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 f o r t r a n s p o r t a t i o n a s s i s t a n c e w a s d e n i e d a s t h e A p p s e t o u t i n s e c t i o n 2 ( 1 ) ( f ) S c h e d u l e " C " o f t h e E m p l o R e g u l a t i o n s ( t h e " R e g u l a t i o n " ) . 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 b 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 b E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )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 ( t h e 1 5 , 2 0 1 4 w h i c h h e l d t h a t t h e A p p e l l a n t ' s r e q u e s t e l l a n t d i d n o t m e e t t h e l e g i s l a t i v e r e q u i r e m e n t s 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 b i l i t i e s i l i t i e s A c t , s e c t i o n 5 i l i t i e s R e g u l a t i o n , s e c t i o n 6 2 , S c h e d u l e " C "
PART E -Surnrnarv of Facts The evidence before the Ministry at reconsideration was as follows: 1. Letter dated November 18, 2013 (the "Ministry Letter") from the Ministry to the Appellant which stated they approved the Appellant's request for custom paid footwear in the amount of $1,650.00. The Appellant noted that the Ministry was only covering a portion of the custom made shoes and there was a shortfall of $325.00. 2 . Request for Non-Local Medical Transportation Assistance dated December 3, 2013 completed and signed by the Appellant requesting mileage for his appointment with an orthopedic s p e c i a l i s t r e f e r r e d b y h i s g e n e r a l p r a c t i t i o n e r . 3. Letter dated December 23, 2013 ("GP Letter") from the Appellant's general practitioner ("GP") to "Whom it May Concern" which stated the following: a. that the Appellant has been a patient of the GP for "many years;" b. that the Appellant has cerebral palsy and consequent problems with his feet and gait; c. that the Appellant always travelled out of town to the same orthotics service provider; d. that there is no similar service provider in their community; and e. that the GP asks that the Ministry would allow the Appellant to continue to use the existing service provider's services. 4. Notice of Appeal dated January 23, 2014 completed and signed by the Appellant advising that the Ministry had not denied coverage for past trips. 5. The Ministry Request for Reconsideration form dated December 11, 2013 completed and signed by the Appellant (the "Reconsideration Form") In the Reason for Request for Reconsideration, Section 3, the Appellant advised the following: i) that being driven to his out of town appointment is the least expensive way to get to his appointment; ii) that the prosthetics and orthotics clinic is equipped to prepare casts and have custom footwear made on site; iii) that the preparation has to be done in the clinic; and iv) that the hospital does not have the required equipment to prepare the products. The Appellant submitted the following additional written documentation prior to the hearing: 1. Letter dated December 12, 2013 written by the Clinic ("Letter #1 ") stating that the Appellant had an appointment on December 12, 2013 to have his feet cast in order to manufacture his custom shoes; the appointment is medically necessary to initiate the manufacturing of his shoe wear; and that the Appellant was driven to the Clinic as he does not have a driver's license. 2. Letter dated December 20, 2013 written by the Clinic ("Letter #2") stating that the Appellant attends the facility for all the Appellant's orthotic needs; that there is no other orthotic facility in the Annellant's communitv; and that all of the Annellant's treatments are reauired to take place in the EAAT 003(10/06/01)
