APPEAL# I PART C -Decision under Appeal The Appellant appeals the reconsideration decision of the Ministry of Social Development and Social Innovation ("Ministry") dated March 11, 2014, in which the Ministry denied the Appellant's request for replacement of her custom-made foot orthotics because the Appellant's replacement request was made before the period of time for replacement of her custom-made foot orthotics (3 years) as set out in the Employment and Assistance for Persons with Disabilities Regulation, Schedule C, section 3(3)(b) and section 3.10(10). PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Regulation ("EAPWDR"), s. 62 and Schedule C, Health Supplements, sections 3(3)(b) and 3.10(10). EAAT003(10/06/01)
APPEAL# '. PART E -Summary of Facts The evidence before the Ministry at the reconsideration included the following: • A Ministry "Orthoses Request and Justification Form" completed for the Appellant on October 30, 2013, with section 2-medical or nurse practitioner recommendation -completed and signed by the Appellant's physician on November 27, 2013, and section 3 -assessment completed by a pedorthist on November 28, 2013 (2 pages); • An estimate sheet from an orthotics company dated November 29, 2013, estimating the cost of custom orthotics for the Appellant at $450 (1 page + fax cover page); • A letter dated February 19, 2014 from the Appellant's doctor (1 page) stating that the Appellant's orthotics are already worn and need replacing and she would benefit from a replacement pair every two years; and • The Appellant's request for reconsideration dated February 11, 2014, including the written submission of the Appellant's advocate, dated February 18, 2014 (2 pages) in which the advocate wrote that the Appellant is "severely disabled and [in) immediate need of replacement of her orthosis. Her last purchase of orthosis in December 2011 are completely worn out and broken. As she is flat footed, it is painful for her to walk. And, as she needs to walk for the benefit of her overall general health she requires new orthosis." The advocate attached the February 19, 2014 letter from the Appellant's physician. The Appellant receives disability assistance and, as noted by the Ministry in its reconsideration decision, is eligible to receive health supplements (in this case, custom-made foot orthotics) under section 62 and Schedule C of the EAPWDR. The Ministry approved a pair of custom-made foot orthotics for the Appellant on December 9, 2011. The Appellant told the panel that she has diabetes and is overweight and her doctor has told her she needs to walk to help reduce her weight and improve her condition. The Appellant says that her custom-made foot orthotics are worn out and she cannot walk without her orthotics because it causes her excruciating pain. The Appellant also told the panel that she works four hours per week at a grocery store in the bakery during which time she has to stand and it is very painful for her to stand for this length of time without her orthotics. The Appellant stated that her doctor confirmed in his letter of February 19, 2014 that her orthotics are worn out and need replacing and that she "would benefit from being able to replace her orthotics every 2 years." In her Notice of Appeal dated March 25, 2014, the Appellant stated that her orthotics are worn out and that her doctor's letter "confirms that fact." She wrote that she needs orthotics to "walk without excruciating pain" and that she wears the orthotics out "earlier than three years." She also wrote that it is hard for her to stand for any length of time. The panel finds that the Appellant's written statements in her Notice of Appeal and her testimony at the hearing relate to her need for replacement of her custom foot orthotics. The panel admits these statements under section 22(4)(b) of the Employment and Assistance Act as testimony in support of information that was before the Ministry at the time the decision being appealed was made. In the reconsideration decision, the Ministry noted that the Appellant meets the criteria for custom made foot orthotics set out in subsections 3(1 )(a) and (b) of Schedule C of the EAPWDR in that she is eliaible under section 62 of the EAPWDR, the minister has pre-authorized the orthotics, there are EAA T003(10/06/01)
no resources available to the A p pellant to pay the cost of or obtain the orth the least expensive appropriate medical equipment. decision that the Appellant met the cr iteria set ou t in sect because a m edi c a l or nurse practitioner p r escribed the orthotics, the o to achieve or mai ntain b a si c fu nctionality, the minister is satisfie surgery and to assist in physical hea ling f ro m s urgery, injury practitioner con f ir med tha t custom-made orth o t ics a orthotics are fitted b y an o r t h o ti st, pedo r thist, occup The Mi nistr y stated that the Appellant received her curr request for replacement of her orthoti c s ha s not been made after the period out in sec t ion 3.10(10) of Schedule C of th e E A P W D EAAT 003( 10/06/01) I APPEAL# o ti cs, a nd the o r tho tic s ar e The Mi nistry a lso no ted in the rec o ns ide r ation ion 3.10(2 ) of Sched u le C of the EAPWDR r t hotic s a re medicall y essential d t he orthotics are requir e d to prevent or disease, and a medical or nurse re m e di cally required. Further, th e cu stom-made a t ional therapist, physical therapist or pod iatrist. e n t or t hotics in December 20 1 1 and h e r of time -3 years -set R.
