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 d a t e d M a r c h 1 1 , 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 c u s t o m c o m p r e s s i o n s t o c k i n g s b e c a u s e : e t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n p r o v i d e d t o s f a m i l y u n i t t o p a y t h e c o s t o f o r o b t a i n t h e m e 3 ( 1 ) ( b ) ( i i ) o f S c h e d u l e C o f t h e E m p l o y m e n t R e g u l a t i o n ( E A P W D R ) ; a n d , e 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 h e a o f t h e E A P W D 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 b a n d S c h e d u l e C , S e c t i o n s 2 a n d 3I A P P E A L # D e v e l o p m e n t ( 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 r e q u e s t f o r a s u p p l e m e n t t o c o v e r t h e c o s t o f h o w t h a t 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 d i c a l e q u i p m e n t o r d e v i c e , a s r e q u i r e d b y S e c t i o n 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 ili t i e s l t h n e e d w e r e n o t m e t , a s r e q u i r e d b y S e c t i o n 6 9 i li 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 s 6 2 a n d 6 9 ,
APPEAL# I PART E -Summar of Facts With the consent of both parties, the hearing was conducted as a written hearing, pursuant to section 22(3)(b) of the Employment and Assistance Act. The evidence before the ministry at the time of the reconsideration decision included: 1) Ministry file notes relating to the appellant for the period September 27, 2013 through February 19, 2014; 2) Monthly Expenses and Recent Purchases for the appellant dated August 2013 indicating in part that the appellant's monthly expenses total $1,101 (including rent of $880, meals, laundry, cable TV, telephone, and power) and "As Required" expenses totaling $2,331; 3) Bank statements for January showing cheques drawn in the amounts of $20 and $31.30 and an end balance of $834.67, and for February 2014 showing cheques drawn in the amounts of $80 and $700, and an end balance of $101.18; 4) Quote dated February 15, 2014 by a health supply company for 2 custom stockings at the total cost of $754.20; 5 ) Undated letter from a physician 'To Whom It May Concern' stating in part that the appellant requires bilateral leg compression stockings for peripheral edema and prevention of deep vein thrombosis. She has tried off-the-shelf compression stockings but the fit is unsuitable due to body habitus. She requires custom compression stocking of 30-40 mmHg compression; 6) Letter dated February 19, 2014 from the ministry to the appellant denying her request for the stockings; and, 7) Request for Reconsideration-Reasons dated March 11, 2014. Prior to the hearing, the appellant provided the following additional documents: 1) Letter from the appellant dated April 17, 2014 in which she wrote that the $167.34 disposable income is actually closer to $150.00 considering most of the 'as needed expenses' are subject to PST and GST. She has not included the special clothing requirements, as noted in previous correspondence, or motorized wheelchair maintenance requirements in the list of 'as needed expenses.' The rent as of April 1, 2014 is now $1,129.13, up $35 since previous correspondence. With the cost of needed items and services, $150 per month disposable income is a juggling act and does not go very far, let alone [provide for] any luxuries. 2 ) Statement of monthly income and expenses showing total monthly income of $1,401.90, total fixed monthly expenses of $1,199.56, including rent of $1,094.13, telephone, bottled water, hearing aid batteries, contents insurance, and cable TV box, leaving a balance of $202.34 ($167.34 after April 1 rent increase) disposable income to cover all other 'as needed expenses.' These expenses include toiletries, haircuts, clothing, bedding, towels, glasses, optometrist, dentist, HandyDART and taxi savers, foot care, vitamins, and long distance telephone; 3) Statement of Account dated January 16, 2014 breaking down the payment of $1,094.13 for rent ($929.13), laundry ($50), meals ($75), hydro ($15), and cable ($25); and, 4) Account Activity Statements for March 2014 showing in part monthly income of $1,299.40 from Old Age Security and $49.30 from the province as well as other $53.20, and pre-authorized debits in the sums of $1,094.13, $3.31 (cable TV), $31. 79 (telephone) and other cheque amounts for $20, $36 and $141.92 that are not identified. The end balance for March 31, 2014 is $1,524.63. In her Request for Reconsideration, the appellant wrote that when she tried to get the cost of her com ression stockin s covered, she was denied because of sufficient assets. As shown in her bank
