P ART C D ec is ion under Ap pe al The dec i sion under appe al is th e M i n ist ry of Soci al reco nsideratio n dec is io n dated A p ril 1, 2014 which supplemen t for a c r own f or tooth num b er 25 bec a use: • t he a ppe ll ant did not rec eive t he m i n i stry's pre-authorizatio by S e ction 4.1 (1 ) (d ) of Schedule C of the Emplo Disabi litie s R e gul at i on ( E APWDR), and th e in t he Sch edule of Fee Allowa n ce s Crown a • t he m i n i stry was n ot sati sfied th at th e a ppe ll through t he p ro vis ion of basi c denta l s ervices EAPWD R; • the de n tal service fo r a crow n is not set ou t Dent al-Dentist; an d, • t he eligibi l i ty criteria f or a life t h r e atening h ealt o f the EAPWD R . PART D -Releva n t Legisl ati o n Emp loym ent an d Assi st an ce for Pe r s o ns Wi t h Disabilities Regulation and 69, an d Schedu l e C, Section 4.1 and 5 Sch e d ule of F ee Allowance s-Crown a n d B r idg ewor Sche dule of F ee A llowances-Emergen cy Dental-Dent I APP EAL# De velopmen t and Soci al In novation ( t he min is t ry) denied the ap pellant's requ e s t f or a dent al n fo r th e de nta l se r vice, a s re qui red yment and Ass is t anc e for P e r s ons With dental service wa s n o t pr o v ided at th e rate s et out n d Brid g ework pursua nt t o Se c ti o n 4 . 1(1)( b); ant ha s a de nta l con dition t ha t canno t be c orrected , as set o u t in Section 4.1( 2) o f Sche dule C o f t he in th e S c h e d ule o f Fe e A ll ow ances-Emergenc y h need were n ot met, as requir e d by Section 69 (EAP WDR), Sec t ions 6 3. 1 , 64, k i st
I APPEAL# PART E -Summarv of Facts The evidence before the ministry at the time of the reconsideration decision consisted of: 1) Patient Receipt dated September 13, 2013 from a dental office which set out services provided on August 22, 2013 and September 5, 2013 for a crown at a total cost of $1,052.96 and was paid in full on September 5, 2013. Additional handwritten notes state in part that the appellant spoke to "the lady at your dental information line" and she said to submit this receipt to the ministry for a reimbursement cheque for the total of $1,052.96 as the appellant had to borrow funds to pay for it. She said it was available through a medical/dental request form, but since she already paid for it with borrowed funds, to submit the bill to the ministry; 2 ) Letter dated September 25, 2013 from the ministry to the appellant denying her request for dental services; 3) Dental Claims History for January 1, 2013 through March 28, 2014 and Dental Benefit Eligibility from Pacific Blue Cross indicating in part that for major restorative services, including crowns, approval is required before proceeding with treatment and to "please ensure the dental office submits a request for pre-authorization"; 4) Email dated March 31, 2014 from Pacific Blue Cross to the reconsideration officer indicating in part that nothing was claimed by the dentist in September 2013 and there is no request for "pre-d" to do a crown on the system either; 5) Clarification Log dated April 1, 2014 noting communication between the reconsideration officer and the office assistant for the dentist indicating in part that the dentist did not apply to Pacific Blue Cross for pre-authorization for the services provided to the appellant on August 22 and September 5, 2013 as "she had to have the crown done or lose the tooth."; and, 6) Request for Reconsideration-Reasons dated March 20, 2014. In her Request for Reconsideration, the appellant wrote that she had to have an emergency crown. She is a recipient of disability assistance and she has attached a handwritten sheet indicating what the ministry told her in regards to being reimbursed. It is her understanding that the ministry does issue funds for crowns. She is in dire need of funds. In her Notice of Appeal, the appellant wrote that she asked the receptionist to get pre-authorization but she refused and said crowns are not okayed. She was in a lot of pain and needed emergency services. At the hearing, the appellant stated that: • She was in a lot of pain at the time and cannot remember all the details but she asked the receptionist at her dentist's office to request a pre-authorization to have the work done on her tooth. The receptionist refused to make the request because she said it is so much paperwork and the ministry hardly ever pays for crowns since they would rather the person lose the tooth and get dentures. • The appellant paid for the work and then called the number for information and was told that, in her circumstances, she should submit the bill to the ministry. The ministry denied her request and the reconsideration process began. She feels it is unfair that she will not be reimbursed when it was the dentist's office that refused to request the pre-authorization. • The appellant agreed that she knew that a pre-authorization was required for this work. In terms of the next step to take, she was in a lot of pain and did not think things through at the time.
