said that he had been the sole tenant of the office for three years. His business card said that he was an acupuncturist.

[15] On the Commission’s second visit, the Commission showed Dr. Landy Wu an example of the prescription pad. Dr. Landy Wu told the Commission that he did not use that prescription pad. The clinic name was not the same as his clinic name. The phone number was incorrect. It was not his signature.

[16] After the investigation, the Commission decided that medical notes issued by Dr. Mark Tao and Dr. Landy Wu using that prescription pad were fraudulent. I find that this was a reasonable decision to make, on the balance of probabilities. There was no evidence that Dr. Mark Tao was a real doctor. Dr. Landy Wu said that he did not use the prescription pad. The signature was not his signature. I accept that the Commission had a reasonable basis to believe that the doctors’ notes were not genuine.

[17] The Commission interviewed the Claimant and asked him about the doctors’ notes. The Commission told the Claimant that they thought his doctors’ notes were false because of their investigation. The Claimant told the Commission that he had hired an agent to help with his application for sickness benefits. He said that he had believed that the doctors’ notes were from real doctors.

[18] The Commission decided that the Claimant did not have enough medical evidence to prove his entitlement to sickness benefits. The Commission made this decision on May 7, 2019. This is more than 36 months after the Claimant submitted the three doctors’ notes.

[19] It does not matter whether it was the Claimant or someone else who made the false or misleading statement. The Commission has the authority to extend the reconsideration period when it has a reasonable basis to believe that anyone has made a false or misleading statement in relation to a claim for benefits.

[20] Even if the Claimant thought that the doctors’ notes were real, the Commission had a reasonable basis to believe that doctors’ notes were not real. It was reasonable for the Commission to come to the opinion that someone had made a false statement about the Claimant’s entitlement to sickness benefits.

[21] The Commission has proven that it had a reasonable basis to extend the reconsideration period to 72 months. The Commission has the authority to reconsider the Claimant’s entitlement to sickness benefits.

Issue 2: Does the Claimant have evidence proving his entitlement to sickness benefits?

[22] The Claimant does not have evidence proving his entitlement to sickness benefits.

[23] The Claimant has to prove his entitlement to employment insurance benefits.^{Footnote 5} To prove his entitlement to sickness benefits, he has to provide a medical certificate. A medical doctor or other medical professional has to sign the medical certificate. The medical certificate must say that the Claimant cannot work. The medical certificate should say how long the Claimant will be sick or injured.^{Footnote 6}

[24] The Claimant provided several new doctors’ notes after the Commission told him that they did not believe the first three doctors’ notes were real. All of the notes are from the same doctor. At the hearing, the Claimant said that this was his family doctor.

• One doctor’s note dated April 18, 2016. It says that the Claimant saw the doctor for a rotator cuff injury and lumbar strain. The note says that the Claimant should avoid heavy lifting.
• One doctor’s note dated April 18, 2016. It says that the Claimant should have physiotherapy for a rotator cuff injury.
• One doctor’s note dated December 15, 2016. It says that the Claimant should have acupuncture therapy for neck and shoulder strain.
• One doctor’s note dated January 13, 2020. It says that the Claimant visited the doctor because of lower back pain and headache. It says that the Claimant visited the doctor on February 11, 2015, April 18, 2016, September 23, 2016, and November 21, 2016. The doctor referred the Claimant to a specialist and the Claimant also had a CT scan.

[25] None of these doctors’ notes say that the Claimant cannot work because of illness or injury. None of these notes estimate a recovery date. At the hearing, the Clamant said that he did not have a doctor’s note that said he could not work.

[26] The law is clear. The Claimant has to provide a medical certificate from a medical professional that says he cannot work. The Claimant does not have a note that says he cannot work. The Claimant does not have evidence proving his entitlement to sickness benefits.

Issue 3: Does the Claimant have to repay benefits?

[27] The Claimant received benefits he was not entitled to receive. He must repay those benefits.

[28] The Claimant argues that he should not have to repay benefits because he hired an agent to help him with his application for sickness benefits. He argues that he thought the doctors’ notes were real.

[29] The Claimant told the Commission that he did not apply for benefits himself. He said that he hired an agent to help him with his application for sickness benefits. The agent did the application on his behalf. At the hearing, the Claimant said that he received the sickness benefits. He received direct deposits to his own bank account.

[30] Even if the Claimant hired someone to complete his application, he still received the benefits himself. The agent did not collect the benefits. The Claimant has not proven that he is entitled to those benefits. He received benefits that he was not entitled to receive.

[31] If a claimant receives benefits that they are not entitled to receive, there is an overpayment and the claimant must repay those benefits.^{Footnote 7} I do not have the authority to waive the Claimant’s obligation to repay any overpayment.^{Footnote 8} Furthermore, I do not have the authority to order the Commission to write off the Claimant’s overpayment.^{Footnote 9}

[32] The Claimant has not proven that he was entitled to sickness benefits. He must repay the benefits he received.

Conclusion

[33] I am dismissing the Claimant’s appeal. The Claimant does not have evidence proving his entitlement to sickness benefits. He must repay the benefits he received.