st atem en t s, she doe s not have the money to cov er a nd c a b le/ t e lus (total appr oxima te ly $ 35) . She also h as othe r toiletrie s , batt eries f or he r he a ring aids, d enti d rink. S h e a lso pays for te nant insurance. The r e f o b ills/ ne c e ssities which means sh e ca nn ot a ffor d t he In her Notic e of Appeal dated A pril 4, 2 014 , the ap pellant ministr y's re co nsider ation decis io n and w rote that s Her mon t hly ren t i s $ 1,0 9 4.13 and he r inc ome mon la undry are $ 85 per m onth a nd additiona l expen ses Mar c h 24, 2014 by Tr ibu n a l. T he mi n istry did not raise an obj ection to the admis attached sta teme n ts an d the p an el admitt e d t hem , pu Assi stanc e A c t , as prov iding f urther deta il re g a rdin g the i n format ion that was before th e ministr y on re con s iderat The ministry relied on the reconsid eration dec i sion, which i • T he a ppe l lant is a n MS O [Medica l Ser vices Onl inc ome assis ta nc e from the ministr y. o O n N ovem b e r 12 , 2013 t he m inistry received a request for co mp ressio n stockings, which in c lud ed the Quote dated fro m t he p hys ician ("pre script ion " ) . • T he A cc ou nt Acti vit y s t atem ent fo r Febr u ar y 2014 does f r om t he app ellan t's a ccount. • T he Mon t h ly Exp e nses an d Re cen t Pur chases $88 0 , food at $9 0 and utili ti es of $13 1, tot al i n APPEAL# I th e costs as s he had to pay for rent ( $1,094. 13) ad t o pay for Ha n dy D ART tic k ets ($90 ) , as we ll s t costs , a n d b ott led water s he is r equ ire d to r e , this mone y went towards t hese co s ts of the sto ckings, whi ch she nee d s. e x press e d h e r disagr eemen t wit h the he i s un a b le to a ff o r d the cost [o f the stocking s]. thly is $1,348.70, l eaving $254. 5 7 lef t over. Foo d / previously p rov ided in l et ter d ated/re c e i v ed sibilit y of the i n fo rmatio n in the appel lant' s l e tter or rsu ant t o Sec t ion 22 ( 4) of the Empl oyment and app e l lant's resou rces and be ing in support of ion. n cluded the fol low i ng facts: y ] cl i ent a nd is not cu rrent ly in rec eipt o f fu nding fo r two pa ir of cus t o m Februa r y 1 5, 2014 and th e Le tte r n ot cat egori ze t h e w ithd r a w al s ma de stat e ment da ted August 2 0 13 sh ows rent at g $ 1,1 01.
I APPEAL# PART F -Reasons for Panel Decision The issue on the appeal is whether the ministry's decision, which denied the appellant's request for a supplement to cover the cost of custom compression stockings because there is insufficient information provided to show that there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device, as required by Section 3(1)(b)(ii) of Schedule C of the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) and the eligibility criteria for a life threatening health need were not met, as required by Section 69 of the EAPWDR, is reasonably supported by the evidence or a reasonable application of the applicable enactment in the appellant's circumstances. Pursuant to Section 62 of the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), the applicant must be a recipient of disability assistance or be a person in receipt of disability assistance ( or a dependant) in a variety of scenarios. If that condition is met, Schedule C of the EAPWDR specifies additional criteria that must be met in order to qualify for a health supplement for various items. In this case, the ministry has not disputed that the requirement of Section 62 has been met in that the appellant has been approved as a recipient of medical services only. The ministry considered the appellant's request for the cost of custom compression stockings under Section 3 of Schedule C of the EAPWDR, which provides: Medical equipment and devices 3 (1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.12 of this Schedule are the health supplements that may be provided by the minister ii (a) the supplements are provided to a family unit that is eligible under section 62 [general health supplements] of this regulation, and (b) all of the following requirements are met: (i) the family unit has received the pre-authorization of the minister for the medical equipment or device requested; (ii) there are no resources available to the family unit to pay the cost of or obtain the medical equipment or device; (iii) the medical equipment or device is the least expensive appropriate medical equipment or device. ... Section 2 of Schedule C of the EAPWDR provides: General health supplements 2 (1) The following are the health supplements that may be paid for by the minister ii provided to a family unit that is eligible under section 62 [general health supplements] of this regulation: (a) medical or surgical supplies that are, at the minister's discretion, either disposable or reusable, ii the minister is satisfied that all of the following requirements are met: (i) the supplies are required for one of the following purposes: (A) wound care; (B) ongoing bowel care required due to loss of muscle function; (C) catheterization; (D) incontinence; (E) skin parasite care; (F) limb circulation care; (ii) the supplies are (A) prescribed by a medical practitioner or nurse practitioner, (B) the least expensive supplies appropriate for the purpose, and (C) necessary to avoid an imminent and substantial danger to health; (iii) there are no resources available to the family unit to pay the cost of or obtain the supplies .... Section 69 of the EAPWDR provides as follows: Health supplement for persons facing direct and imminent life threatening health need 69 The minister mav Provide to a familv unit anv health sunnlement set out in sections 2 (1) (al and (I) faeneral