I APPEAL# • She is allergic to nickel and if any of the materials for the removable prosthetic include nickel, would not be able to use it. The dentist said that gold is the material used in the crown because it will last but it also makes it expensive. • When she got the crown, it did relieve the pain she had been experiencing. The ministry relied on the facts as set out in the reconsideration decision that: • The appellant is a Person With Disabilities (PWD) and is eligible for dental supplements. • On September 18, 2013 the ministry received a receipt from a dental office which showed that the sum of $1,052.96 had been received for dental services performed on August 22 (bonded composite core in conjunction with a crown) and September 5, 2013 (crown porcelain/ceramic/polymer glass, fused to metal base). • Pre-authorization was not provided for the appellant's crown work. At the hearing, the ministry clarified that: • The ministry will only pay up to the maximum of the amount detailed in the Schedule of Fee Allowances for a particular service. The appellant then has the option of paying any additional amount that the dentist requires for the service on her own, or finding another dentist who only charges the amount set out in the Schedule.
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 e a p p e a l i s w h e t h e r t h e m i n i s t r y ' s d c o v e r a g e f o r d e n t a l s e r v i c e s f o r a c r o w n a s p r e a u t s e t o u t i n t h e S c h e d u l e o f F e e A l l o w a n c e s E m e r g e o f t h e f e e s c h e d u l e r a t e s f o r C r o w n a n d B r i d g e w o r k b e c o r r e c t e d t h r o u g h b a s i c d e n t a l s e r v i c e s , a n d d i d h e a l t h n e e d , w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d 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 . S e c t i o n 6 3 . 1 o f t h e 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 s t i p u l a t e s 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 a c r o w n a n C , S e c t i o n 4 . 1 S e c t i o n 4 . 1 o f S c h e d u l e C o f t h e E A P W D R p r o v i d e C r o w n a n d b r i d g e w o r k s u p p l e m e n t 4 . 1 ( 1 ) I n t h i s s e c t i o n , " c r o w n a n d b r i d g e w o r k " m e a n s a ( a ) t h a t i s p r o v i d e d b y a d e n t i s t , ( b ) t h a t i s s e t o u t i n t h e S c h e d u l e o f F e e A l l o w a n 2 0 1 O a n d i s o n f i l e w i t h t h e o f f i c e o f t h e d e p u ( c ) t h a t i s p r o v i d e d a t t h e r a t e s e t o u t f o r t h e s e r v ( d ) f o r w h i c h a p e r s o n h a s r e c e i v e d t h e p r e a u t h ( 2 ) A h e a l t h s u p p l e m e n t m a y b e p a i d u n d e r s e c t i o n o n l y i f t h e m i n i s t e r i s o f t h e o p i n i o n t h a t t h e p e r s o t h r o u g h t h e p r o v i s i o n o f b a s i c d e n t a l s e r v i c e s b e ( a ) t h e d e n t a l c o n d i t i o n p r e c l u d e s t h e p r o v i s i o n o S e r v i c e s s e c t i o n o f t h e S c h e d u l e o f F e e A l l o w ( b ) o n e o f t h e f o l l o w i n g c i r c u m s t a n c e s e x i s t s : ( i ) t h e d e n t a l c o n d i t i o n p r e c l u d e s t h e u s e o f ( i i ) t h e p e r s o n h a s a p h y s i c a l i m p a i r m e n t t h a r e m o v a b l e p r o s t h e t i c ; ( i i i ) t h e p e r s o n h a s a n a l l e r g i c r e a c t i o n o r o t h a r e m o v a b l e p