PM 03-13-02-b: Determination of Medical Barrier

WAG 03-13-02-b.

new & revised textFor RSP development, see PM 02-09-06-c.  

An applicant or customer with a temporary or chronic medical condition may have an illness or injury serious enough to prevent the person from working or participating in activities.

Pregnancy and Post-Partum Period

A CAU determination is not required to approve a medical barrier due to pregnancy six (6) weeks prior to expected delivery date and twelve (12) weeks after delivery. Approve a medical barrier without submitting medical information to CAU if a verified pregnancy and delivery is within this time frame.

If a pregnant woman states she is unable to work due to complications earlier than the 6-week period prior to her due date, a CAU determination is required.

CAU Responsibility

The Client Assessment Unit (CAU) decides whether or not the person has a temporary or chronic medical barrier. The decision is based on medical reports and social data. FCRC staff gather medical evidence, use observation, and include other case facts when submitting a request to CAU for a determination that a barrier exists. A minor ailment or injury, such as a cold, broken finger, or rash, is not normally serious enough to be a barrier. A licensed physician (including a licensed psychiatrist, osteopath, or other medical doctor) or licensed or certified psychologist must verify the person's physical or mental impairment and its effect on their ability to work or participate in work and training activities. Send the information to CAU for a determination of medical status.

When CAU determines that the person has a medical barrier, they also determine if the medical barrier is "chronic" or "temporary."

new textCAU determines a client should apply for SSI when the medical condition is:

  • serious; and
  • chronic, and
  • the client has significant functional limitations which are not temporary.

When CAU determines that the person can do some type of work, their finding will be one of "no medical barrier."

Provide the applicant or customer with written notice of the decision on a medical barrier.

Review of Medical Barrier

Review the medical barrier as needed, based on specific case facts. Send the customer's current medical records and relevant social data to CAU for a determination of whether a customer's medical condition continues to prevent them from working or completing work and training activities. If the customer still has a medical barrier, continue to recognize it until the next review.

If the customer no longer has a medical barrier, send the customer a notice of the decision. The notice states that the customer must now complete work and training activities or be subject to sanction for failure to participate.