P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l m i n i s t r y ) r e c o n s i d e r a t i o n d e c i s i o n d a t e d J a n u a r y 1 t h e c o s t o f a n a s s e s s m e n t a n d l a b o u r a s s o c i a t e d w f o o t w e a r l i f t m o d i f i c a t i o n . I n p a r t i c u l a r , t h e m i n i s t r y t h e s h e l f o r t h o p e d i c f o o t w e a r u p t o t h e m a x i m u m a o f t h e 1 ½ i n c h f o o t w e a r l i f t , b u t t h a t h e w a s n o t e l i l a b o u r ( $ 2 7 5 ) a s t h o s e i t e m s e x c e e d t h e m a x i m u m A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s R e g u l a t i o n a n d 3 . 1 0 ( 4 . 2 ) f o r o f f t h e s h e l f o r t h o p e d i c f o o t w e a r . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s W i t h D i s a S c h e d u l e C , s e c t i o n s 3 a n d 3 . 1 0A P P E A L # I D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ' s ( t h e 4 , 2 0 1 4 w h i c h 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 i t h h i s o f f t h e s h e l f o r t h o p e d i c f o o t w e a r a n d d e t e r m i n e d t h a t t h e a p p e l l a n t w a s e l i g i b l e f o r o f f m o u n t o f $ 2 5 0 a n d w a s e l i g i b l e f o r $ 7 5 f o r t h e c o s t g i b l e f o r t h e c o s t o f t h e a s s e s s m e n t ( $ 7 5 ) o r t h e l e g i s l a t e d a m o u n t s e t o u t i n E m p l o y m e n t a n d ( E A P W D R ) s e c t i o n 6 2 a n d S c h e d u l e C , s e c t i o n 3 b i l i t i e s R e g u l a t i o n ( E A P W D R ) S e c t i o n 6 2 &
P A R T E S u m m a r y o f F a c t s T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t t h e t i m e o f r e c 1 ) 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 c o n s i d e r a t i o n ( R a p p e l l a n t s t a t e s t h a t t h i s i s s u e h a s b e e n d e c i d e d a m o n e y s h o u l d b e s a v e d b y n o t f i g h t i n g a c a s e t h a t u s e p r e v i o u s d e c i s i o n s t o s h o w l u n a c y o f f i g h t i n g t f o r c o n s t r u c t i o n o f t h e l i f t f o r h i s b o o t s b u t n o t a l l t h t h a t h a v e b e e n p a i d f o r r e p e a t e d l y i n t h e p a s t t h r o u a p p e l l a n t s t a t e s t h a t w i t h o u t t h e o rt h o p e d i c b o o t s h s u f f e r i n g a n d t r e m e n d o u s c o s t t o t a x p a y e r s . T h e a r e q u i r e s a h i g h t o p b o o t t o p r o t e c t h i s a n k l e s f r o m a n d t h a t c h e a p b o o t s c a n n o t b e f i t t e d w i t h a l i f t a n d f r e q u e n t r e p l a c e m e n t . T h e a p p e l l a n t s t a t e s t h a t h e d i a b e t i c r e q u i r e m e n t s n e e d w a r m d r y b o o t s a n d t h a t a x p a y e r d u e t o m e d i c a l c o s t s a n d p o s s i b l e s u r g e r i t r e a d h e f a l l s a n d i n t h e p a s t h a s s u s t a i n e d i n j u r i e s T h e a p p e l l a n t a l s o s t a t e s t h a t " d e n i a l c o n f l i c t s m i n i h e h a s d o n e h i s p a rt b y f i n d i n g d o n o r b o o t s t h a t l a s a p p e l l a n t s t a t e s t h a t t h e " p u b l i c w ill w a n t y o u , t h e m d e c i d e d d e c i s i o n s a t t r i b u n a l . F a il u r e t o c o m p l y w i l f r o m t h e p a s t ' ; 2 ) L e t t e r f r o m t h e m i n i s t r y t o t h e a p p e l l a n t d a t e d N o d a t e d S e p t e m b e r 3 0 , 2 0 1 O t h e E m p l o y m e n t a n d A s w a s a p p r o v e d f o r t w o ( 2 ) p a i r o f o f f t h e s h e l f o rt h o p l e f t s h o e -1 ½ i n c h r a i s e s . 3 ) L e t t e r s f r o m t h e m i n i s t r y t o t h e a p p e l l a n t d a t e d N r e q u e s t f o r 2 p e r m a n e n t m o d i f i c a t i o n s t o o f f t h e s h e e x c e e d $ 2 0 0 a n d t w o ( 2 ) p a i r s o f o f f t h e s h e l f o r t h o a t o t a l n o t t o e x c e e d $ 5 0 0 . 4 ) Q u o t e f r o m a m e d i c a l e q u i p m e n t p r o v i d e r , u n d a t d i s c r e p a n c y a n d a r t h r i t i s d u e t o f r a c t u r e s a n d t h a t h r a i s e m o d i f i c a t i o n o f 1 . 