r o s t h e t i c ; ( i v ) t h e p e r s o n h a s a m e n t a l c o n d i t i o n t h a t m r e s p o n s i b i l i t y f o r a r e m o v a b l e p r o s t h e t i c . ( 3 ) T h e m i n i s t e r m u s t a l s o b e s a t i s f i e d t h a t a h e a l t h a d e q u a t e t o c o r r e c t t h e d e n t a l c o n d i t i o n . ( 4 ) A h e a l t h s u p p l e m e n t f o r c r o w n a n d b r i d g e w o r k m t h a n o n c e i n a n y p e r i o d o f 6 0 c a l e n d a r m o n t h s . S e c t i o n 6 4 o f t h e E A P W D R s t i p u l a t e s t h e e l i g i b i l i t y a s s e t o u t i n S c h e d u l e C , S e c t i o n 5 . I f t h o s e r e q u i r e E A P W D R s p e c i f i e s t h a t t h e h e a l t h s u p p l e m e n t s t o b d e n t a l s e r v i c e s . " S e c t i o n 1 o f S c h e d u l e C f u r t h e r d e f i n e s " e m e r g e n c y " e m e r g e n c y d e n t a l s e r v i c e " m e a n s a d e n t a l s e r v i c e n e ( a ) i f p r o v i d e d b y a d e n t i s t , ( i ) i s s e t o u t i n t h e S c h e d u l e o f F e e A l l o w a n c e s 2 0 1 O a n d i s o n f i l e w i t h t h e o f f i c e o f t h e d e p u t y m ( i i \ i s o r o v i d e d a t t h e r a t e s e t o u t i n t h a t S c h e d u l e , a n I A P P E A L # e c i s i o n , 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 h o r i z a t i o n w a s n o t r e c e i v e d , t h e s e r v i c e s w e r e n o t n c y D e n t a l D e n t i s t , i n c l u d e d a n a m o u n t i n e x c e s s a n d d i d n o t s h o w a d e n t a l c o n d i t i o n t h a t c a n n o t 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 f o r a l i f e t h r e a t e n i n g e n c e o r 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 r P e r s o n s W i t h D i s a b il i t i e s R e g u l a t i o n ( E A P W D R ) d b r i d g e w o r k s u p p l e m e n t a s s e t o u t i n S c h e d u l e s : d e n t a l s e r v i c e c e s C r o w n a n d B r i d g e w o r k , t h a t i s e f f e c t i v e A p r i l 1 , t y m i n i s t e r , i c e i n t h a t S c h e d u l e , a n d o r i z a t i o n o f t h e m i n i s t e r . 6 3 . 1 o f t h i s r e g u l a t i o n f o r c r o w n a n d b r i d g e w o r k b u t n h a s a d e n t a l c o n d i t i o n t h a t c a n n o t b e c o r r e c t e d c a u s e f t h e r e s t o r a t i v e s e r v i c e s s e t o u t u n d e r t h e R e s t o r a t i v e a n c e s D e n t i s t , a n d a r e m o v a b l e p r o s t h e t i c ; t m a k e s i t i m p o s s i b l e f o r h i m o r h e r t o p l a c e a e r i n t o l e r a n c e t o t h e c o m p o s i t i o n o r m a t e r i a l s u s e d i n a k e s i t i m p o s s i b l e f o r h i m o r h e r t o a s s u m e s u p p l e m e n t f o r c r o w n a n d b r i d g e w o r k w i l l b e a y n o t b e p r o v i d e d i n r e s p e c t o f t h e s a m e t o o t h m o r e r e q u i r e m e n t s f o r e m e r g e n c y d e n t a l s u p p l e m e n t s m e n t s a r e m e t , S e c t i o n 5 o f S c h e d u l e C o f t h e e p a i d f o r u n d e r S e c t i o n 6 4 a r e " e m e r g e n c y d e n t a l s e r v i c e " a s f o l l o w s : c e s s a r y f o r t h e i m m e d i a t e r e l i e f o f p a i n t h a t , E m e r g e n c y D e n t a l D e n t i s t , t h a t i s e f f e c t i v e A p r i l 1 , i n i s t e r , a n d d
