Systemic Problems in the Settlement Process
The problems described on this page are not isolated incidents. They are patterns that claimants across Canada have experienced over the 25+ years this fund has been operating. If you recognize your own experience here, you are not alone.
The Four Patterns
1. Delay
Claims sit for months or years without a decision. Loss of Income applications go unprocessed. Requests for information receive no response. The Administrator has no published service standards, no processing timelines, and no penalties for delay.
Why it matters: Many claimants are elderly, seriously ill, or dying. Every month of delay is a month without benefits they need to survive. For some, delay is a death sentence — if the claimant dies before a decision is rendered, the claim may be extinguished.
What you can do: Document everything. Send status inquiries by email so you have a paper trail. Note dates, names, and what was said. If you have been waiting more than 90 days for a decision, contact us.
2. Silence
You send an email. No reply. You leave a voicemail. No callback. You submit documents. No acknowledgment. Weeks pass. Months pass. Nothing.
Why it matters: Silence is not neutral. Silence prevents you from knowing whether your claim is being processed, whether your documents were received, or whether you need to take further action. Silence runs out the clock.
What you can do: Always communicate in writing (email, not phone). Keep copies of everything you send. If you get no response within 10 business days, send a follow-up referencing the date and content of your original message.
3. Retroactive Requirements
You have been receiving a benefit for years — medication reimbursement, cost of care, or other entitlements. Without warning, the Administrator demands new documentation, a specialist letter, or evidence that was never required before. If you cannot produce it, the benefit is suspended.
Why it matters: Retroactive requirements are not in the Settlement Agreement. If you were approved for a benefit under certain conditions, those conditions cannot be changed after the fact. This is a basic principle of administrative fairness called estoppel — an organization cannot change the rules and then penalize you for not meeting the new rules.
What you can do: Request in writing the specific provision of the Settlement Agreement that authorizes the new requirement. If they cannot cite one, the requirement is not valid.
4. Obstruction
You ask for a routine adjustment. Instead of processing it, the Administrator reopens questions that were already decided. You ask for your records. You are told you cannot have them. You submit evidence. It is ignored or "lost."
Why it matters: The Administrator's job is to process claims — not to create obstacles. When settled questions are reopened, when records are withheld, and when evidence disappears, the process is not working as the courts intended.
What you can do: Keep copies of every document you submit. Send documents by tracked mail or email with read receipts. If a question that was previously decided is being reopened, cite Article 10.01 and the principle of finality.
The Financial Incentive to Delay
The fund currently holds $942 million and earned $55.7 million in investment income in 2024. Unpaid benefits remain invested in the fund, earning returns for the fund — not for the claimant who is owed that money.
There is no penalty for the Administrator when claims are delayed. There is no interest paid to claimants on late payments. There is no performance standard that requires claims to be processed within a specific timeframe.
In other words: delay costs the claimant everything and costs the fund nothing.
What Should Exist But Does Not
- Mandatory processing timelines — Every claim should have a maximum processing time, with consequences if the deadline is not met.
- Interest on late payments — If the fund delays your payment, the fund should pay interest at the same rate it earns on your money.
- Independent ombudsman — Claimants should have somewhere to go when the Administrator is not responsive. That is what this website aims to provide.
- Accountability reporting — The fund should publish processing times, denial rates, and complaint statistics so claimants and the public can evaluate the Administrator's performance.
- Claimant bill of rights — A clear, enforceable statement of what every claimant is entitled to expect from the administration of this fund.