Certifying Client Sick Leave & Related Needs

Midwives across the province have had challenges with insurance companies and employment insurance agents with respect to writing sick notes. There have been inconsistencies and misinformation about the role of midwives as primary care providers and what types of medical certificates can be signed by midwives.

Job-protected leaves of absence are governed by the Employment Standards Act and the Human Rights Code. Accommodations in the workplace are also governed by the Code. The legislation now states which health care providers may certify a client’s inability to work because of pregnancy or sickness that may arise during a client’s course of care.

On January 1, 2018, the Employment Standards Act is amended to specify, in section 46, that “legally qualified medical practitioner” means

  • a person who is qualified to practice as a physician,
  • a person who is qualified to practice as a midwife,
  • a registered nurse who holds an extended certificate of registration under the Nursing Act, 1991,
  • or in the prescribed circumstances, a member of a prescribed class of medical practitioners.

Employment Insurance is implemented by Service Canada who will accept a midwife’s certification about a client’s inability to work due to “sickness” if that sickness if within their field of practice. Extended health benefits are managed by private health insurance companies that work independently and have differing policies. Most will accept prescriptions written by midwives (e.g., for massage therapy, compression stockings, breast pumps). Some of them may not initially accept them as they may be unfamiliar with the midwifery scope of practice.

Midwives who encounter difficulties having their certificates accepted can contact the AOM’s policy department for advocacy support.


Template letter for insurance or employer

Midwives can adapt this letter when their letters, certificates or prescriptions have been refused by insurance or employment agencies.