lab. At the hearing, the Ministry advised that she was not provided with a copy of the additional documentation prior to hearing. The Panel read the content of Letter #1 and Letter #2 and made arrangements for the letters to be faxed to the Ministry by the Advocate after the hearing. The Ministry had no objections upon hearing the contents of Letter #1 and Letter #2. The Panel finds that the additional evidence provided by the Appellant clarified his current situation and was admissible under section 22(4) of the Employment and Assistance Act as it was in support of the records before the Ministry at reconsideration. EAAT003(10/06/01)
PART F -Reasons for Panel Deci sion The iss u e is whether the Ministry's decision to de n y the Appella transportation t o attend an appointment is a reasonab the Appellant. Section 62(1)(a) of the EAPWDR states the Mini s tr y indivi du al as set out in section s 2 (ge neral heal th) or sect in Schedule "C." Schedule "C," se ction 2(1 )(f)(i-iv) allows the M i nistry to pay for the least expensive app of tra nspor tation to or from the office of a med ical or nu specialist in a field of medicine or surgery if the person has b practitioner or the n ea rest ho spita l or rehabi litation h receive under the Medicar e Protection Act. The Min no reso urces available to the rec ipie n t to co ver t he S e ction 2(1)( f) states as follows: (1 ) T h e f o l low i n g ar e the health supp lements that ma y eligi ble unde r section 6 2 o f this r eg u lati o n : (f) the le ast expens ive app r op r iat e m o de of tr ansport (i) an offi ce , i n the lo c a l area, of a medical p (ii ) the office o f the nearest available speciali b ee n referr ed to a specialis t in that f ield (iii) the neares t su i t abl e gener al h osp ital sec ti on 1.1 of the Hos p ital I ns uran ce A ( iv ) the neares t suitable hos p ital a s d efined s e ction 1 of t he Hospital Insurance Act, pro vided that (v) t he transp o r t ation is to enable the person to receive a benefit under the Medicare Protection Act or a general hospital service under the Hosp (vi) there are no resources available to the person's family unit to cover the cost. In determining the Appellant did n ot qualify for a health supplement for transportation under section 2(1) (f), the Ministry conclu ded the following: The m inistry ha d de t e rmined your requ e s t for a health s cri teria s et ou t i n Sc hedule C Se c tio n 2( 1)(1), b ecaus e nearest office of a specialist in a fiel d of m ed i cine or s ur health supplement to cover the costs for transportation to attend your appointment... The Ministrv was not satisfied that the Aooellant wa s EAAT 003( 10106/01) nt a h ealth sup plement for le a ppli ca tion of t h e l a w i n the circumstances of ma y p rovide any hea l t h supple m e nt s f or an io n 3 (medical equipment a n d d evices) liste d ropriate m ode rse pract itioner or the nearest ava ilable e en referred to a specia lis t by a medic al o spita l provided that t h e recipient is ena ble to i s t ry m u st additionally be satisfied th at there are cost . be paid for b y t h e minister if provide d to a fam i l y un i t tha t is ati on t o or f r o m ractitioner or nurse p ractiti one r , st i n a f i el d of m edicine or surge ry if th e person h as by a local m edical practit ione r or nu rse p r act i ti on er, o r rehab i l i t ation ho s p i ta l, a s those facilities ar e de fined i n c t Re gulatio n s, or i n p aragr aph (e) of t he d efinit io n of "ho s p i ta l" in ital Insuranc e Act, a n d up plemen t for transportation does no t meet the le gislative y ou are not r equired to atten d your appointment at the gery or to a hos pita l . T h erefore you are not eligibl e for a reau ired to attend his annoi ntm e nt at the
