‘Prov[ing] What You Already Know’: The Overreliance on Medical Evidence in Adjudicating Ontario Disability Support Program Applications

Authors

• Alison Imrie, Landings LLP

Publication Date

2026

Document Type

Article

English Abstract

The Ontario Disability Support Program (ODSP) relies heavily on medical evidence when adjudicating applications. In doing so, it positions healthcare providers as the undisputed experts on applicants’ disabilities. This poses particular challenges for applicants with under-recognized or misunderstood medical conditions like Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome (ME/CFS), who may struggle to obtain adequate medical care and thus adequate medical evidence for the purpose of ODSP applications. Through qualitative interviews with five individuals with ME/CFS who applied for ODSP, this paper illuminates the particular challenges faced by those with ME/CFS and other under-recognized disabilities in the ODSP application process. Drawing on literature identifying gaps between how healthcare providers and patients assess patients' symptoms, as well as on research about the influence of gender and race on physician perceptions of patient credibility, this paper criticizes the overreliance on medical evidence in adjudicating ODSP applications. Ultimately, this paper argues that a new approach is necessary - that the ODSP application process ought to recognize and value the embodied knowledge of people with disabilities themselves, rather than treating medical practitioners as the sole authority in recognizing and assessing disability.

Citation Information

Imrie, Alison. "‘Prov[ing] What You Already Know’: The Overreliance on Medical Evidence in Adjudicating Ontario Disability Support Program Applications." Journal of Law and Social Policy 38. (2026): 87-108.
DOI: https://doi.org/10.60082/0829-3929.1517
https://digitalcommons.osgoode.yorku.ca/jlsp/vol38/iss1/6

References

1 Tranchemontagne v Ontario (Director, Disability Support Program), 2006 SCC 14 at para 3.

2 Ontario Disability Support Program Act, SO 1997, c 25, Sch B, s 5(1)(c) [ODSP Act].

3 ODSP Act, supra note 2, s 5(1)(c). For a single person, the prescribed limit is $40,000, set out in O Reg 222/98, s 27(1).

4 Ibid.

5 Government of Ontario, “Ontario Disability Support Program,” online: [perma.cc/4263-QKL4].

6 Ibid.

7 ODSP Act, supra note 2, s. 4(1).

8 Ibid, s 4(1)(a).

9 Ibid, s 4(1)(b).

10 Ibid, s 4(1)(c).

11 Government of Ontario, “Internal Reviews and Appeals for Social Assistance,” online: [perma.cc/7ZGY-FGAX].

12 Ibid.

13 Tribunals Ontario, “Appeal and Hearing Process,” online: [perma.cc/2CH2-83PA].

14 ODSP Act, supra note 2, s 9(1)–(2).

15 Government of Ontario, “2.9: Medical Reviews” (September 2023), online: [perma.cc/4G96-ZKBD].

16 The naming associated with this condition is controversial, and a number of different names have been used over the years. Many patients prefer myalgic encephalomyelitis, as they find chronic fatigue syndrome trivializing. Following the convention of most literature on the illness, this paper uses “ME/CFS” as a catch-all term.

17 Ontario Task Force on Environmental Health, An Action Plan to Improve Care for People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Fibromyalgia (FM) and Environmental Sensitivities/Multiple Chemical Sensitivity (ES/MCS) (Ontario: Government of Ontario, 2018) at 56, online (pdf): [perma.cc/39XQ-72XQ].

18 Lucinda Bateman et al, “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management” (2021) 96:11 Mayo Clinic Proceedings 2681 at 2861.

19 Maya Dusenbery, Doing Harm (United States: HarperOne, 2018) at 253.

20 Bateman et al, supra note 18 at 2862.

21 Betsy A. Keller, John Luke Pryor & Ludovic Giloteaux, “Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO2 peak indicates functional impairment” (2014) 12 J Translational Medicine 1 at 2.

22 Bateman et al, supra note 18 at 2865

23 Ibid at 2863; Keller, Pryor & Giloteaux, supra note 21 at 2; Manuel Thoma et al, “Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is Inconsistent with Current Evidence and Harmful to Patients” (2024) 60:1 Medicine 1 at 1–2.