5 i n c h e s a t a c o s t o f $ 6 7 5 b a m a t e r i a l s , s h o e r a i s e a n d f o o t w e a r ( $ 3 2 5 ) ; 5 ) P u r c h a s e A u t h o r i z a t i o n d a t e d N o v e m b e r 2 8 , 2 0 1 c o s t o f t h e a p p e l l a n t ' s o f f t h e s h e l f o r t h o p e d i c f o o t w 6 ) O rt h o s e s R e q u e s t a n d J u s t i f i c a t i o n ( t h e " 2 0 1 3 O r d a t e d J u n e 2 8 , 2 0 1 3 e x p l a i n s t h a t t w o p r e v i o u s t r i b a s a c o m p o n e n t o f c u s t o m o r t h o s i s . T h e p h y s i c i a n a p p e l l a n t h a s l e g l e n g t h d i s c r e p a n c y a n d a rt h r i t i s s e r e c o m m e n d i n g a c u s t o m m a d e o r t h o s i s t o c o r r e c t g c o m p l e t e d b y a c e r t i f i e d o r t h o t i s t d a t e d J u l y 1 0 , 2 0 1 f o o t w e a r w i t h e x t e r n a l s h o e r a i s e o f 1 ½ i n c h e s . T h o n s i d e r a t i o n c o n s i s t e d o f : F R ) d a t e d D e c e m b e r 3 1 , 2 0 1 3 i n w h i c h t h e t t r i b u n a l o v e r a n d o v e r . T h e a p p e l l a n t s t a t e s t h a t h a s b e e n w o n o v e r a n d o v e r a n d t h a t " t r i b u n a l w ill h i s ' . T h e a p p e l l a n t s t a t e s t h a t t h e $ 2 5 0 p a y s o n l y e b u i l d i n g m a t e r i a l s i n c l u d i n g b o o t s f o r m o d i f i c a t i o n g h t r i b u n a l v i c t o r i e s a t m i n i s t r y c o s t . T h e e f a l l s a n d g e t i n j u r e d r e s u l t i n g i n p a i n a n d p p e l l a n t a l s o s t a t e s t h a t h e h a s s i z e 1 3 f e e t a n d s p r a i n s . H e s t a t e s t h a t p r o p e r b o o t s a r e e x p e n s i v e d o n o t l a s t c a u s i n g f u rt h e r w a s t e t o t a x p a y e r a n d n e e d s s e a s o n a l b o o t s , s p r i n g a n d w i n t e r a s t f a i l u r e t o p r o v i d e t h e s e w i l l c o s t f u rt h e r c o s t t o e s f o r a m p u t a t i o n . H e s t a t e s t h a t w i t h o u t p r o p e r s u c h a s b r o k e n r i b s a n d i n j u r e d k n e e s a n d a n k l e s . s t r i e s v i s i o n s t a t e m e n t o f f i s c a l r e s p o n s i b i l i t y " , t h a t t l o n g e r w h i c h e q u a l s s a v i n g s t o t a x p a y e r . T h e i n i s t r y , t o d o t h e s a m e b y s t a n d i n g b y p r e v i o u s l y l u p s e t t a x p a y e r d u e t o f a il u r e o f m i n i s t r y t o l e a rn v e m b e r 2 2 , 2 0 1 0 s t a t i n g t h a t i n t h e i r d e c i s i o n s i s t a n c e A p p e a l T r i b u n a l f o u n d t h a t t h e a p p e l l a n t e d i c s h o e s w i t h p e r m a n e n t m o d i f i c a t i o n s t o e a c h o v e m b e r 2 2 , 2 0 1 O a p p r o v i n g t h e a p p e l l a n t ' s l f s h o e s : 1 . 5 i n c h l i f t a t a c o s t o f $ 1 0 0 e a c h , n o t t o p e d i c b o o t s a t a n e s t i m a t e d c o s t o f $ 2 5 0 e a c h , f o r e d , s t a t i n g t h a t t h e a p p e l l a n t h a s l e g l e n g t h e r e q u i r e s o rt h o p e d i c f o o t w e a r a n d e x t e r n a l s h o e s e d o n a n a s s e s s m e n t ( $ 7 5 ) , l a b o u r ( $ 2 7 5 ) a n d 3 t o a m e d i c a l e q u i p m e n t p r o v i d e f o r $ 2 5 0 f o r t h e e a r w i t h m o d i f i c a t i o n s ; t h o s e s R e q u e s t " ) i n w h i c h t h e a p p e l l a n t ' s s e c t i o n , u n a l s r e g a r d e d t h e i n c l u s i o n o f t h e c o s t o f " b o o t s " s e c t i o n d a t e d J u l y 2 , 2 0 1 3 i n d i c a t e s t h a t t h e c o n d a r y t o f r a c t u r e s t h a t o c c u r r e d i n 1 9 8 3 a n d a i t a n d l e g l e n g t h / a l i g n m e n t . S e c t i o n 3 w a s 3 s p e c i f y i n g t h a t t h e a p p e l l a n t r e q u i r e s o r t h o p e d i c e o r t h o t i s t s t a t e s t h a t t h e o r t h o p e d i c f o o t w e a r
