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AllowedSocial Security Tribunal of Canada (Employment Insurance)·

SST Allows Appeal on EI Eligibility Based on Hypothetical WLI Benefits

Case No. 2026 SST 280 · Member Stephen Bergen

📌 In brief

The Social Security Tribunal allowed an appeal challenging a decision about Employment Insurance (a person) eligibility based on hypothetical Wage Loss Indemnity (WLI) benefits. The Appeal Division found that the General Division made errors in its interpretation of the law and facts, leading to the case being returned for reconsideration.

⚖️ Legal holding

A claimant's income for Employment Insurance purposes includes hypothetical WLI benefits to which they would be entitled if they applied, even if the application was incomplete or refused.

Topics

employment insurancewage loss indemnity

📖 Technical summary

The Appeal Division allowed an appeal challenging a General Division decision on Employment Insurance benefits eligibility.

📜 Headnote Official document

The Social Security Tribunal allowed an appeal challenging a General Division decision regarding Employment Insurance (EI) eligibility based on hypothetical Wage Loss Indemnity (WLI) benefits. The Appeal Division found that the General Division made errors of law and fact by considering incomplete applications as valid for determining EI eligibility.

📚 Full judgment Official document

OUTCOME: Allowed

Citation: MK  v  Canada Employment Insurance Commission , 2026  [NAME]  280 Social Security Tribunal of Canada Appeal Division Decision Appellant: [redacted] Respondent: [redacted] Representative: [COUNSEL] under appeal: General Division decision dated December 22, 2025 (GE-25-2927) Tribunal member: [NAME] of hearing: In Writing Decision date: April 7, 2026 CORRIGENDUM DATE May 5, 2026 File number: AD-25-817 On this page Decision Overview Preliminary matters Issues Analysis Conclusion Decision [ 1 ] The appeal is allowed. The General Division made errors of law and fact. I have returned the matter for reconsideration. Overview [ 2 ] [APPELLANT]. is the Appellant. I have called him the Claimant because this application is about his claim for Employment Insurance ( [NAME] ) benefits. The Respondent is the Canada Employment Insurance Commission, which I will call the Commission. [ 3 ] The Claimant took a medical leave from his employment and claimed [NAME] sickness benefits. He was reluctant to apply for the Wage Loss Indemnity (WLI) benefits offered by a private insurance plan ([NAME]) through his employer, because he did not want to disclose the detailed personal health information required by [NAME]. [ 4 ] On October 2, 2025, the Commission informed the Claimant that he was not eligible for sickness benefits because he had not exhausted his entitlement to the employer-paid WLI benefits. It chose $9,999.00 to stand in for the amount of weekly earnings the Claimant would have received under the [NAME], and it allocated that amount as though the [APPELLANT] had received it when he could not work. The Claimant asked the Commission to reconsider but it would not change its decision. [ 5 ] The [APPELLANT] did finally apply to [NAME] for WLI on October 21, 2025, the same day he received the reconsideration decision. However, he did not give [NAME] all the information it demanded, so it declined his claim. [ 6 ] The [APPELLANT] appealed the reconsideration decision to the General Division, but the General Division dismissed his appeal. Now, he is appealing the General Division decision to the Appeal Division. [ 7 ] I am allowing the appeal. The General Division made an error of law by allocating the [NAME] earnings without considering whether they were payable by [NAME], and it made an error of fact by confirming the [NAME] earnings at $9,999.00 per week. [ 8 ] I am returning the matter for reconsideration. Preliminary matters New evidence [ 9 ] The [APPELLANT] provided new evidence together with his application (identified as AD1) as well as in later submissions (AD4, AD7, AD13). [ 10 ] With few and limited exceptions, the Appeal Division is not permitted to consider new evidence that was not available to the General Division. Footnote 1 [ 11 ] The [APPELLANT] purpose in providing much of the new evidence is clear from his submissions. He believes that his new evidence will help him to prove that the Commission had not properly evaluated or estimated his [NAME] earnings, and to prove that the [NAME] was not a group plan (and therefore should not have been allocated). In other words, he is asking me to accept new evidence to prove facts that are relevant to the appeal outcome. [ 12 ] New evidence that is provided to prove facts that are in issue does not fall within any of the permitted exceptions. I cannot consider this evidence. [ 13 ] The [APPELLANT] also provided documents to support an argument that the General Division acted unfairly. He believes that his new evidence shows that the employer’s Record of Employment and participation in the Premium Reduction