24 Bateman et al, supra note 18 at 2865

25 Jose G. Montoya et al, “Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome” (2021) 9:10 Healthcare 1331 at 3.

26 While I have used the language of “contested” and “controversial” to describe ME/CFS and its treatment, I point readers to the helpful language set out by an author and person with ME/CFS who instead describes ME/CFS as “controversialised”, in order to emphasize that the alleged controversy is actively produced and maintained by state actors and insurance companies who push psychosomatic narratives and chronically underfund biomedical research into ME/CFS: “Capital and the Controversialisation of Illness,” Epistemology of the Clinic (February 16, 2024) online: [perma.cc/H6ZY-M4VG].

27 Bateman et al, supra note 18 at 2864. See also: Anthony L. Komaroff et al, “Neurologic Abnormalities in Myalgic Encephalomyeltis/Chronic Fatigue Syndrome” 70:1 Brain Nerve 41; Anthony L. Komaroff, “Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome” 322:6 JAMA 499; Julian A. G. Glassford, “The Neuroinflammatory Etiopathology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)” 8 Frontiers in Physiology 1.

28 Ibid at 2871, quoting Mary Burgess & Trudie Chalder, Cognitive Behaviour Therapy for CFS/ME (UK: PACE Trial Management Group, 2004); Keith Geraghty et al, “The ‘Cognitive Behavioural Model’ of Chronic Fatigue Syndrome: Critique of a Flawed Model” (2019) 6:1 Health Psychology Open 1.

29 Geraghty et al, supra note 28 at 2–3.

30 Bateman et al, supra note 18 at 2871.

31 See e.g. Eiren Sweetman et al, “Current Research Provides Insight into the Biological Basis and Diagnostic Potential for Myalgic Encephalomyelitis/Ehronic Fatigue Syndrome (ME/CFS)” 9 Diagnostics 73; Institute of Medicine, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness (Washington: National Academies Press, 2015); Thoma et al, supra note 23 at 3–5.

32 It is worth noting that the key issue in framing ME/CFS as a psychological illness is the mismatch between illness etiology and appropriate treatment – not that psychological illnesses should be treated as less valid or less worthy of consideration than physical illnesses. Rather, a psychological framing of ME/CFS results in a treatment paradigm that does not provide adequate care to patients: Manuel Thoma et al, “Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients” (2024) 60:1 Medicina 83.

33 Dana J Brimmer et al, “US Healthcare Providers’ Knowledge, Attitudes, Beliefs, and Perceptions Concerning Chronic Fatigue Syndrome” (2010) 11 BMC Family Practice 28.

34 Keng Ngee Hng, Keith Geraghty &Derek F.H. Pheby, “An Audit of UK Hospital Doctors’ Knowledge and Experience of Myalgic Encephalomyelitis” (2021) 57 Medicina 1 at 11.

35 Ibid at 10.

36 Ibid.

37 Stephanie McManimen et al, “Dismissing Chronic Illness: A Qualitative Analysis of Negative Health Care Experiences” (2019) 40:3 Health Care for Women International 241; Keith J Geraghty & Charlotte Blease, “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and the Biopsychosocial Model: a Review of Patient Harm and Distress in the Medical Encounter” (2019) 41:25 Disability & Rehabilitation 3092 at 3094–3097.

38 Dusenbery, supra note 19 at 255.

39 For a discussion on the value of reflexivity in disability scholarship, see e.g. Jen Rinaldi, “Reflexivity in Research: Disability between the Lines” (2013) 33:2 Disability Studies Quarterly.

40 I received ethics approval for this research from the Osgoode Ethics Committee on 15 October 2021.

41 Interview of Participant A (20 October 2021) [A1]; Written Responses of Participant A2 (16 November 2021) [A2]; Interview of Participant A3 (11 November 2021) [A3]; Written Responses of Participant A4 (12 November 2021) [A4]; Written Responses of Participant A5 (18 November 2021) [A5].

42 For more information about which health care professionals may complete the ODSP application, see Government of Ontario, “Ontario Disability Support Program Disability Determination Package”, online: https://www.ontario.ca/page/ontario-disability-support-program-disability-determination-package.

43 A sample version of the 2020 Disability Determination Package can be found through Steps to Justice, “Sample Revised Disability Determination Package” (2020), online (pdf): [perma.cc/H98Z-JBXW].

44 Ibid.

45 This portion of the Health Status Report was recently updated from a 1-4 scale to the current 0-3 scale. A copy of the updated Health Status Report can be found at ibid.