m u s t h a v e e x t r a d e p t h t o e b o x a n d m o d i f i a b l e s o l e a l i g n m e n t t o f e e t / a n k l e s , p a r t i c u l a r l y o n t h e l e f t , w h r e s u l t i n g i n a r t h r i t i s . T h e o rt h o t i s t s t a t e s t h a t e x t e r n k e e p p a t i e n t s a f e l y m o b i l e , a n d t h a t w i t h o u t t h e r a i k n e e s , h i p o r b a c k . T h e o r t h o t i s t s t a t e s t h a t t h e i t e w i t h o u t t h e s h o e r a i s e t h e a p p e l l a n t r i s k s f u r t h e r d a l e n g t h d i f f e r e n c e . I n a n s w e r t o q u e s t i o n 4 , t h e o r t h o r t h o t i c t h a t w i l l b e m a d e f r o m a h a n d c a s t m o l d b u 7 ) P r e s c r i p t i o n f r o m t h e a p p e l l a n t ' s p h y s i c i a n d a t e d s h e l f o r t h o p e d i c f o o t w e a r w i t h e x t e r n a l s h o e r a i s e t 8 ) M i n i s t ry n o t e r e g a r d 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 t h a t t h e a p p e l l a n t h a d p r e v i o u s o r t h o s i s i n 2 0 1 0 a n N o v e m b e r 2 8 , 2 0 1 3 t o a p p r o v e $ 2 5 0 f o r t h e p r o g r a I n h i s N o t i c e o f A p p e a l d a t e d F e b r u a r y 1 0 , 2 0 1 4 t h e m a d e b e f o r e a t t r i b u n a l a n d t h e m i n i s t r y ' s " r e f u s a l t a n d c o s t l y t o t a x p a y e r ' ' . A t t h e h e a r i n g t h e a p p e l l a n t s u b m i t t e d a d d i t i o n a l d o 1 ) L e t t e r f r o m a m e d i c a l e q u i p m e n t p r o v i d e r d a p a t i e n t a n d h a s b e e n s e e n a n d a s s e s s e d w i T h e p r o v i d e r s t a t e s t h a t i t h a s b e e n p a r t o f h b e h a l f o f p a t i e n t s s u c h a s t h e a p p e l l a n t . T h e t o i n c l u d e a n a s s e s s m e n t c o s t , a m a t e r i a l s c o r t h o t i s t ' s q u o t e s t o t h e m i n i s t r y i n t h i s m a n n t h a t s h e h a s n e v e r e x p e r i e n c e d a r e q u e s t a f a s s e s s m e n t f e e , n o r h a s t h e o r t h o t i s t s h e w o t h a n t h e f u l l a p p r o v e d q u o t e s u b m i t t e d , i n c l u t h a t s h e h a s f i r s t h a n d k n o w l e d g e t h a t t h e a p a n o t h e r m e d i c a l e q u i p m e n t p r o v i d e r i n t h e p s i n c e c l o s e d ; 2 ) Q u o t e f o r c u s t o m b i l a t e r a l f o o t o r t h o t i c s d a t e f o r c u s t o m f o o t w e a r i n t h e a m o u n t o f $ 2 , 2 0 0 3 ) A p r e s c r i p t i o n f r o m t h e a p p e l l a n t ' s p h y s i c i a n 4 ) O r t h o s e s R e q u e s t a n d J u s t i f i c a t i o n d a t e d M a i n d i c a t i n g t h a t t h e a p p e l l a n t r e q u i r e s a c u s t o m p l a s t e r m o l d s o f t h e a p p e l l a n t ' s f e e t w i l l b e u 5 ) L e t t e r f r o m t h e a p p e l l a n t ' s p r e v i o u s m e d i c a l e i n d i c a t i n g t h a t t h e a p p e l l a n t h a s b e e n a p a t i e f o o t / a n k l e a n d h a s a s i g n i f i c a n t l e g l e n g t h d i s e x p l a i n s t h a t i n o r d e r t o m o d i f v h i s f o o t w e a r a r e q u i r e d t o p r o v i d e a d e q u a t e s u p p o r t a n d i c h i s c o m p r o m i s e d b y p r e v i o u s f r a c t u r e s , n o w a l s h o e r a i s e i s r e q u i r e d t o e q u a l i z e l e g l e n g t h a n d s e t h e a p p e l l a n t m a y h a v e i n j u r i e s / d a m a g e t o h i s m i s r e q u i r e d f o r p r e v e n t i o n o f s u r g e r y a n d t h a t m a g e / i n j u r i e s f r o m f a l l s , a m b u l a t i o n w i t h 4 c m l e g o t i s t s t a t e s t h a t t h e o r t h o s i s i s a c u s t o m m a d e f o o t t d o e s n o t p r o v i d e a n y f u r t h e r e x p l a n a t i o n ; J u l y 9 , 2 0 1 3 s t a t i n g t h a t t h e a p p e l l a n t r e q u i r e s o f f o e q u a l i z e l e g l e n g t h 1 . 