Digest of Benefit Entitlement Principles - Chapter 11

11.1.0    BENEFITS OF A SPECIFIC TYPE

11.1.1     While a Person is Unable to Work
11.1.2     With Respect to Two Entitlement Conditions

11.1.0    BENEFITS OF A SPECIFIC TYPE

The employment insurance program combines several income protection measures adapted to a variety of forms of unemployment that might arise during an insured person's working life¹. While the Act contains no specific term designating the type of benefits paid in case of inability to work by reason of illness, injury or quarantine, the term "sickness benefits" has been adopted for everyday usage. Thus, it has been provided that a person who becomes incapable of work by reason of illness, injury or quarantine may receive benefits of a specific type. The statement of the principle in this case is found in the following provision of the Act²:

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

(a)     . . . ;
(b)    unable to work because of prescribed illness, injury or quarantine, and that the claimant would otherwise be available for work . . .

On reading these few lines, we are already forewarned that sickness benefits are not paid to all claimants or in all circumstances. Instead, they are subject to entitlement conditions and to provisions concerning payment, which will be explained as the chapter proceeds.

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1. see 1.1.5, "Types of Benefit";
2. EIA 18.

11.1.1    While a Person is Unable to Work

These legislative provisions apply to every insured person who is unable to work by reason of illness, injury or quarantine, with some exceptions. There are specific provisions for those who work in the fishing industry¹ and for those who are employed under a work-sharing agreement or who are attending a training course or participating in any other employment activity to which they have been referred by the authority designated by the Commission. In the latter three cases, a person is deemed to be unemployed, capable of and available for work².

The Act also provides for the making of claims for benefit by, and for the payment of benefit to, any person or agency on behalf of deceased or incapacitated persons or persons of unsound mind³.

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1. EIR (Fishing) 8(17) &(18); see 15.7.0
2. EIA 24(3); EIA 25;
3. EIA 54(h); EIR 27.

11.1.2    With Respect to Two Entitlement Conditions

Regardless of the type of benefits being claimed, an insured person must meet the qualifying conditions for the specific benefits claimed¹. With respect to sickness benefits, the qualifying conditions stipulate that the claimant must be major attached, that is have accumulated 600 hours of insurable employment during the qualifying period² and must have an interruption of earnings from employment³.

It should be noted that in situations where a claimant has accumulated a violation on a previous claim, the claimant will require more than 600 hours of insurable employment during the qualifying period to be eligible for these benefits. Violations range from minor to subsequent⁴ with a related increase in the number of hours required to qualify for benefits⁵.

Having met the required qualifying conditions to have a benefit period established does not necessarily authorize the payment of sickness benefits. The following passage leaves no doubt about the specific conditions to fulfill for the insured person who makes a claim for benefits⁶:

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

(a)    . . . ;
(b)    unable to work because of prescribed illness, injury or quarantine, and that the claimant would otherwise be available for work . . .

This extract identifies two conditions for entitlement to sickness benefits. It is not enough for a person to demonstrate that he or she is incapable of work by reason of a prescribed illness, injury or quarantine⁷, but also that he or she would be otherwise available for work⁸.

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1. EIA 7; EIA 7.1; EIR 93; see 1.2.0, "Establishing a Benefit Period";
2. EIA 6(1), see 1.2.3, "New Entrant or Re-Entrant"; see 1.2.5, "Regular Qualifier-Claimant other than a New Entrant or Re-Entrant";
3. see Chapter 2, "Interruption of Earnings";
4. EIA 7.1(5);
5. EIA 7.1(1); see Section 18.5.3, "The Increased Entrance Requirement Sanction
6. EIA 18;
7. see 11.2.0, "First Entitlement Condition: To Be Unable To Work"; see 11.2.3, "Other Means and Sources of Information";
8. see 11.3.0, "Second Entitlement Condition: To Be Otherwise Available For Work."

[October 2006 ]