Program were fraudulent. He says that these documents show that the General Division relied on a fraudulent record, and he characterizes this as a breach of natural justice. [ 14 ] I may consider new evidence if it supports a claim that the General Division acted in a way that was procedurally unfair, because this is one of the exceptions. [ 15 ] It is actually unclear how the new evidence is relevant to the issues of earnings and allocation. I can only assume that he believes the new evidence would cause the General Division to give less weight to the employer’s evidence or to evidence concerning the employer. [ 16 ] However, none of the Claimant’s new evidence supports his assertion that the General Division acted in a way that was procedurally unfair. The General Division based its decision on the evidence that was in the record. That was precisely its job. If the Claimant wanted to dispute the reliability of any evidence in the materials before the General Division, he was responsible to bring that challenge to the General Division and present whatever evidence he thought necessary to support his position. [ 17 ] The Claimant has not shown that his new evidence is exceptional in any way that would allow me to consider it at the Appeal Division. Issues [ 18 ] The issues in this appeal are as follows a) Did the General Division make an error of jurisdiction by failing to consider the Claimant’s privacy concerns? b) Did the General Division make an error of law by misinterpreting section 35(2) of the Employment Insurance Regulations (Regulations) i) To find that “hypothetical” benefits, that the Claimant might have received under different circumstances, were earnings that he was “entitled to receive”? ii) By failing to grapple with whether “on application” contemplates only an application in the form and substance demanded by [NAME]? iii) By failing to consider whether the information demands of the [NAME] in the Wage Loss Indemnity (WLI) plan were reasonable? iv) By failing to analyze whether, or when, payments under the Claimant’s deemed [NAME] entitlement were actually payable by [NAME]? c) Did the General Division make an important error of fact i) By accepting that the [NAME] was a “group” wage loss indemnity plan? ii) By accepting that the deemed earnings of $9,999.00 were earnings that the Claimant was entitled to receive on application? Analysis General principles for appeals to the Appeal Division [ 19 ] The Appeal Division may only consider errors that fall within one of the following grounds of appeal: a) The General Division hearing process was not fair in some way. b) The General Division did not decide an issue that it should have decided. Or, it decided something it did not have the power to decide (error of jurisdiction). c) The General Division made an error of law when making its decision. d) The General Division based its decision on an important error of fact. Footnote 2 Error of jurisdiction The General Division did not make an error of jurisdiction (or of law) by failing to consider the Claimant’s privacy concerns [ 20 ] The General Division did not make an error by failing to consider the Claimant’s privacy concerns. [ 21 ] The [APPELLANT] argues that the General Division should not have declined jurisdiction to consider his privacy concerns. He says the employer claimed it was not subject to the federal Personal Information Protection and Electronic Documents Act, so someone needed to take jurisdiction. [ 22 ] I understand the Claimant’s frustration, but the General Division had no jurisdiction to decide whether [NAME] or employer could require the Claimant to disclose additional personal health information in his application, or on how they should manage that information. [ 23 ] The [NAME] state that a claimant’s income includes the WLI benefits they would have received “on application.” They also state that a claimant’s income includes other benefits that they could receive, which are also stated to be “on application.” But the Regulations do not stipulate the form of the application required for any of those benefits. They do not require that a WLI benefit [NAME] may only ask for certain information, or that it must manage that information in some particular way. [ 24 ] Whether the employer rightly or wrongly asserted that it was not subject to federal privacy regulation is irrelevant to this appeal. I do not doubt that the Claimant had a legitimate concern to keep his health information private, but that is an issue that is between him and his employer, or between him and [NAME]. He may have a remedy in some forum If his information was used inappropriately or there was a privacy breach, but the Social Security Tribunal is not that forum. Error of law. The General Division did not make an error of law by considering “hypothetical benefits” as benefits that the Claimant was entitled to receive [ 25 ] Section 35(2) of the Regulations states that a claimant’s income includes WLI payments that a claimant has received or, “on application, is