5 i n c h e s ; a n d r o r t h o p e d i c f o o t w e a r w i t h e x t e r n a l r a i s e i n d i c a t i n g d 2 0 1 1 a n d t h a t t h e d e c i s i o n w a s m a d e o n m m a x i m u m f o r o rt h o p e d i c s h o e s . a p p e l l a n t s t a t e s t h a t t h i s d e c i s i o n h a s b e e n o a c k n o w l e d g e d e f e a t a g a i n i s c o m p l e t e l y il l o g i c a l c u m e n t a t i o n a s f o l l o w s : t e d M a r c h 1 0 , 2 0 1 4 s t a t i n g t h a t t h e a p p e l l a n t i s a t h r e s p e c t t o o r t h o p e d i c f o o t w e a r o n J u l y 8 , 2 0 1 3 . e r j o b t o s e c u r e f u n d i n g t h r o u g h t h i r d p a rt i e s o n p r o v i d e r s t a t e s t h a t q u o t e s m u s t b e b r o k e n d o w n o s t a n d a l a b o u r c o s t a n d t h a t s h e h a s s u b m i t t e d e r f o r t h e p a s t m a n y y e a r s . T h e p r o v i d e r s t a t e s t e r t h e f a c t f o r a q u o t e t h a t d o e s n ' t i n c l u d e a n r k e d f o r e v e r r e c e i v e d p a y m e n t f o r a n y t h i n g l e s s d i n g t h e a s s e s s m e n t f e e . T h e p r o v i d e r a l s o s t a t e s p e l l a n t w a s p r e v i o u s l y s e e n a n d a s s e s s e d b y a s t b u t t h a t m e d i c a l e q u i p m e n t p r o v i d e r t h a t h a s d A p r i l 2 9 , 2 0 1 1 i n t h e a m o u n t o f $ 4 5 0 a n d q u o t e d a t e d S e p t e m b e r 1 0 , 2 0 1 O ; f o r o r t h o t i c i n s e r t s d a t e d A p r i l 1 2 , 2 0 1 1 ; r c h 1 7 , 2 0 1 1 ( t h e " 2 0 1 1 O r t h o s e s R e q u e s t " ) m a d e f o o t o r t h o t i c i n d i c a t i n g a n d t h a t h a n d c a s t s e d ; q u i p m e n t p r o v i d e r d a t e d S e p t e m b e r 2 8 , 2 0 1 0 n t s i n c e O c t o b e r 2 8 , 2 0 0 0 w i t h r e s p e c t t o h i s c r e p a n c y ( l e f t s h o r t e r t h a n r i g h t ) . T h e l e t t e r n d a d d t h e e x t e r n a l l i f t , s e v e r a l t h i n a s n e e d t o b e
done to the existing sole. The required amount of lift, or height, is "sandwiched" between the cut away sole and the shoe and glued into place, adding the original sole back to the bottom, including the original tread. The letter states that the appellant's footwear averages 12-18 months, typically at a cost of $175 to $225 before modifications. The letter also states that custom footwear would also provide the appellant with the same benefits, at a cost of $2,000 and upward, per pair; 6) A pedorthic assessment for gait and foot assessment dated February 21, 2011 with a form indicating the requirements to the appellant's footwear modifications; and 7) Hospital emergency care forms dated August 19, 2010 and September 4, 2010 indicating that the appellant has a history of chronic foot pain and was referred to a foot specialist. The ministry did not object to the admission of the appellant's additional documentation. The panel has admitted the appellant's documentation into evidence as it is in support of information and records that were before the ministry at the time of reconsideration, in accordance with section 22(4) of the Employment and Assistance Act. In particular, the new information relates to the appellant's ongoing left foot pain and leg length discrepancy and previous orthopedic footwear. At the hearing the appellant's evidence was that this issue has been decided by the tribunal before and that the ministry's refusal to pay for the cost of the assessment and labour required for the modifications to his footwear is not consistent with the ministry's vision statement or mission statement. The appellant states that because the tribunal previously approved this request before the ministry should be approving it now and that to deny his request is a "huge waste of money'. The appellant's evidence is that the footwear that he requires is not "off the shelf" footwear as the ministry states but is custom footwear as the boot must have the sole cut away and the lift inserted and glued into place and the original sole added back to the bottom of the boot. He states that the shoe is just one component of the construction. He states that a cast was used previously in order to make the insert but that a new cast is not required every time he needs new footwear as the cast is used again. The appellant's evidence is that he does not have the funds or resources to pay for the custom footwear. The ministry relied on its reconsideration decision. The ministry representative also stated that previous ministry and/or tribunal decisions are not relied on as each new request is reviewed and a new decision made as there can be changes to the request and changes to legislation since the last decision was made. The ministry representative stated that in the ministry's view the appellant's request is for off the shelf orthopedic footwear not custom-made footwear. t---