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e o n t h i s a p p e a l i s t h e r e a s o n a b l e n e s s o f 2 0 1 4 , d e n y i n g t h e A p p e l l a n t ' s r e q u e s t f o r r e p l a c e m h e r r e q u e s t d o e s n o t m e e t t h e e l i g i b i l i t y c r i t e r i a s e t E A P W D R b e c a u s e t h e r e q u e s t w a s m a d e l e s s t h a o r t h o t i c s . A p p l i c a b l e L e g i s l a t i o n T h e A p p e l l a n t m e e t s t h e c r i t e r i a s e t o u t i n s e c t i o n 6 G e n e r a l h e a l t h s u p p l e m e n t s s . 6 2 ( 1 ) S u b j e c t t o s u b s e c t i o n s ( 1 . 1 ) a n d ( 1 . 2 ) , t h e i n s e c t i o n . . . 3 [ m e d i c a l e q u i p m e n t a n d d e v i c e s ] o f s u p p l e m e n t i s p r o v i d e d t o o r f o r a p e r s o n i n t h e f a m ( a ) a r e c i p i e n t o f d i s a b i l i t y a s s i s t a n c e , T h e e l i g i b i l i t y r e q u i r e m e n t s f o r m e d i c a l e q u i p m e n t a o r t h o t i c s , a r e s e t o u t i n s e c t i o n 3 o f S c h e d u l e C o f s p e c i f i c a l l y a d d r e s s e d i n s . 3 . 1 0 o f S c h e d u l e C o f t S c h e d u l e C o f t h e E A P W D R a d d r e s s t h e r e p l a c e m S c h e d u l e C H e a l t h S u p p l e m e n t s M e d i c a l e q u i p m e n t a n d d e v i c e s 3 ( 1 ) S u b j e c t t o s u b s e c t i o n s ( 2 ) t o ( 5 ) o f t h i s s e c t i o n s e c t i o n 3 . 1 t o 3 . 1 1 o f t h i s S c h e d u l e a r e t h e h e a l t h s ( 3 ) S u b j e c t t o s u b s e c t i o n ( 6 ) , t h e m i n i s t e r m a y p r o v m e d i c a l e q u i p m e n t o r m e d i c a l d e v i c e , p r e v i o u s l y p r d a m a g e d , w o r n o u t o r n o t f u n c t i o n i n g i f ( a ) i t i s m o r e e c o n o m i c a l t o r e p l a c e t h a n t o r p r o v i d e d b y t h e m i n i s t e r , a n d ( b ) t h e p e r i o d o f t i m e , i f a n y , s e t o u t i n s e c t i o t h e p u r p o s e s o f t h i s p a r a g r a p h , h a s p a s s M e d i c a l e q u i p m e n t a n d d e v i c e s o r t h o s e s 3 . 1 0 ( 1 ) I n t h i s s e c t i o n , " o f f t h e s h e l f " , i n r e l a t i o n t o a n o r t h o s i s , m e a n s a p r u n i q u e t o a p a r t i c u l a r p e r s o n ; " o r t h o s i s " m e a n s ( a ) a c u s t o m m a d e o r o f f t h e s h e l f f o o t o r t h o t i c ; ( b ) . . . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # t h e M i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n o f M a r c h 1 1 , e n t o f h e r c u s t o m f o o t o r t h o t i c s o n t h e b a s i s t h a t o u t i n s e c t i o n 3 . 1 0 ( 1 0 ) o f S c h e d u l e C o f t h e n 3 y e a r s a f t e r s h e r e c e i v e d h e r c u s t o m m a d e 2 o f t h e E A P W D R w h i c h p r o v i d e s a s f o l l o w s : m i n i s t e r m a y p r o v i d e a n y h e a l t h s u p p l e m e n t s e t o u t S c h e d u l e C t o o r f o r a f a m i l y u n i t i f t h e h e a l t h i l y u n i t w h o i s n d d e v i c e s , w h i c h i n c l u d e c u s t o m m a d e f o o t t h e E A P W D R . C u s t o m m a d e f o o t o r t h o t i c s a r e h e E A P W D R . S u b s e c t i o n s 3 ( 3 ) a n d 3 . 