( b ) i f p r o v i d e d b y a d e n t u r i s t , ( i ) i s s e t o u t i n t h e S c h e d u l e o f F e e A l l o w a n c e s 2 0 1 0 a n d i s o n f i l e w i t h t h e o f f i c e o f t h e d e p u t y m ( i i ) i s p r o v i d e d a t t h e r a t e s e t o u t i n t h a t S c h e d u l e ; S e c t i o n 6 9 o f t h e E A P W D R p r o v i d e s a s f o l l o w s : H e a l t h s u p p l e m e n t f o r p e r s o n s f a c i n g d i r e c t a n d i m 6 9 T h e m i n i s t e r m a y p r o v i d e t o a f a m i l y u n i t a n y h e a l t h h e a l t h s u p p l e m e n t s ] a n d 3 [ m e d i c a l e q u i p m e n t a n d 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 i l y u n i t w h o i s o t h i s r e g u l a t i o n , a n d i f t h e m i n i s t e r i s s a t i s f i e d t h a t ( a ) t h e p e r s o n f a c e s a d i r e c t a n d i m m i n e n t l i f e t h r e a p e r s o n ' s f a m i l y u n i t w i t h w h i c h t o m e e t t h a t n e e d ( b ) t h e h e a l t h s u p p l e m e n t i s n e c e s s a r y t o m e e t t h a t ( c ) t h e p e r s o n ' s f a m i l y u n i t i s r e c e i v i n g p r e m i u m a s s ( d ) t h e r e q u i r e m e n t s s p e c i f i e d i n t h e f o l l o w i n g p r o v i s ( i ) p a r a g r a p h ( a ) o r ( f ) o f s e c t i o n ( 2 ) ( 1 ) ; ( i i ) s e c t i o n s 3 t o 3 . 1 2 , o t h e r t h a n p a r a g r a p h ( a ) o C r o w n a n d b r i d g e w o r k s u p p l e m e n t M i n i s t ry ' s p o s i t i o n T h e m i n i s t r y h a s 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 , a s s u p p l e m e n t u n d e r S e c t i o n 6 3 . 1 a n d S c h e d u l e C , S p o s i t i o n i s t h a t t h e d e n t a l o f f i c e d i d n o t a p p l y f o r a b y S e c t i o n 4 . 1 ( 1 ) ( d ) o f S c h e d u l e C o f t h e E A P W D R F e e A l l o w a n c e s C r o w n a n d B r i d g e w o r k . T h e m i n i p r o v i d e d a t t h e r a t e s e t o u t i n t h e S c h e d u l e f o r a c r p o l y m e r g l a s s , f u s e d t o m e t a l b a s e ) a s t h e d e n t i s t m i n i s t r y i s n o t a u t h o r i z e d t o p r o v i d e c o v e r a g e f o r f e a r g u e d f u r t h e r t h a t i n f o r m a t i o n w a s n o t p r o v i d e d t o p r e c l u d e d t h e p r o v i s i o n o f r e s t o r a t i v e s e r v i c e s a n d S e c t i o n 4 . 1 ( 2 ) ( b ) o f S c h e d u l e C . A p p e l l a n t ' s p o s i t i o n 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 s h e a s k e d t h e r e c e p a n d s a i d t h a t i t i n v o l v e s a l o t o f p a p e r w o r k a n d t h e a p p e l l a n t a r g u e d t h a t s h e w a s i n a l o t o f p a i n a n d d h e r f a u l t t h a t t h e p r e a u t h o r i z a t i o n w a s n o t o b t a i n e d s h e i s a l l e r g i c t o n i c k e l a n d i f t h a t s u b s t a n c e i s u s e o p t i o n a v a i l a b l e t o h e r . P a n e l ' s d e c i s i o n T h e m i n i s t r y h a s 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 i s e l o f t h e E A P W D R w h i c h i s d e f i n e d , i n S e c t i o n 4 . 