PART F -Reasons fo r P an e l D ecisi on The i s sue under a ppeal i s whethe r th e m in is try's r econsidera appell ant's re q ues t fo r the cost of the a sse ssm ent shelf orth ope d ic f o otwear and pe rmane nt m od if i ca tions maximum l egi sl ated amount s et out in Empl o yment a Regul a t ion (EAPW DR) secti o n 62 and S chedule C The r eleva nt secti ons o f the legisla t ion ar e a s fol lows: E APW DR EAPWD R , Sche d ule C Medi cal e quip m en t and dev i c es 3 (1) Subject t o sub sections ( 2) to ( 5) o f this section, the med 3.12 of t his Sched ule ar e th e heal t h suppleme nts that m ay be pr ( a) the suppleme n ts are p ro vi d ed to a fa m ily un it th a t Is eli thi s re gu lation, and (b) al l of t h e followi n g requirements a r e m e t: (I) th e family u nit has r e c e ived t he pre-author iza t ion o f the minister requested; (ii) t here are no resourc es ava ilab le to t he family unit to device; (Ill) the me dic a l equi pmen t or device is th e least exp ensi (2) For medical equipment or devices referred to in sections 3.1 to 3.8 or section 3.12, In addition to the requiremen In those s ections and s ubsection (1) of this section, the family following, as requested by the minist er : (B.C. Reg. 197/2012) (a) a prescription of a medical practitioner or nurse practitioner for the medical equipment or device; (b) an a s sessment by a n oc cupational the r apist or ph ysi ca l th equipment or device. Medical equipment and devices -orthoses 3.10 (1) In this section, "off-the-shelf". In relation to an orthosls. means a prefabricated. mass-nroduced orthosis that is not unique to a A PPEAL# I tion decision wh i ch de ni e d the ( $ 75) an d labour ( $ 275) as sociated wi th his off t h e to footwea r on the ba sis tha t it exceeded th e n d As si stance fo r Pe rsons w i th Di sabiliti e s , s ec tion 3 and 3.10 w as reasonable. ic a l e q uipment and devic e s des cribe d in se ction s 3. 1 to ovided by t he m ini ste r if ( B .C . Reg . 1 97/20 12) gib l e unde r section 62 [gen e ral he alth suppl e m ent s ] of for t h e medic al e quipment or de vice pay the co st of o r obtain the medic al eq u ipment or ve a p propriate medical equip ment or d ev i ce. ts unit must provide to the minister one or both of the e ra pi st c onfirmi ng t he medical ne ed f or the m edical
APPEAL# I particular person; "orthosis" means (a) a custom-made or off-the-shelf foot orthotic; (b) custom-made footwear; (c) a permanent modification to footwear; (d) off-the-shelf footwear required for the purpose set out In subsection (4.1) (a); (e) off-the-shelf orthopaedic footwear; (f) an ankle brace; (g) an ankle-foot orthosis; (h) a knee-ankle-foot orthosls; (I) a knee brace; (i) a hip brace; (k) an upper extremity brace; (I) a cranial helmet used for the purposes set out In subsection (7); (m) a torso or spine brace; (n) a foot abduction orthosls; (B.C. Reg. 197/2012) (o) a toe orthosls. (B.C. Reg. 197/2012) (B.C. Reg. 144/2011) (2} Subject to subsections (3) to (11} of this section, an orthosis is a health supplement for the purposes of section 3 of this Schedule if (a) the orthosls Is prescribed by a medical practitioner or a nurse practltoner, (b} the minister Is satisfied that the orthosis Is medically essential to achieve or maintain basic functionality, (c} the minister is satisfied that the orthosis Is required for one or more of the following purposes: (i} to prevent surgery; (ii} for post-surgical care; (iii} to assist In physical healing from surgery, injury or disease; (iv) to Improve physical functioning that has been Impaired by a neuro-muscuio-skeletal condition, and (d) the orthosls Is off-the-shelf unless (B.C. Reg. 144/2011) (I} a medical practitioner or nurse practitioner confirms that a custom-made orthosls is medically required, and (Ii) the custom-made orthosls Is fitted bv an orthotlst oedorthlst. occuoatlonal theraolst. ohvslcal theraolst or I