1 0 ( 1 0 ) o f e n t o f c u s t o m m a d e f o o t o r t h o t i c s . , t h e m e d i c a l e q u i p m e n t a n d d e v i c e s d e s c r i b e d i n u p p l e m e n t s t h a t m a y b e p r o v i d e d b y t h e m i n i s t e r i f i d e a s a h e a l t h s u p p l e m e n t a r e p l a c e m e n t o f o v i d e d b y t h e m i n i s t e r u n d e r t h i s s e c t i o n , t h a t i s e p a i r t h e m e d i c a l e q u i p m e n t o r d e v i c e p r e v i o u s l y n s 3 . 1 t o 3 . 1 2 o f t h i s S c h e d u l e , a s a p p l i c a b l e , f o r e d . e f a b r i c a t e d , m a s s p r o d u c e d o r t h o s i s t h a t i s n o t
( 1 0 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b o r t h o s i s i s t h e n u m b e r o f y e a r s f r o m t h e d a t e o n w h r e p l a c e d t h a t i s s e t o u t i n C o l u m n 2 o f T a b l e 2 o p p o C o l u m n 1 . T a b l e 2 I t e m C o l u m n 1 O rt h o 1 C u s t o m m a d e f o 2 T h e p a n e l n o t e s t h a t s e c t i o n 3 ( 6 ) o f S c h e d u l e C o f t m i n i s t r y d o e s n o t c o n s i d e r t h a t t h e A p p e l l a n t d a m a g T h e A p p e l l a n t d o e s n o t d i s a g r e e t h a t h e r r e q u e s t f o w a s m a d e l e s s t h a n 3 y e a r s s i n c e t h e M i n i s t r y a p p r 2 0 1 1 . T h e A p p e l l a n t a r g u e d t h a t h e r c u s t o m m a d e a n d s h e s a y s t h a t h e r d o c t o r h a s c o n f i r m e d s h e n e e A p p e l l a n t a r g u e d t h a t t h e M i n i s t r y s h o u l d c o n s i d e r h f o o t o r t h o t i c s o n c o m p a s s i o n a t e g r o u n d s . I n i t s r e c o n s i d e r a t i o n d e c i s i o n , t h e M i n i s t r y d e t e r m i n c u s t o m f o o t o r t h o t i c s o n D e c e m b e r 9 , 2 0 1 1 , s h e w o D e c e m b e r 9 , 2 0 1 4 . I n i t s r e c o n s i d e r a t i o n d e c i s i o n , p e r i o d d o e s n o t a p p l y w h e n a n i t e m i s r e q u i r e d d u e g r o w t h " b u t f o u n d t h a t t h e A p p e l l a n t ' s d o c t o r " h a s n " n e e d t o b e r e p l a c e d d u e t o t h e s e a b o v e m e n t i o n e d A p p e l l a n t d i d n o t m e e t t h e e l i g i b i l i t y r e q u i r e m e n t s f o s e c t i o n 3 ( 3 ) ( b ) o f S c h e d u l e C o f t h e E A P W D R . I n t h s e c t i o n 3 ( 6 ) ( b ) o f S c h e d u l e C ; h o w e v e r , t h e p a n e l n s e c t i o n 3 ( 6 ) ( b ) o f S c h e d u l e C o f t h e E A P W D R . T h e M i n i s t r y d e n i e d t h e A p p e l l a n t ' s r e q u e s t f o r r e p l a b a s i s t h a t h e r r e p l a c e m e n t r e q u e s t d i d n o t m e e t t h e t h e E A P W D R . U n d e r s e c t i o n 3 ( 3 ) o f S c h e d u l e C , t h m e d i c a l e q u i p m e n t ( s u c h a s t h e A p p e l l a n t ' s c u s t o m t h a n t o r e p a i r t h e m e d i c a l e q u i p m e n t a n d t h e p e r i o d p a s s e d . B o t h c o n d i t i o n s m u s t b e m e t i n o r d e r t o m e S e c t i o n 3 . 