1 o f s h e w a s a w a r e t h a t p r e a u t h o r i z a t i o n w a s r e q u i r e d o f f i c e r e f u s e d t o r e q u e s t t h e p r e a u t h o r i z a t i o n s o i t r e c e i v e d . A l t h o u g h t h e a p p e l l a n t s t a t e d t h a t s h e w a d e n t i s t p e rf o r m t h e w o r k d e s p i t e t h e i r r e f u s a l t o d o a n d t h e a n n e l l a n t t h e r e b v a s s u m e d t h e r i s k o f f i n a n I A P P E A L # E m e r g e n c y D e n t a l D e n t u r i s t , t h a t i s e f f e c t i v e A p r i l 1 , i n i s t e r , a n d m i n e n t l i f e t h r e a t e n i n g h e a l t h n e e d s u p p l e m e n t s e t o u t i n s e c t i o n s 2 ( 1 ) ( a ) a n d ( f ) [ g e n e r a l d e v i c e s ] o f S c h e d u l e C , i f t h e h e a l t h s u p p l e m e n t i s t h e r w i s e n o t e l i g i b l e f o r t h e h e a l t h s u p p l e m e n t u n d e r t e n i n g n e e d a n d t h e r e a r e n o r e s o u r c e s a v a i l a b l e t o t h e , n e e d , i s t a n c e u n d e r t h e M e d i c a r e P r o t e c t i o n A c t , a n d i o n s o f S c h e d u l e C , a s a p p l i c a b l e , a r e m e t : f s e c t i o n 3 ( 1 ) . a P W D , i s e l i g i b l e f o r a c r o w n a n d b r i d g e w o r k e c t i o n 4 . 1 o f t h e E A P W D R . T h e m i n i s t ry ' s c r o w n a n d r e q u e s t a p r e a u t h o r i z a t i o n , a s r e q u i r e d a n d a s s e t o u t i n t h e p r e a m b l e t o t h e S c h e d u l e o f s t r y a l s o a r g u e d t h a t t h e s e r v i c e s w e r e n o t o w n ( f e e c o d e 2 7 2 1 1 c r o w n , p o r c e l a i n / c e r a m i c / c h a r g e d $ 9 6 2 . 4 0 a n d t h e f e e i s $ 6 2 4 . 2 0 a n d t h e e s i n e x c e s s o f t h e r a t e s s e t o u t . T h e m i n i s t r y c o n f i r m t h a t t h e a p p e l l a n t ' s d e n t a l c o n d i t i o n o n e o f t h e s i t u a t i o n s e x i s t e d , a s d e s c r i b e d i n t i o n i s t t o g e t p r e a u t h o r i z a t i o n b u t s h e r e f u s e d m i n i s t r y h a r d l y e v e r a p p r o v e s c r o w n s . T h e o e s n o t r e m e m b e r a l l t h e d e t a i l s , b u t i t w a s n o t . T h e a p p e l l a n t p o i n t e d o u t a t t h e h e a r i n g t h a t d i n a r e m o v a b l e p r o s t h e t i c , t h i s w o u l d n o t b e a n i g i b l e f o r d e n t a l s u p p l e m e n t s u n d e r S e c t i o n 6 3 . 1 S c h e d u l e C . T h e a p p e l l a n t a c k n o w l e d g e s t h a t f o r t h e c r o w n w o r k b u t a r g u e s t h a t t h e d e n t a l i s n o t h e r f a u l t t h a t t h e p r e a u t h o r i z a t i o n w a s n o t s i n a l o t o f p a i n , s h e p r o c e e d e d t o h a v e t h i s a s s h e a s k e d a n d r e q u e s t t h e p r e a u t h o r i z a t i o n , c i a l r e s p o n s i b i l i t v f o r t h e s e r v i c e s p r o v i d e d . T h e
I APPEAL# panel finds that the ministry reasonably determined that the requirement set out in Section 4.1( d ) of Schedule C of the EAPWDR was not met since the appellant had not received the ministry's pre authorization for the crown work as detailed in the receipt dated September 13, 2013. Upon review of the Schedule of Fee Allowances-Crown and Bridgework, the panel finds that the ministry also reasonably determined that the maximum amount allocated for the service of Crown, Porcelain/ Ceramic/ Polymer Glass, Fused to Metal Base, which has code #27211, is $624.20 with lab fees included, while the appellant's dentist charged $962.40 for this service. While the appellant pointed out her allergy to nickel as potentially having an impact on her use of a removable prosthetic, the panel finds that the dentist has not confirmed the circumstances in Section 4.1 (2)(b)(iii), i.e. that the appellant has an allergic reaction or other intolerance