APPEAL# I podiatrist. (3) For an orthosis that is a custom-made foot orthotic, in addition to the requirements in subsection (2) of this section, all of the following requirements must be met: (a) a medical practitioner or nurse practitioner confirms that a custom-made foot orthotlc is medically required; (b) the custom-made foot orthotic Is fitted by an orthotlst, pedorthist, occupational therapist, physical therapist or podiatrist; (c) Repealed (B.C. Reg. 144/2011) (d) the custom-made foot orthotlc must be made from a hand-cast mold; (e) the cost of one pair of custom-made foot orthotics, Including the assessment fee, must not exceed $450. (B.C. Reg. 144/2011) ( 4 ) For an orthosis that is custom-made footwear, in addition to the requirements in subsection (2) of this section, the cost of the custom-made footwear, including the assessment fee, must not exceed $1 650. (4,2) For an orthosis that is off-the-shelf orthopaedic footwear, in addition to the requirements in subsection (2) of this section, the cost of the footwear must not exceed $250. (B,C. Reg, 144/2011) Basic Eligibility The ministry held that as a Person with Disabilities designation, the appellant is eligible for the health supplements set out in EAPWDR Schedule C provided his request meets all the eligibility criteria. The ministry approved the appellant's request for off the shelf orthopedic footwear in the amount of $250 and $75 for the cost of the lift to modify his footwear. The items that are at issue in this appeal are the assessment cost of $75 and the footwear modification labour costs of $275 for a total of $350. Position of the parties The ministry's position is that the appellant meets the criteria set out in Schedule C, section 3.10(2) which requires that for an orthosis that is off the shelf orthopedic footwear, it must be prescribed by a medical practitioner or nurse practitioner, and the minister must be satisfied that the orthosis is medically essential to achieve or maintain basic functionality and is required for one or more of the following purposes: to prevent surgery, for post-surgical care, to assist in physical healing from surgery, injury or disease; or to improve physical functioning that has been impaired by a neuro musculo-skeletal condition. The ministry's position is that because the appellant met the legislated criteria, they approved his request for the maximum allowable cost of the off the shelf orthopedic footwear of $250 as set out in EAPWDR Schedule C, section 3.10(4.2). I The ministry's position was that the aooellant also met the eliQibilitv criteria for the 1 ½" lift as it met
t h e d e f i n i t i o n o f o r t h o s i s s e t o u t i n E A P W D R S c h e m o d i f i c a t i o n t o f o o t w e a r . T h e m i n i s t r y p r o v i d e d a p f o o t w e a r m o d i f i c a t i o n s . T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e m i n i s t r y h a s n o l e l e g i s l a t e d a m o u n t , s o t h e m i n i s t r y h a s n o l e g i s l a t e d l a b o u r c o s t s o f $ 2 7 5 , s o t h e a p p e l l a n t ' s r e q u e s t f o r T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h i s r e q u e s t i s n o t f o m a d e f o o t o r t h o t i c u n d e r E A P W D R S c h e d u l e C , s e E A P W D R S c h e d u l e C s e c t i o n 3 . 