entitled to receive.” [ 26 ] The Claimant argues that he did apply to [NAME] for WLI benefits but that he was formally refused. He argues that the General Division misinterpreted section 35(2) to include hypothetical benefits that he might have received if he had applied “differently.” [ 27 ] The General Division did not misinterpret the meaning of “entitled to receive.” It is plain on its face that section 35(2) contemplates the inclusion of WLI benefits to which a claimant would be entitled—if the claimant applied for them. [ 28 ] The Claimant did not need to actually receive the WLI benefits to which he was entitled, or to even apply for them, for those benefits to be considered earnings under the Regulations. The General Division did not fail to grapple with whether the Claimant’s application was an application within the meaning of section 35(2)(c) of the Regulations [ 29 ] The Claimant’s real quarrel is with the definition of “application.” He argues that the General Division did not grapple with the legal distinction between an administrative denial and an “unmade application.” [ 30 ] The Claimant submitted an application for benefits to the [NAME]. According to the Claimant, it does not matter whether his application included all the information that [NAME] required. Complete or not, the Claimant asserts that he submitted an application, as required, and that his application was refused by [NAME]. According to the Claimant, this refusal proves that he was not entitled to benefits “on application.” [ 31 ] The Commission’s view is that an “application” under section 35(2)(c) must be a complete, bona fide application. It argues that [NAME] did not actually refuse the Claimant’s “application” for benefits. Instead, [NAME] refused to consider his eligibility for benefits because the Claimant did not provide it with the information it required to decide whether he was eligible for benefits. [ 32 ] The General Division did not fail to grapple with the Claimant’s argument. It clearly turned its mind to whether the Claimant’s incomplete application should be considered an application for the purpose of section 35(2)(c). Footnote 3 [ 33 ] The General Division restated the [APPELLANT] argument that he had applied to [NAME] and was refused, and his view that he was not entitled to WLI benefits as a result. However, it observed that the Claimant was unwilling to disclose what it called “the basic medical information necessary to determine eligibility.” It noted that, “unsurprisingly, the claim was rejected for lack of medical information.” [ 34 ] The General Division held that it is implicit in the ( [NAME] ) legislative scheme that an “application” includes sufficient information to allow [NAME] to approve or deny the application on its merits. As a result, it found that the Commission was correct to treat the application as though it had not been made. [ 35 ] I appreciate that the Regulations simply state that a claimant’s income includes WLI benefits to which the claimant, “on application, is entitled to receive.” They do not stipulate that an application must be in such form as may be required by either the employer or [NAME] under the [NAME]. [ 36 ] Nonetheless, the General Division made no legal error in finding that an application must be “sufficiently complete” to allow [NAME] to assess the Claimant’s entitlement. Section 35(2)(c) says that both the WLI payments a claimant has received and the WLI payments to which a claimant would have been entitled if they had applied, are considered earnings. Since entitlement to WLI benefits may be deemed where a Claimant makes no application at all, it makes sense that entitlement may also be deemed in the case of an application that is rejected because the Claimant willfully refuses to complete the application. In both cases, the deeming is necessary because of the Claimant’s action or inaction. The General Division did not make an error of law by failing to consider whether the information demands of [NAME] were reasonable [ 37 ] It was not an error of law for the General Division to have not considered whether [NAME]’s demands were reasonable, or whether the Claimant acted reasonably by refusing to comply. [ 38 ] Where there is a [NAME], a claimant is entitled to benefits under that plan, providing they would have been eligible if they applied. If a claimant has such an entitlement to benefits, the Commission must allocate that entitlement to weeks in which it is payable. [ 39 ] The Claimant believes that [NAME]’s demands were unreasonable and says it was an error for the General Division to ignore this. But the General Division’s decision is not based on whether [NAME]’s demands were unreasonable. It did not state that the Claimant was required to comply with each and every information demand of [NAME], however unreasonable. [ 40 ] Instead, the General Division reviewed what the Claimant had actually submitted. And it found that he had not provided even the basics. He had not provided sufficient information for [NAME] to adjudicate his eligibility. The General Division’s finding was based on evidence of what the Claimant actually provided to [NAME]. It did not depend on the information demands of [NAME]. The General Division made an error of law by failing to analyze whether payments from [NAME] were payable after July 27, 2025? [ 41 ] I have accepted that the General Division made no error when it found that the Claimant would have been entitled to WLI benefits if he had applied. However, the General Division’s job is not done once it decides that a claimant is entitled to earnings. It must also decide how to allocate those earnings. [ 42 ] The Claimant argued that the General Division should have found that his WLI earnings were not payable in the weeks to which they were allocated. Footnote 4 [ 43 ] Earnings from a [NAME] may only be allocated to weeks in which they are paid or payable. Footnote 5 The General Division decided that the Claimant’s earnings were correctly allocated to weeks after July 27, 2025. However, the Claimant was not actually paid the WLI benefit to which he was entitled, and the General Division made no finding on whether and when the Claimant’s WLI deemed entitlement was payable. [ 44 ] This was an error of law. [ 45 ] The allocation of the deemed WLI earnings to weeks of benefits was at the heart of the appeal. The allocation was what prevented the Claimant from receiving some or all of the [NAME] benefits to which he would otherwise have been entitled. [ 46 ] The General Division understood that this was a key issue. It noted that the Claimant’s earnings must be allocated depending on the reason for the earnings. And it referenced section 36(12) of the Regulations, which states that payments under a [NAME] must be allocated to the weeks in which they are paid or payable. Ultimately, the General Division confirmed the Commission’s allocation decision. It confirmed that the Commission could allocate $9,999.00 (as the Claimant’s deemed entitlement under the [NAME]) to weeks of benefits beginning July 27, 2025. [ 47 ] Nonetheless, the General Division failed to analyze whether or when the Claimant’s deemed entitlement under the [NAME] was actually payable by [NAME]. [ 48 ] There is very little legal authority that addresses the allocation of a deemed WLI benefit entitlement when the claimant does not apply, or where their application is defective. However, the issue was considered by the [NAME] in decision [NAME] 52557. [ 49 ] I am not bound by decisions of the [NAME]. However, I agree with its decision in this case. [NAME] 52557 concerned a claimant in similar circumstances. Like the Claimant in the present appeal, the claimant in [NAME] 52577 did not want to disclose sensitive information to a [NAME] beyond that which he would have had to disclose for [NAME] sickness benefits. The claimant had initially applied for the WLI benefit but then withdrew his application. He negotiated a substitutionary payment from the employer that was partially in lieu of the WLI benefits. [ 50 ] The Commission’s position before the [NAME] was that it should be allowed to deem the claimant to have received the WLI payments as earnings and to allocate the deemed earnings to weeks of benefits. But the [NAME] agreed with the [NAME] that the claimant’s withdrawal of his application for WLI should not affect his [NAME] entitlement. In making its decision, it did not have to consider whether the substitutionary payment was earnings to be allocated. It left this to be decided later. Footnote 6 [ 51 ] In another appeal with similar facts, a different panel of the General Division (from the member that decided this present appeal) cited [NAME] 52557 with approval. In AT  v  Canada Employment Insurance Commission , the claimant did not want to apply for the WLI because her employer had told her she could lose her job or seniority if she were denied. At the same time, she did not believe she was even eligible for the WLI benefit. The General Division found that “payable” means “will be paid, not may be paid.” (Emphasis in original). It said that there was no guarantee of approval of WLI upon application and no automatic payment of benefits. It ultimately found that the Claimant had no WLI earnings. Footnote 7 [ 52 ] The Commission believes AT is distinguishable, so it should not be considered. It notes that the claimant in AT had argued that she would not have been eligible for WLI because her injury was work-related. It says there is no evidence in the present case to suggest the [APPELLANT] would not have been eligible for WLI benefits. [ 53 ] That much is true. However, the General Division’s analysis in AT, and its finding that the claimant did not have earnings “payable upon application,” did not depend on whether the claimant’s disability related to a work injury or whether she would have been eligible for the WLI benefits. The General Division identified the question of whether she would have been eligible for WLI benefits if she had applied, as a separate and alternative