to the composition or materials used in a removable prosthetic, and also that the appellant's dental condition precludes the provision of restorative services section of the Schedule of Fee Allowances-Dentist, as set out in Section 4.1 (2)(a) of Schedule C. Therefore, the panel finds that the ministry reasonably concluded that there is insufficient information provided to establish that that the appellant has a dental condition that cannot be corrected through the provision of basic dental services under Section 4.1( 2) of Schedule C. Emergency Dental Services Ministry's position The ministry's position is that the health supplements that may be paid under Section 64 of the EAPWDR are those set out in Schedule C, Section 5, namely "emergency dental service" which are defined in Section 1 of Schedule C to mean a dental service that is necessary for the immediate relief of pain that (a) if provided by a dentist, is set out in the Schedule of Fee Allowances-Emergency Dental-Dentist that is effective April 1, 201 0 and is on file with the office of the deputy minister, and is provided at the rate set out for the service in that Schedule. The ministry points out that the Schedule of Fee Allowances-Emergency Dental-Dentist does not include the service requested for a crown. Appellant's position The appellant's position is that she was in a lot of pain because of problems with the tooth and needed emergency services, and that the crown relieved that pain. Panel's decision Section 1 of Schedule C defines "emergency dental service" to mean a dental service that is necessary for the immediate relief of pain that (a) if provided by a dentist, is set out in the Schedule of Fee Allowances-Emergency Dental-Dentist that is effective April 1, 201 0 and is on file with the office of the deputy minister, and is provided at the rate set out for the service in that Schedule. The appellant stated that the dental service provided to her, namely the crown work, provided relief from the pain that she was experiencing from the tooth; however, the other part of the definition in Section 1 is that the emergency dental service must be set out in the Schedule of Fee Allowances Emergency Dental-Dentist and paid at the rate set out in that Schedule. Upon review of the Schedule of Fee Allowances-Emergency Dental-Dentist, the panel finds that the ministry reasonably concluded that the services provided to the appellant, being a crown, porcelain/ ceramic/ polymer glass, fused to metal base, with a code of #27211, is not listed in the Schedule and the ministry does not have the discretion to pay fees for items not included in the Schedule. Life-threatening health need Ministry's position The ministry's position is that information provided does not demonstrate that the appellant faced a direct and imminent life-threatenina need for the services provided. The ministry also araued that
S e c t i o n 6 9 o f t h e E A P W D R s t i p u l a t e s t h a t t h e r e m t o m e d i c a l s u p p l i e s , m e d i c a l t r a n s p o r t a t i o n a n d m e s u p p l e m e n t s a r e n o t s e t o u t i n t h e s e c t i o n a n d , t h e A p p e l l a n t ' s p o s i t i o n T h e a p p e l l a n t d i d n o t d i r e c t l y a d v a n c e a p o s i t i o n t h n e e d f o r t h e d e n t a l s e r v i c e b u t s t a t e d t h a t s h e w a s a n d n e e d e d e m e r g e n c y s e r v i c e s , a n d t h a t