1 0 ( 4 ) a n d t h a t t h e f u l l . T h e a p p e l l a n t s t a t e s t h a t a s i d e n t i f i e d i n t h e l e t t e r f p r o v i d e d i n s u p p o r t o f h i s p r e v i o u s r e q u e s t f o r c u s t c u t a w a y a n d t h e l i f t i n s e r t e d a n d g l u e d i n t o p l a c e a t h e b o o t . T h e a p p e l l a n t ' s p o s i t i o n i s t h a t b e c a u s e o r t h o s i s i s n o t o f f t h e s h e l f f o o t w e a r a s t h e b o o t i s j a p p e l l a n t ' s p o s i t i o n i s t h a t a s t h e 2 0 1 1 O r t h o s i s R e f o o t w a s u s e d a n d n o t h i n g h a s c h a n g e d s i n c e t h a t a g a i n . T h e a p p e l l a n t s t a t e s t h a t t h e p r o c e s s i s e s s e n e e d e d t o p r o d u c e h i s f o o t w e a r . H i s p o s i t i o n i s t h a n e e d s n e w f o o t w e a r a s t h e c a s t i s u s e d a g a i n , t h e o r t h o p e d i c f o o t w e a r . T h e a p p e l l a n t p o i n t s o u t t h a t O r t h o s i s R e q u e s t c o n f i r m s t h a t t h e o r t h o s i s i s a c u m o l d . P a n e l D e c i s i o n T h e p a n e l a p p r e c i a t e s t h a t t h e a p p e l l a n t i s f r u s t r a t e a p p e a l t h i s m a t t e r t o t h e t r i b u n a l a s t h e r e h a v e b e e a p p e a l a n d w e r e f o u n d i n f a v o r o f t h e a p p e l l a n t . H a n d t r i b u n a l d e c i s i o n s b e f o r e t h e m i n i s t r y r e g a r d i n g l o o k a t t h e c u r r e n t r e q u e s t a n d c u r r e n t d o c u m e n t a t h e a l t h s u p p l e m e n t s a r e b e i n g r e c o m m e n d e d a n d w l e g i s l a t e d c r i t e r i a i n p l a c e a t t h e t i m e o f r e c o n s i d e r a O n t h e 2 0 1 3 O r t h o s e s R e q u e s t t h e a p p e l l a n t ' s p h y r e c o m m e n d e d a n d t h e o r t h o t i s t c o n f i r m s t h a t t h e a p i s f i t t e d b y a n o r t h o t i s t . D e s p i t e u s i n g t h e w o r d c u s s u b s e q u e n t p r e s c r i p t i o n i n d i c a t e s t h a t t h e p h y s i c i a n w i t h e x t e rn a l s h o e r a i s e t o e q u a l i z e l e g l e n g t h 1 . 5 i n " o r t h o s i s " a s s e t o u t i n E A P W D R S c h e d u l e C , s e c t i t o f o o t w e a r a n d o f f t h e s h e l f o r t h o p e d i c f o o t w e a r . E A P W D R S c h e d u l e C s e c t i o n 3 . 1 0 ( 3 ) s t a t e s t h a t f o a m e d i c a l p r a c t i t i o n e r o r n u r s e p r a c t i t i o n e r m u s t c o n r e a u i r e d , i t m u s t b e f i t t e d b v a n o r t h o t i s t , o e d o r t h i s t ' A P P E A L # I d u l e C , s e c t i o n 3 . 1 0 ( 1 ) ( c ) a s a p e r m a n e n t u r c h a s e a u t h o r i z a t i o n f o r $ 7 5 f o r t h e c o s t o f t h e g i s l a t e d a u t h o r i t y t o a p p r o v e f u n d s a b o v e t h e a u t h o r i t y t o f u n d t h e a s s e s s m e n t f e e o f $ 7 5 a n d t h e a d d i t i o n a l $ 3 5 0 i s d e n i e d . r o f f t h e s h e l f o rt h o p e d i c f o o t w e a r b u t f o r a c u s t o m c t i o n 3 . 1 0 ( 3 ) o r c u s t o m m a d e f o o t w e a r u n d e r a s s e s s m e n t a n d l a b o u r c o s t s s h o u l d b e p a i d i n r o m t h e o r t h o p e d i c e q u i p m e n t p r o v i d e r p r e v i o u s l y o m m a d e f o o t w e a r , t h e b o o t m u s t h a v e t h e s o l e n d t h e o r i g i n a l s o l e a d d e d b a c k t o t h e b o t t o m o f o f t h e m o d i f i c a t i o n s t h a t m u s t t a k e p l a c e , t h e u s t o n e c o m p o n e n t o f t h e c o n s t r u c t i o n . T h e q u e s t c o n f i r m s t h a t a h a n d c a s t p l a s t e r m o l d o f t h e t i m e , t h e h a n d c a s t p l a s t e r m o l d w i l l b e u s e d n t i a l l y u n c h a n g e d w i t h r e s p e c t t o t h e c u s t o m w o r k t a l t h o u g h a n e w c a s t i s n o t r e q u i r e d e v e r y t i m e h e o r t h o s i s i s s t i l l c u s t o m f o o t w e a r n o t o f f t h e s h e l f t h e i n f o r m a t i o n f r o m t h e o r t h o t i s t o n t h e 2 0 1 3 s t o m m a d e f o o t o r t h o t i c m a d e f r o m a h a n d c a s t d a t w h a t h e f e e l s i s a w a s t e o f t i m e i n h a v i n g t o n s i m i l a