basis on which it could find that these benefits were not payable. I am not obligated to follow a General Division decision, but I do not agree with how the Commission seeks to distinguish AT. AT supports the Claimant’s position. [ 54 ] In any event, I have analyzed the issues differently than the General Division in AT. In AT, the General Division was concerned with whether the benefits were “payable on application.” It conflated the claimant’s entitlement “on application” with whether benefits were “payable” for allocation. I have taken a different approach to differentiate between the issue of the Claimant’s deemed (or “hypothetical”—to use the Claimant’s word) entitlement, and the issue of allocation. [ 55 ] A claimant must become entitled to payments for those payments to be considered earnings. But those earnings must also be “paid or payable” before they can be allocated. In my view, a claimant may be deemed entitled to benefits because they could have applied for them, without finding that the benefits are payable by [NAME], or payable from the date that they could have applied. Subject to that qualification, I agree and adopt the AT’s conclusion and reasoning that “payable” means “will be paid, not may be paid.” [ 56 ] According to the Federal Court of Appeal in [APPELLANT] , a claimant must be in a position at law to enforce payment in order for that payment to be considered, “payable.” Footnote 8 That means that the Claimant’s entitlement to WLI benefits is only payable when [NAME] has the legal obligation to pay them. [ 57 ] The Commission agrees with this. Its argument notes that an amount is payable when the claimant is in a position at law to enforce the payment. Footnote 9 [ 58 ] The [NAME] had set up a [NAME] and was participating in the Premium Reduction Program. It was up to the Claimant to prove that he was not entitled to WLI benefits, but the General Division found that he failed to do so. Therefore, it was open to the General Division to find that he was entitled to benefits under the [NAME]. And since the Claimant was entitled under that plan to receive WLI benefits from [NAME], it stands to reason that [NAME] had a corresponding obligation to pay those benefits. [ 59 ] However, [NAME] also stated that “payable” means “payable at once,” when it is used without qualification (as it is in section 36(12)). The General Division did not evaluate the evidence to determine when, or how much, or for how long, [NAME] was obligated to pay. [ 60 ] The Commission referred to section 21(3) of the [NAME] Act, which states that benefits payable to a claimant under a plan in which the employer received a reduced premium (which is evidenced in the file) must be deducted from weeks of sickness benefits. That is correct, but the benefits must first be payable before they can offset [NAME] benefits. [ 61 ] The General Division made an error of law because it failed to analyze whether the Claimant’s WLI benefits were payable after July 27, 2025, or in which weeks they were payable after July 27, 2025. Error of fact The General Division did not make an important error of fact by accepting that the [NAME] was a group wage loss indemnity plan [ 62 ] The General Division makes an important error of fact when it bases its decision on a finding that ignores or misunderstands relevant evidence, or on a finding that does not follow rationally from the evidence. Footnote 10 [ 63 ] The General Division made a general statement that the employer had a “group wage loss indemnity plan.” The Claimant asserts that this ignores or misunderstands the evidence. [ 64 ] The Claimant argues that there were both short-term disability (STD) and long-term disability (LTD) benefits available under the [NAME]. He provided pay stub evidence which shows that he paid 100% of the premiums for the [APPELLANT] portion of his [NAME] benefit. The Claimant states that this evidence is relevant to whether the [NAME] was a group plan. [ 65 ] As correctly noted by the General Division, section 35(2)(c) of the Regulations requires that payments from a “group wage loss indemnity plan” must be considered as earnings for the purpose of determining the amount to be deducted from a claimant’s [NAME] benefits. Footnote 11 Payments from non-group WLI plans are not earnings for the purpose of allocation. Footnote 12 [ 66 ] A [NAME] can only be considered a group plan if it is financed at least in part by the employer. Footnote 13 The pay stub evidence that was before the General Division assigns payments for STD in the taxable benefit section. This suggests that the employer paid the premiums for the STD plan. The pay stubs also show that the employer made biweekly deductions from the Claimant’s pay for LTD, with no corresponding [APPELLANT] entry in the taxable benefits section. Overall, the pay stub evidence supports the [APPELLANT] contention that he paid 100% of the premiums of the [COMPANY] plan, or the [COMPANY] portion of the [NAME]. [ 67 ] However, this does not mean that the General Division