46 Ibid.

47 Ontario Ministry of Community and Social Services, Ontario Disability Support Program Adjudication Framework (Ontario: Ministry of Community and Social Services, 2017) at 15 [emphasis in original].

48 A1, supra note 41; A2, supra note 41; A5, supra note 41.

49 A5, supra note 41.

50 A4, supra note 41.

51 A1, supra note 41; A3, supra note 41.

52 1709-07627 (Re), 2018 ONSBT 1734 at para 21 [ONSBT 1734].

53 1706-04939 (Re), 2018 ONSBT 1053 at paras 17–18; 1303-02668 (Re), 2014 ONSBT 654 at para 3.

54 1706-04939 (Re), supra note 52; 1709-07937 (Re), 2018 ONSBT 3596 at para 13

55 1608-06231 (Re), 2017 ONSBT 4396 at para 26.

56 1701-00492 (Re), 2018 ONSBT 2166 at para 18.

57 1707-05883 (Re), 2018 ONSBT 1582 at para 5; 1409-10304 (Re), 2015 ONSBT 5976 at para 29; 1302-00134 (Re), 2013 ONSBT 5663 at para 20.

58 1409-10304 (Re), 2015 ONSBT 5976, at para 29.

59 1302-01134 (Re), 2013 ONSBT 5663, at para 20.

60 Honda Canada v Keays, 2008 SCC 39.

61 Ibid at para 89.

62 1406-06266 (Re), 2015 ONSBT 3896 at para 28.

63 1708-06869 (Re), 2018 ONSBT 2026 at para 20.

64 1307-07582 (Re), 2014 ONSBT 1771 at para 17.

65 1402-02082R (Re), 2015 ONSBT 5573 at para 14.

66 1312-13652 (Re), 2014 ONSBT 4211 at para 12.

67 1611-08299 (Re), 2017 ONSBT 4436 at paras 19–22.

68 1312-13329 (Re), 2014 ONSBT 4756 at para 26.

69 See e.g. 1206-08051 (Re), 2013 ONSBT 1895 at paras 21, 24; 1611-08244 (Re), 2017 ONSBT 3485 at paras 18–21; 1410-12268 (Re), 2015 ONSBT 5051 at paras 23–25.

70 A1, supra note 41; A3, supra note 41; A5, supra note 41; A4, supra note 41.

71 A1, supra note 41.

72 A3, supra note 41.

73 A4, supra note 41.

74 Ibid.

75 A5, supra note 41.

76 A2, supra note 41.

77 A1, supra note 41; Ontario Task Force on Environmental Health, supra note 17 at 30.

78 Ontario Task Force on Environmental Health, supra note 17 at 34.

79 A1, supra note 41.

80 A2, supra note 41.

81 A1, supra note 41.

82 A3, supra note 41.

83 A1, supra note 41.

84 A5, supra note 41.

85 Ibid.

86 A1, supra note 41.

87 A3, supra note 41.

88 A5, supra note 41.

89 A3, supra note 41.

90 A1, supra note 41.

91 S Ford, L Fallowfield & S Lewis, “Can Oncologists Detect Distress in Their Out-Patients and How Satisfied Are They with Their Performance During Bad News Consultations?” (1994) 70:4 British J Cancer 767.

92 Lisa J Staton et al, “When Race Matters: Disagreement in Pain Perception Between Patients and Their Physicians in Primary Care” (2007) 99:5 J National Medical Association 532 at 535.

93 R J Stephens et al, “Randomized Trials with Quality of Life Endpoints: Are Doctors’ Ratings of Patients’ Physical Symptoms Interchangeable with Patients’ Self-Ratings?” (1997) 6:3 Quality of Life Research 225.

94 Ibid at 229.

95 Ibid [raw data omitted from quotation].

96 Stuart A Grossman et al, “Correlation of Patient and Caregiver Ratings of Cancer Pain” (1991) 6:2 J Pain & Symptom Management 53 at 55.

97 Stephens et al, supra note 93 at 235.

98 Andrew Allegretti et al, “Paired Interviews of Shared Experiences Around Chronic Low Back Pain: Classic Mismatch Between Patients and Their Doctors” (2010) 27:6 Family Practice 676.