r p r i o r r e q u e s t s t o t h e m i n i s t r y t h a t w e n t t o o w e v e r , w h i l e t h e r e m a y h a v e b e e n i n f o r m a t i o n t h e a p p e l l a n t ' s p r i o r r e q u e s t s , t h e m i n i s t r y m u s t i o n s u p p o r t i n g t h e r e q u e s t t o d e t e r m i n e w h a t h e t h e r t h o s e h e a l t h s u p p l e m e n t s m e e t t h e t i o n . s i c i a n c o n f i r m s t h a t a c u s t o m m a d e o r t h o s i s i s p e l l a n t r e q u i r e s a c u s t o m m a d e f o o t o r t h o t i c t h a t t o m m a d e o r t h o s i s o n t h e O r t h o s e s R e q u e s t t h e i s p r e s c r i b i n g a n " o ff s h e l f o rt h p a e d i c f o o t w e a r c h e s " . 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p odiatrist, it must be m ade from a hand-c ast mo ld orth oti cs , in c l udi ng the asses sment fee , must no t ex p resc r i be s o f f the s h e lf orthopedi c fo otwear not a cu requested items do no t f it t h e le gisl ated cri teria of a s ectio n 3.10(3). Whil e the panel understa nds that the mod ifi cati ons to be cut awa y , the l ift insert ed between the c ut away th en t he or igi nal sol e put b ack o n the b ott om o f the s ort hosis prescribed is off the sh elf orth opedi c f o otwea fo otwear, s o des pite the modifi cati ons that must b e ma that the reques ted item s do not me et the legis lat ed crit S ch edule C, secti on 3.10 (4). The ap pella nt's own evide shelf and t hen p erma ne ntly mo difie d sup ports the p As t h e ap pel lant's ph ysi cia n presc r i bes of f the shel panel fi nds that the mi nis tr y w as r e ason able in determini maxi mum l e gi slate d amo unt of $25 0 for of f the shel Sch ed ule C, section 3.10(4 . 2 ) a nd f o r the permane EAPWDR sec t i on 3.1 0( 1 ) ( c) and confirms th is part of the H avi ng mad e t hat determinat ion howeve r, t he min istry de te r mine that the ap pella nt w as only elig ible for the $ not t he a ssociat ed assessme nt cost o f $75 or labo ur l e gisl a ted maxim um a mount of $250 for th e cos t of EAPWDR Sc h edule C, s e c t i on 3. 1 0( 4.2) but this s ection of m axi m um cos t th at can b e provid ed for the off the s p ermane nt mo d i f ic ation t o the foot wea r or other c osts the fo ot we ar. As t he minis t ry does not c ite the legisla t ive criteria to support the decision tha modific at i on t o fo otwear s hould b e limited to the cost of the materials and asse ssm e nt and labour costs, the panel finds that this part of is not a reasonable application of the legislation in the circumstances of the appellant. Therefore, t he panel rescinds t he minist r y 's reconsideration an d the cos t of on e pa ir of cust om-made foot cee d $450. As the appellant's physic ia n s t o m m ad e foot ortho tic t h e pa nel fi nds t hat the c ustom ma de foot orthotic u nd er EAPW DR m ade to the appellant's footw ear requ ir e t h e sole sole and the shoe and glued into pla ce and hoe , the p hys ic ian 's prescripti on sta te s tha t the r wi t h pe r m ane nt m odi fica tio ns and n ot c ustom de to t h e app ella nt's footwear, the pa ne l fi nds eria o f cu stom footwear u nde r EAPWDR nce th at the bo ot itse lf is pu rc h ased off the an el 's f i nd ing s in t his rega rd. f orthop edic footwe ar wi th ext e rnal sho e raise , the ng t ha t the ap pe l lan t was eli gibl e f o r the f orthope dic foot wea r provi ded by EAPWDR nt mod ification to fo otwe ar as an orthosis unde r mi nistry d ecisio n. did n ot ci t e the le gisl a tive crit e ria u sed to 75 cost for the m a terials of the fo otwea r lift an d costs o f $27 5. The minist ry r efers t o the the off t h e s helf orth opedic foot we ar set ou t in the l egislatio n deals o nly wi t h the helf orth oped ic f oot wear, not the c o s t o f the ass o c iate d with the perm an en t modi fica tion to t the permanent not the ass o c i ated the ministry's reconsideration decision decisi o n.
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.