made an error of fact. The Claimant is correct that the General Division did not refer to pay stub evidence that the Claimant paid the premium for his [APPELLANT] benefit. Assuming the [APPELLANT] benefit is severable from the STD benefit, proof that the Claimant paid the entire premium is clearly relevant to the question of whether the [NAME] is a group or non-group plan. [ 68 ] It is a relevant factor, but it is not a determinative factor. In fact, it could not have changed the outcome. [ 69 ] The pay stub evidence was relevant to only one of the requirements to classify a [NAME] as non-group. There are other requirements as well. As the Commission notes, non-group plans must also be not related to a group of persons who are all employed by the same employer voluntarily purchased by the person participating in the plan completely portable (meaning that a claimant’s benefits and premium rates under the plan would be unchanged if they were to be employed by any other employer in the same occupation) provide constant benefits while permitting deductions for income from other sources, where applicable, and have rates of premium that do not depend on the experience of a group of persons employed by the employer. Footnote 14 [ 70 ] If a [NAME] is not to be considered a group plan, it must satisfy all of the criteria. Footnote 15 Documents submitted by the Claimant demonstrate that he and the employer both acknowledged that the [COMPANY] benefit was part of the employer’s group plan. Footnote 16 No one disputed this. So, the plan could not have been a [non-group] group plan for that reason alone. It “related to a group of persons who are all employed by the same employer.” [ 71 ] And there was no evidence before the General Division by which it could have confirmed that the [NAME] satisfied the other non-group criteria. [ 72 ] The evidence that the Claimant paid the [APPELLANT] premium is not so important that I would expect the General Division to have referred to it, unless it failed to consider it. The General Division is not required to refer to each and every piece of evidence. It is ordinarily presumed to have considered all the evidence before it. Footnote 17 [ 73 ] The General Division did not make an error of fact by failing to refer to the pay stub evidence. The General Division made an important error of fact by accepting that the Claimant was entitled to deemed earnings of $9,999.00 from his [NAME] [ 74 ] The General Division made an error of fact when it confirmed that the Claimant received $9,999.00 in (weekly) earnings as a WLI benefit. [ 75 ] The Commission told the Claimant that it had estimated his earnings from the [NAME] based on the information he had provided. Footnote 18 Assuming that the actual amount of the WLI benefit could not have been discovered through a diligent investigation, it may have been reasonable for the Commission to estimate the earnings that the Claimant would have received from the [NAME]. [ 76 ] However, it is apparent that the Commission did not estimate the Claimant’s earnings from the [NAME], as it claimed. According to the reconsideration file, the Commission did not even have a copy of the plan. Nor did it have any information about the amount of the available weekly benefit as either a STD or an LTD benefit. [ 77 ] The Commission did not estimate the [APPELLANT] wage loss indemnity from his actual wage loss, either. The Commission had the Claimant’s Record of Employment ( ROE ) which showed that his earnings were just over $2000.00 for most of the included two-week pay periods. This is likely a good representation of his wage loss, but in any event—it is the only evidence in the record from which his wage loss could be inferred. The Commission’s $9,999.00 “estimate” of weekly earnings, would mean that [NAME] would have indemnified the [APPELLANT] for an amount roughly ten times his actual wage loss, which seems unlikely. [ 78 ] In fact, the Commission’s arguments acknowledge that it allocated $9,999.00 to each week to “ensure that the allocation clearly exceeded the claimant’s benefit rate to achieve the intention that the employer’s plan was the first payer.” Footnote 19 [ 79 ] The Geneal Division understood that the Commission employed the $9,999.00 figure as a “stopgap,” until such time as the [APPELLANT] proved his eligibility or non-eligibility under the [NAME]. But I cannot find any legal authority for the Commission to do so. The Commission is supposed to be determining the Claimant’s earnings based on evidence, and it is the Claimant’s earnings that it must allocate. It cannot choose a figure arbitrarily or select an amount for the wage loss indemnity that it knows is far in excess of the [APPELLANT] actual wage loss. [ 80 ] The General Division made an error of fact when it confirmed that the Claimant had [NAME] earnings at $9,999.00 per week, without any evidence that he would actually be entitled to this amount or evidence to support $9,999.00 as a reasonable estimate of his weekly earnings. Remedy [ 81 ] Because I have found that the General Division made errors in its decision, I must consider how best to provide a remedy. I have the power to send the matter back to the General Division to reconsider, or I may make the decision that the General Division should have made. Footnote 20 [ 82 ] The Claimant asks that I make the decision that the General Division should have made. Footnote 21 The Commission did not indicate any preference for remedy or take a position on whether the record was complete. [ 83 ] I have decided to return the matter for reconsideration because the file is not complete. I am not satisfied that I have all the evidence I need to make a decision or that the Claimant had a full and fair opportunity to supply it. [ 84 ] There are no details on the record of the benefits to which the Claimant would have been entitled under the [NAME] if he had applied properly, or payable by [NAME]. There is no evidence of the actual terms of [NAME] plan beyond a brief description of the Claimant’s sickness benefit options. Footnote 22 And the employer apparently did not respond to requests for information about the Claimant’s WLI benefit entitlement. Footnote 23 [ 85 ] Even if the deemed amount of $9,999.00 represented a reasonable approximation of the Claimant’s weekly STD benefit (and I have found that it was not), there was no evidence as to whether [NAME] had a waiting period or whether benefits would be paid retroactive to the date of disability. There is no evidence that the long-term disability (LTD) benefit would have been in the same amount as the STD. If they are not the same amount, it could be important to know the date at which the STD benefits would have transitioned to LTD benefits. There was no evidence of that transition, and there was no evidence of when benefits under the [NAME], if paid, would finally be exhausted. Conclusion [ 86 ] The appeal is allowed. The General Division made errors of law and fact. [ 87 ] I am returning the matter for reconsideration. The General Division has recently been replaced by a Board of Appeals. The Board of Appeals will reconsider the General Division’s decision. Footnotes Footnote 1 For the exceptions, see Association of Universities and Colleges of Canada  v  [NAME] (Access Copyright), 2012  FCA  22; See also [NAME]  v  Canada (Attorney General) , 2022  FCA  157; [NAME]  v  Canada (Attorney General) , 2019  FCA  256; [NAME]  v  Canada (Attorney General ), 2016  FC  1387; [NAME]  v  Canada (Attorney General) , 2014  FC  963. Return to footnote 1 referrer Footnote 2 This is a plain-language version of the three grounds. The full text is in section 58(1) of the Department of Employment and Social Development Act ( DESDA ). Return to footnote 2 referrer Footnote 3 See paras 14 to 17 of the General Division decision. Return to footnote 3 referrer Footnote 4 See AD7-4, AD9-6. Return to footnote 4 referrer Footnote 5 See section 36(12)(b) of the Regulations. Return to footnote 5 referrer Footnote 6 [NAME] ([NAME]) 52557 . Note: The [NAME] was the final level of appeal for [NAME] matters under the former administrative appeal scheme. The [NAME] was the first level of appeal, similar to the General Division and to the Board of Appeal that is replacing the General Division. Return to footnote 6 referrer Footnote 7 See AT  v  Canada Employment Insurance Commission , 2024  [NAME]  1685. Return to footnote 7 referrer Footnote 8 See Canada (Attorney General)  v  [NAME],  A-494-94. Return to footnote 8 referrer Footnote 9 See AD6-10. Return to footnote 9 referrer Footnote 10 I have tried to make this error more understandable. This ground of appeal is defined in section 58(1)(c) of the DESDA : The General Division will have made an error of fact where it, “based its decision on an erroneous finding of fact that it made in a perverse or capricious manner or without regard for the material before it.” Return to footnote 10 referrer Footnote 11 See para 13 of the General Division decision. Return to footnote 11 referrer Footnote 12 See sections 35(7)(b) and 35(2) of the Regulations. Return to footnote 12 referrer Footnote 13 See section 35(8)(b) of the Regulations. Return to footnote 13 referrer Footnote 14 See section 35(8) of the Regulations. Return to footnote 14 referrer Footnote 15 [NAME]  v  Canada (Human Resources Development) , 2003  FCA  449, which found that the [COMPANY] plan did not satisfy two of the six criteria. It upheld the decision of the [NAME] and [NAME] that the plan was not a group plan because it “did not meet every aspect of Regulation 35(8).” Return to footnote 15 referrer Footnote 16 Return to footnote 16 referrer Footnote 17 [NAME] to footnote 17 referrer Footnote 18 See GD3-32 Return to footnote 18 referrer Footnote 19 See AD6-11. Return to footnote 19 referrer Footnote 20 See section 59(1) of the DESDA . Return to footnote 20 referrer Footnote 21 See AD7-7. Return to footnote 21 referrer Footnote 22 See GD2-37. Return to footnote 22 referrer Footnote 23 See GD3-31. Return to footnote 23 referrer