n e a r e s t o f f i c e o f a s p e c i a l i s t i n a f i e l d o f m e d i c i n e o r n o t e l i g i b l e f o r a h e a l t h s u p p l e m e n t t o c o v e r t h e c o s A t t h e h e a r i n g t h e M i n i s t r y c l a r i f i e d t h e i r p o s i t i o n a n a s a " s u p p l i e r " a n d n o t a n o f f i c e o f a s p e c i a l i s t i n t h e p u r p o s e s o f t h e s e c t i o n . T h e M i n i s t r y c o n c l u d e d t h t r a n s p o r t a t i o n a s s i s t a n c e t o t h e A p p e l l a n t a s t h e C l i p u r s u a n t t o s e c t i o n 2 ( 1 ) ( f ) . T h e A p p e l l a n t a r g u e d t h a t h e h a s b e e n a t t h e C l i n i c t r a n s p o r t a t i o n a s s i s t a n c e o n e v e r y o c c a s i o n w i t h t h e T h e M i n i s t r y n o t e d t h a t t h e A p p e l l a n t d i d h a v e o t h e r t h a t c o v e r e d t h e A p p e l l a n t s t r a v e l f o r o u t o f t o w n a p m a d e i n t h e l a s t t w o y e a r s . T h e M i n i s t r y n o t e d p r i o r a p p o i n t m e n t s w i t h t h e A p p e l l a n t ' s n e u r o l o g i s t s . T h e A p p e l l a n t a l s o s u b m i t t e d a l e t t e r w r i t t e n b y t h e c o m m u n i t y w h i c h w a s c o n f i r m e d b y t h e G P i n h i s l e T h e l e g i s l a t i o n i s c l e a r t h a t t h e M i n i s t r y m a y p a y f o r a c c e s s i n g t h e l e a s t e x p e n s i v e a p p r o p r i a t e m o d e o f a v a i l a b l e s p e c i a l i s t i n a f i e l d o f m e d i c i n e o r s u r g e r y t h a t f i e l d b y a m e d i c a l p r a c t i t i o n e r o r t h e n e a r e s t s u i T h e A p p e l l a n t i n d i c a t e d t h a t t h e p r o s t h e t i c s a n d o r t h m a k e c u s t o m f o o t w e a r o n s i t e s o t h a t a l l t h e p r e p a r a h o s p i t a l d o e s n o t h a v e t h e r e q u i r e d e q u i p m e n t t o p r p r o s t h e t i c s a n d o r t h o t i c s c l i n i c c a n n o t b e c h a r a c t e r i z s p e c i a l i z e s i n a f i e l d o f m e d i c i n e o r s u r g e r y . T h e p a n e l t h e r e f o r e f i n d s t h e M i n i s t r y ' s d e t e r m i n a t i o s u p p l e m e n t f o r t r a n s p o r t a t i o n w a s d e n i e d a s t h e A p s e t o u t i n s e c t i o n 2 ( 1 ) ( f ) S c h e d u l e " C " o f E A P D R w a e n a c t m e n t i n t h e c i r c u m s t a n c e s o f t h e a p p e l l a n t a n d E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )s u r g e ry o r t o a h o s p i t a l a n d d e t e r m i n e d h e w a s t s o f t r a n s p o r t a t i o n t o a t t e n d t h e a p p o i n t m e n t . d s t a t e d t h a t t h e C l i n i c i n q u e s t i o n w a s c l a s s i f i e d f i e l d o f m e d i c i n e o r s u r g e r y o r a h o s p i t a l f o r e y h a d n o l e g i s l a t i v e a u t h o r i t y t o p r o v i d e n i c d i d n o t m e e t t h e d e f i n i t i o n o f e l i g i b l e p r o v i d e r s o n a t l e a s t 1 0 o c c a s i o n s a n d w a s a p p r o v e d f o r e x c e p t i o n o f t h i s a p p l i c a t i o n . a p p l i c a t i o n s o n f i l e f o r t r a n s p o r t a t i o n a s s i s t a n c e p o i n t m e n t s b u t t r a v e l t o t h e C l i n i c w a s n o t a c l a i m a p p r o v e d t r a n s p o r t a t i o n a s s i s t a n c e w a s f o r C l i n i c s t a t i n g t h e r e w a s n o o r t h o t i c f a c i l i t y i n h i s t t e r d a t e d D e c e m b e r 2 3 , 2 0 1 3 . s p e c i f i c h e a l t h s u p p l e m e n t s i f t h e r e c i p i e n t i s t r a n s p o r t a t i o n t o o r f r o m t h e o f f i c e o f t h e n e a r e s t i f t h e p e r s o n h a s b e e n r e f e r r e d t o a s p e c i a l i s t i n t a b l e h o s p i t a l . o t i c s c l i n i c i s e q u i p p e d t o p r e p a r e c a s t s a n d t i o n h a s t o b e d o n e i n t h e C l i n i c a n d t h a t t h e e p a r e t h e p r o d u c t s . T h e p a n e l f i n d s t h a t t h e e d a s a m e d i c a l o f f i c e , o r a n o f f i c e t h a t n t h a t t h e A p p e l l a n t ' s r e q u e s t f o r a h e a l t h p e l l a n t d i d n o t m e e t t h e l e g i s l a t i v e r e q u i r e m e n t s s a r e a s o n a b l e a p p l i c a t i o n o f t h e a p p l i c a b l e c o n f i r m s t h e d e c i s i o n . r
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.