99 Ibid at 680.

100 Ibid at 681.

101 Ethan Basch et al, “Patient Versus Clinician Symptom Reporting Using the National Cancer Institute Common Terminology Criteria for Adverse Events: Results of a Questionnaire-based Study” (2006) 7:11 Lancet Oncology 903.

102 Ibid at 906.

103 Ibid.

104 Bateman et al, supra note 18 at 2864, 2866.

105 Judith Mosoff, “Lost in Translation? The Disability Perspective in Honda v Keays and Hydro-Quebec v Syndicat” (2009) 3:1 McGill JL & Health 137 at 141–144.

106 Ibid at 141 –144.

107 While credibility may also impact the assessment of applicants’ written applications and testimony at hearings, given limited space I have focused on how physicians’ determinations of patient credibility impact who is able to get the medical evidence necessary to advance a successful ODSP application.

108 Cathryn Molloy, “Vulnerable Rhetors and Stigma in Health and Medicine” in Rhetorical Ethos in Health and Medicine (New York: Routledge, 2019) at 32.

109 Dara E Purvis, "A Female Disease: The Unintentional Gendering of Fibromyalgia Social Security Claims" (2011) 21:1 Tex J Women & L 85 at 110, citing Mary Crossley, “The Disability Kaleidoscope,” (1999) 74 Notre Dame L Rev 621 at 693–695.

110 Ibid at 87.

111 Ibid at 111.

112 Ibid at 112, citing Peter V Lee, Sheri Porath & Joan E Schaffner, “Engendering Social Security Disability Determinations: The Path of a Woman Claimant” (1994) 68 Tull L Rev 1477 at 1505.

113 Linda Mills, “A Calculus for Bias: How Malingering Females and Dependent Housewives Fare in the Social Security Disability System” (1993) 16 Harv Women’s LJ 211.

114 Ibid at 219.

115 Ibid at 219, 221.

116 Laverne Jacobs, “The Canada Disability Benefit Act and Women With Disabilities: Pursuing Disability Equality and Reducing Administrative Violence” (2024) 61:2 OHLJ 547 at 566–567.

117 Ibid at 567.

118 Ibid.

119 Staton et al, supra note 92 at 535.

120 Ibid.

121 Jane Pryma, “‘Even My Sister Says I’m Acting Like a Crazy to Get a Check’: Race, Gender, and Moral Boundary-Work in Women’s Claims of Disabling Chronic Pain” (2017) 181 Social Science & Medicine 66 at 70-71.

122 See e.g. Kimberlé Crenshaw, “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics” (1989) 1:8 University of Chicago Legal Forum 139.

123 Pryma, supra note 121 at 68.

124 Ibid.

125 Ibid, citing Khiara Bridges, Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization (California: University of California Press, 2011) at 211.

126 Ibid at 68.

127 A4, supra note 41.

128 A3, supra note 41.

129 For a discussion on how the patriarchy harms men as well as women, see bell hooks, The Will to Change: Men, Masculinity, and Love (New York: Washington Square Press, 2004) at 24–30.

130 Anne Levesque & Ravi A. Malhotra, “The Dawning of the Social Model? Applying a Disability Lens to Recent Developments in the Law of Negligence” (2019) 13:1 McGill J L and Health 1.

131 Ibid at 11.

132 Ibid.

133 Judith Mosoff, “Lost in Translation?: The Disability Perspective in Honda v. Keays and Hydro-Quebec v. Syndicat” (2009) 3:1 McGill JL & Health 137 at 142.

134 Levesque & Malhotra, supra note 130 at 12. See also: Louise Bélanger-Hardy, “Thresholds of Actionable Mental Harm in Negligence: A Policy-Based Appraisal” (2013) 36:1 Dalhousie LJ 103 at 121–122.

135 Susan Wendell, The Rejected Body (New York: Routledge, 1997) at 117.

136 Ibid at 119 [emphasis added].

137 Ibid at 122.

138 Ibid.

139 Ibid.

140 Ibid.

141 Ibid at 125 [emphasis in original].

142 Charlotte Blease & Keith Geraghty, “Are ME/CFS Patient Organizations ‘Militant’? Patient Protest in a Medical Controversy” (2018) 15 J Bioethical Inquiry 393 at 396–397.