📊 How courts decide similar cases

Among 12 similar decisions in this collection:

A snapshot of this collection — not a prediction of your case's outcome.

⚖️ What tends to weigh in cases like this

✅ Tends to be accepted

  • A decision must consider all relevant circumstances as required by the Employment Insurance Act when determining eligibility for benefits.| A claimant may have just cause to leave a concurrent employment position if they had reasonable grounds to believe their other position would continue.| A decision must ensure procedural fairness by informing an unrepresented litigant of their right to challenge a CRA ruling on insurable earnings.| An important factual error occurred when the General Division calculated the claimant's rate of weekly benefits.| A penalty and notice of violation imposed on a claimant for failing to report earnings while receiving Employment Insurance benefits must be reconsidered if there is evidence of procedural unfairness.

❌ Tends to be rejected

  • A claimant who leaves employment voluntarily without just cause is not disqualified from receiving benefits if they were referred to training by a designated authority.| Earnings paid as vacation during a planned leave period after a layoff do not qualify for the exemption set out in section 77.997 of the Employment Insurance Regulations.

Patterns observed in similar cases in this collection — every case is unique.

❓ Frequently asked questions

What did this decision decide?

The Social Security Tribunal allowed an appeal challenging a decision about Employment Insurance (EI) eligibility based on hypothetical Wage Loss Indemnity (WLI) benefits.

Who was involved?

A claimant and the Canada Employment Insurance Commission were involved in the dispute over EI eligibility.

How did the court decide, and why?

The Appeal Division found that the General Division made errors of law and fact by considering incomplete applications as valid for determining EI eligibility.

Which laws or rules were applied?

No specific laws or rules were cited in this decision.

What was the argument that mattered most?

The claimant argued that the General Division misinterpreted section 35(2) of the Employment Insurance Regulations by considering incomplete applications as valid for determining EI eligibility.

Was the decision for or against the person who brought the case?

The decision was in favour of the person who brought the case.

What does this mean for someone in a similar situation?

Someone in a similar situation may be able to appeal a decision if they believe there were errors of law and fact made by the General Division.

Can a decision like this be appealed?

Decisions from the Social Security Tribunal can generally be appealed to higher courts, but specific rules apply.

Is it worth getting a lawyer for a case like this?

It is advisable to seek legal advice from a qualified lawyer for cases involving Employment Insurance appeals.

Official source: Social Security Tribunal of Canada (Employment Insurance) headnote and full judgment reproduced from the court's public records. View on the official source ↗Summary, holding, technical summary and questions: produced by Artificial Intelligence based on the official headnote and judgment. These are VadeLab’s own material and are not the work of the Court.This decision was issued by the Social Security Tribunal of Canada (Employment Insurance). It is a reproduction of an official work published by the Government of Canada, and the reproduction has not been produced in affiliation with, or with the endorsement of, the Government of Canada. It is not an official version.