t h e c r o w P a n e l ' s d e c i s i o n T h e p a n e l a c k n o w l e d g e s t h a t t h e a p p e l l a n t s t a t e d t h a t h a d d e v e l o p e d w i t h h e r t o o t h ; h o w e v e r , t h e r e t h e t o o t h p o s e d a l i f e t h r e a t e n i n g c o n d i t i o n t h a t n e t h e m i n i s t ry r e a s o n a b l y c o n c l u d e d t h a t t h e r e w a s i n i m m i n e n t l i f e t h r e a t e n i n g n e e d f o r t h e s e r v i c e s r e q r e a s o n a b l y c o n c l u d e d t h a t t h e r e m e d y s e t o u t i n S h e a l t h n e e d o n l y a p p l i e s t o m e d i c a l s u p p l i e s , m e d i o u t i n S e c t i o n s 2 a n d 3 o f S c h e d u l e C , a n d d e n t a l t h e r e f o r e , n o t e l i g i b l e i t e m s . T h e p a n e l f i n d s t h a t t h c o v e r a g e o f d e n t a l s e r v i c e s f o r c r o w n w o r k d o e s n o h e a l t h n e e d u n d e r S e c t i o n 6 9 o f t h e E A P W D R w a s C o n c l u s i o n T h e p a n e l f i n d s t h a t 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 c o v e r a g e f o r d e n t a l s e r v i c e s f o r a c r o w n a s p r e a u t s e t o u t i n t h e S c h e d u l e o f F e e A l l o w a n c e s E m e r g e o f t h e f e e s c h e d u l e r a t e s f o r C r o w n a n d B r i d g e w o r k b e c o r r e c t e d t h r o u g h b a s i c d e n t a l s e r v i c e s , a n d a l s t h r e a t e n i n g h e a l t h n e e d , w a s a r e a s o n a b l e a p p l i c a t c i r c u m s t a n c e o f t h e a p p e l l a n t a n d , t h e r e f o r e , t h e p a A P P E A L # I e d y f o r a l i f e t h r e a t e n i n g h e a l t h n e e d o n l y a p p l i e s d i c a l e q u i p m e n t a n d t h a t d e n t a l a n d d e n t u r e r e f o r e , a r e n o t e l i g i b l e i t e m s . a t s h e f a c e d a d i r e c t a n d i m m i n e n t l i f e t h r e a t e n i n g i n a l o t o f p a i n b e c a u s e o f p r o b l e m s w i t h t h e t o o t h n r e l i e v e d t h a t p a i n . s h e w a s i n c o n s i d e r a b l e p a i n b e c a u s e o f p r o b l e m s w a s n o i n f o r m a t i o n p r o v i d e d t h a t t h e c o n d i t i o n o f c e s s i t a t e d t h e c r o w n w o r k , a n d t h e p a n e l f i n d s t h a t s u f f i c i e n t i n f o r m a t i o n t o d e m o n s t r a t e a d i r e c t a n d u e s t e d . T h e p a n e l f i n d s t h a t t h e m i n i s t r y a l s o e c t i o n 6 9 o f t h e E A P W D R f o r a l i f e t h r e a t e n i n g c a l t r a n s p o r t a t i o n a n d m e d i c a l e q u i p m e n t , a s s e t s u p p l e m e n t s a r e n o t s e t o u t i n t h e s e c t i o n a n d a r e , e m i n i s t r y ' s c o n c l u s i o n t h a t t h e r e q u e s t f o r 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 f o r a l i f e t h r e a t e n i n g r e a s o n a b l e . e c i s i o n , 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 h o r i z a t i o n w a s n o t r e c e i v e d , t h e s e r v i c e s w e r e n o t n c y D e n t a l D e n t i s t , i n c l u d e d a n a m o u n t i n e x c e s s a n d d i d n o t s h o w a d e n t a l c o n d i t i o n t h a t c a n n o t o d i d 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 f o r a l i f e i o n o f t h e a p p l i c a b l e e n a c t m e n t i n t h e n e l c o n f i r m s t h e d e c i s i 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.