143 See e.g. The ME Association, Illness Management Report: CBT, GET and Pacing (UK: ME Association, 2015), online: [perma.cc/4SBF-ZTXN]; Mark Vink and Alexandra Vink-Niese, “Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review” (2018) Health Psychology Open 1 at 7; Graham McPhee et al, “Monitoring treatment harm in myalgic encephalomyelitis/ chronic fatigue syndrome: A freedom-of-information study of National Health Service specialist centres in England” (2021) 26:7 J Health Psychology 975 at 976.

144 Blease & Geraghty, “Are ME/CFS Patient Organizations ‘Militant’?,” supra note 142 at 395–397.

145 McPhee et al, supra note 143 at 976.

146 National Institute for Health and Care Excellence, Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (UK: NICE, 2021), online (pdf): [perma.cc/W9GR-5DKN].

147 See e.g. Keith Geraghty, Mark Hann & Stoyan Kurtev, “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients’ Reports of Symptom Changes Following Cognitive Behavioural Therapy, Graded Exercise Therapy and Pacing Treatments: Analysis of a Primary Survey Compared with Secondary Surveys” (2019) 24:10 J Health Psychology 1318; Monserrat Nuñez et al, “Health-related Quality of Life in Patients with Chronic Fatigue Syndrome: Group Cognitive Behavioural Therapy and Graded Exercise Versus Usual Treatment” (2011) 30:3 Clinical Rheumatology 381; Tom Kindlon, “Do Graded Activity Therapies Cause Harm in Chronic Fatigue Syndrome?” (2017) 22:9 J Health Psychology 1146; Keith J Geraghty, “Further Commentary on the PACE Trial: Biased Methods and Unreliable Outcomes” (2017) 22:9 J Health Psychology 1209.

148 See e.g. The ME Association, supra note 143; The ME Association, “ME Association press statement about the results of the PACE study” (February 18, 2011), online: [perma.cc/83BV-KP8G]; ME Research UK, “Experiences of graded exercise therapy” (July 27, 2013), online: [perma.cc/3H8Q-TXN4].

149 Odelia R Bay, “Malingerer or Maligned: A Comparative Study of Multiple Chemical Sensitivity Case Law” (2015) 36:3 Comp Lab L & Pol’y J 381.

150 Ibid at 408.

151 Ibid.

152 Ibid at 409.

153 Hardychuk v Johnstone, 2012 BCSC 1359 at para 10; see also: Pike v Ooh La La Café and others (No. 3), 2023 BCHRT 99 at para 25 [Pike]; Bhangu v Inderjit Dhillon and others, 2023 BCHRT 24 at para 8; Brooks v Skyacres Turkey Ranch Ltd. and others (No. 2), 2022 BCHRT 73 at para. 21; RR v Vancouver Aboriginal Child and Family Services Society (No. 6), 2022 BCHRT 116 at para 16.

154 Pike, ibid at para 25.

155 SO 1997, c 16, Sch A, s 119(2). See also WSIB Ontario, Operational Policy Manual: Decision-Making (29 September 2023), online: [perma.cc/7VD5-CVDN].

156 Doron Dorfman, “Fear of the Disability Con: Perceptions of Fraud and Special Rights Discourse” (2020) 53:4 Law & Society 1 at 2–3.

157 Janet Mosher & Joe Herman, “Welfare Fraud: The Constitution of Social Assistance as Crime” in Joan Brockman & Janet E Mosher, eds, Constructing Crime: Contemporary Processes of Criminalization (Vancouver: UBC Press, 2010) at 18.

158 Ibid.

159 This figure reflects the increased rates as of July 2025 as set out by the Ontario government: Government of Ontario, “Ontario Disability Support Program,” online: [perma.cc/PS4J-DZDK].

160 See e.g. Tracy Smith-Carrier et al, “Erosion of Social Support For Disabled People In Ontario: An Appraisal of the Ontario Disability Support Program (ODSP) Using a Human Rights Framework” (2020) 9:1 Can J Disability Studies 1 at 15–16; Leah Hamilton & James P Mulvale, “‘Human Again’: The (Unrealized) Promise of Basic Income in Ontario” (2019) 23:7 J Poverty 576 at 587; Participant A1, supra note 41, also mentioned this concern in her interview.

161 2003 SCC 54 at paras 108–117.

162 ODSP Act, supra note 2, s 1(c)–(d).

163 Surdivall v Ontario (Director, Disability Support Program), 2014 ONCA 240 at para 44.