1 0 ( 1 0 ) o f S c h e d u l e C p r o v i d e s t h a t t h e p e S c h e d u l e C w i t h r e s p e c t t o r e p l a c e m e n t o f a n o r t h o s f o o t o r t h o t i c s , 3 y e a r s . T h e A p p e l l a n t a s k e d t h e p a n e l ( a n d t h e M i n i s t r y ) t o y e a r r e p l a c e m e n t p e r i o d r e q u i r e d b y s e c t i o n s 3 ( 3 ) a c o m p a s s i o n a t e g r o u n d s . T h e p a n e l n o t e s t h a t i t h a s d e n y t h e A p p e l l a n t ' s r e q u e s t f o r r e p l a c e m e n t c u s t o m r e n l a c e m e n t n e r i o d o n c o m n a s s i o n a t e a r o u n d s . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # : ) o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n i c h t h e m i n i s t e r p r o v i d e d t h e o r t h o s i s b e i n g s i t e t h e d e s c r i p t i o n o f t h e a p p l i c a b l e o r t h o s i s i n s i s C o l u m n 2 T i m e o e r i o d o t o r t h o t i c 3 v e a r s h e E A P W D R d o e s n o t a p p l y t o t h e A p p e l l a n t t h e e d h e r o r t h o t i c s t h r o u g h m i s u s e . r r e p l a c e m e n t o f h e r c u s t o m m a d e f o o t o r t h o t i c s o v e d h e r r e q u e s t f o r t h e o r t h o t i c s o n D e c e m b e r 9 , o r t h o t i c s h a v e w o r n o u t a n d n e e d t o b e r e p l a c e d d s t o r e p l a c e h e r o r t h o t i c s e v e r y t w o y e a r s . T h e e r r e q u e s t f o r r e p l a c e m e n t o f h e r c u s t o m m a d e e d t h a t a s i t h a d p r o v i d e d t h e A p p e l l a n t w i t h u l d n o t b e e l i g i b l e f o r r e p l a c e m e n t o r t h o t i c s u n t i l t h e M i n i s t ry a l s o s t a t e d t h a t " t h e r e p l a c e m e n t t i m e t o c h a n g e s i n a p e r s o n ' s m e d i c a l c o n d i t i o n o r o t c o n f i r m e d " t h a t t h e A p p e l l a n t ' s c u s t o m o r t h o t i c s c i r c u m s t a n c e s . " T h e M i n i s t r y d e t e r m i n e d t h a t t h e r r e p l a c e m e n t o f h e r c u s t o m o r t h o t i c s u n d e r e r e c o n s i d e r a t i o n d e c i s i o n , t h e M i n i s t r y r e f e r r e d t o o t e s t h i s i s a t y p o g r a p h i c a l e r r o r a s t h e r e i s n o c e m e n t o f h e r c u s t o m m a d e f o o t o r t h o t i c s o n t h e c r i t e r i a s e t o u t i n s e c t i o n 3 ( 3 ) ( b ) o f S c h e d u l e C o f e m i n i s t e r m a y p r o v i d e a r e p l a c e m e n t o f w o r n o u t m a d e o r t h o t i c s ) i f i t i s m o r e e c o n o m i c a l t o r e p l a c e o f t i m e s e t o u t i n s e c t i o n 3 . 1 O o f S c h e d u l e C h a s e t t h e r e q u i r e m e n t o f s e c t i o n 3 ( 3 ) o f S c h e d u l e C . r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b ) o f i s i s , i n t h e c a s e o f t h e A p p e l l a n t ' s c u s t o m m a d e r e p l a c e h e r c u s t o m m a d e o r t h o t i c s b e f o r e t h e 3 n d 3 . 1 0 ( 1 0 ) o f S c h e d u l e C o f t h e E A P W D R o n n o j u r i s d i c t i o n t o r e s c i n d t h e M i n i s t r y ' s d e c i s i o n t o m a d e o r t h o t i c s p r i o r t o t h e l e g i s l a t e d 3 y e a r
I n i t s r e c o n s i d e r a t i o n d e c i s i o n , t h e M i n i s t r y i n d i c a t e w h e n a n i t e m i s r e q u i r e d d u e t o c h a n g e s i n a p e r s o a s p e c i f i c s e c t i o n o f t h e E A P W D R i n w h i c h t h i s i s s f o u n d t h a t t h e A p p e l l a n t ' s d o c t o r h a s n o t c o n f i r m e d b e r e p l a c e d d u e t o a c h a n g e i n m e d i c a l c o n d i t i o n o A p p e l l a n t ' s p h y s i c i a n w r o t e t h a t t h e A p p e l l a n t ' s o r t h S h e w o u l d b e n e f i t f r o m b e i n g a b l e t o r e p l a c e h e r o rt t h a t s h e h a s d i a b e t e s a n d n e e d s t o w a l k t o h e l p h e A p p e l l a n t ' s d o c t o r d i d n o t i n d i c a t e t h a t t h e A p p e l l a n o r t h o t i c s a s a r e s u l t o f c h a n g e s i n h e r m e d i c a l c o n d T h e r e f o r e , t h e A p p e l l a n t m u s t m e e t t h e c r i t e r i a s e t o r d e r t o r e c e i v e r e p l a c e m e n t c u s t o m m a d e f o o t o r t p r o v i d e d h e r c u s t o m m a d e f o o t o r t h o t i c s o n D e c e m o r t h o t i c s i s D e c e m b e r 9 , 2 0 1 4 . A c c o r d i n g l y , t h e p a A p p e l l a n t d o e s n o t m e e t t h e e l i g i b i l i t y r e q u i r e m e n t s u n d e r s e c t i o n 3 ( 3 ) ( b ) o f S c h e d u l e C o f t h e E A P W D M i n i s t r y ' s d e n i a l o f t h e a p p e l l a n t ' s r e q u e s t f o r r e p l a b a s e d o n t h e e v i d e n c e . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )'. A P P E A L # d t h a t t h e r e p l a c e m e n t t i m e p e r i o d " d o e s n o t a p p l y n ' s m e d i c a l c o n d i t i o n o r g r o w t h " b u t d i d n o t r e f e r t o e t o u t o r w h e t h e r i t i s a M i n i s t r y p o l i c y . T h e M i n i s t r y t h a t t h e A p p e l l a n t ' s c u s t o m m a d e o r t h o t i c s n e e d t o r g r o w t h . I n h i s l e t t e r o f F e b r u a r y 1 9 , 2 0 1 4 , t h e o t i c s " a r e a l r e a d y w o r n o u t a n d n e e d r e p l a c i n g . h o t i c s e v e r y 2 y e a r s . " T h e A p p e l l a n t t o l d t h e p a n e l r l o s e w e i g h t ; h o w e v e r , t h e p a n e l n o t e s t h a t t h e t r e q u i r e s r e p l a c e m e n t o f h e r c u s t o m m a d e i t i o n o r g r o w t h . o u t i n s e c t i o n 3 ( 3 ) o f S c h e d u l e C o f t h e E A P W D R i n h o t i c s . T h e A p p e l l a n t a g r e e s t h a t t h e M i n i s t r y b e r 9 , 2 0 1 1 , a n d t h a t t h e r e p l a c e m e n t d a t e f o r h e r n e l f i n d s t h a t t h e M i n i s t r y ' s d e t e r m i n a t i o n t h a t t h e f o r r e p l a c e m e n t o f h e r c u s t o m m a d e f o o t o rt h o t i c s R w a s r e a s o n a b l e . T h e p a n e l c o n f i r m s t h e c e m e n t o f h e r c u s t o m f o o t o r t h o t i c s a s r e a s o n a b l e
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.