health s up pleme n ts] a nd 3 [medical equi pment an d pro vid e d to or for a p erson in the f amily unit wh o i s ot t his r egulati o n , an d i f the mini s t e r is s atisfied tha t (a) the person fa ces a di re ct a n d imm in ent l ife threa t p er s o n ' s famil y unit with wh i ch t o meet tha t need, (b) t he h ea l th supplemen t is n ecessa ry to meet that need, ( c ) the p erson' s family unit is rece i ving prem i um a s si (d) t he re qui re ment s sp ecified in the f o l lowing provisions (i) parag raph ( a ) o r ( f ) of s ection (2) (1); (ii ) sec t ions 3 to 3.1 2, other than p aragr a ph (a) of section 3 ( No resources av ail a bl e: Ministry' s p o s ition The min is tr y's positio n i s that as a med i cal se r vic es hea l th s upplement s under Se ction 6 2 of the EAPWDR, to cove r t he cos t of c us tom co m pressio n stockin g s Se cti o n 3 of Schedule C o f the EA PWDR. T he mi nis S ec tion 3(1)(b) (ii) h ave not be en m e t as there is ins r esou rces to t h e family unit to pay t h e cos t or obt ai n po i nted o u t in th e dec is ion th at the ap pellant' s f in a n r ega r ding credits t o h e r b ank a cco u nt (i ncome or o t appel lan t 's month ly inc o m e a nd iden tific ation o f the minis try to deter m ine if the e xpend itur es a re to provi poi n ted out that the Monthly Exp enses and Re cen t r ent at $880 which i s diffe r e n t from th e withdra wa l of presu med t o b e for rent , and s ince t he r ent has cha statemen t i s st il l accurat e. Th e mi nis tr y s ta ted tha t ge n e r a l he alth su p pl em e n t c osts through her own re her bank account in Jan uary 201 4. The minist ry a lso pa i r o f st o c ki n gs, acc o m moda ti on could b e m a d e b y alternating with o ff-t h e-shelf stockin g s until a second Ap pellant ' s pos ition The appellant position, as set out in her N otice of App the stockings which she needs. The appellant argued that her rent as of April 1, 2014 is now $1,129.13, up $35 since her previous correspondence, and with the cost of needed items and services, $150 per month disposable inco me does not go very far. additional expenses, as se t out in th e st atement provide bedding, towels, glasses, optometri s t , dentist, HandyDART and taxi savers, foo long distance telephone and these are bills /nece s sities. Panel's decision While the ministry considered the appellant's request under Section 3 of Schedule C of the EAPWDR, the panel finds that compression st o c kin devices as detailed in Section 3.1 to 3.12 of the Schedule; however, the ministry appellant meeting her "general health supplement" costs, which are covered under Sect Schedule C and includes the same criteria in Section 2(1 )(a)(iii), namely that there are no resources available to the f amily uni t to pay the cost of or obtain the supplies, as that in Section 3(1 )(b)(ii). annellant reauested a sunnlement to cover the cost of two oair of custom stockinas and it is not I APPE A L# d evices) of Sche du l e C, if t he health s up pleme n t is herwi se no t eli g i ble f or the health s up ple ment u nde r enin g nee d a nd there are no resourc es a vailable to the s tance un d er the Me di care Prot ec t ion Act, and of Sc hedule C, as appli ca ble, are m et : 1). onl y recipient the a ppe l la nt i s e l igi ble to recei v e bu t the appella nt ' s request f or a su p plement does not meet all o f the a pp li c able c r iteria o f t r y sta t ed s p e cif ica lly th at t he requi remen ts i n ufficie nt inf o rma t i on to show t hat there are no the medi cal eq ui pmen t or de vice. The m in ist ry cial documents are l acking som e vi tal information her assets) to allow th e mi n i s try t o det erm ine the withdr a wals from her a cco unt to allow the d e for basic living necessities. The minist ry Pu rchases statemen t d a t ed August 20 13 shows $1,094.13 o n February 1, 2014, w hi ch is n ged it is un certai n i f the m o n thly ex p ense t he app ellant has suffi cient resourc e s to meet he r so u rces as sh e h ad a ba lan ce o f ov er $80 0 in st a t ed th at whil e the appellant requ ested tw o purchasing one pa i r o f stocki ng s at $377. 10 and p air could be purc hase d. e al, is that she i s una ble t o affo rd the cost of The appella nt argued that she has d , which include toiletries, haircuts, clothing, t care, vitamins, and g s are not any o f th e medical eq uipm ent and also referred to the i o n 2 of The
d i s p u t e d t h a t t h e t o t a l c o s t i s $ 7 5 4 . 2 0 . T h e a p p e l l a $ 1 , 1 2 9 . 1 3 a n d , w i t h t h e c o s t o f n e e d e d i t e m s a n d s i n c o m e a v a i l a b l e t o c o v e r a n u m b e r o f e x p e n s e s a n t w o p a i r o f c u s t o m s t o c k i n g s . T h e m i n i s t r y p o i n t e d d o c u m e n t s a r e l a c k i n g s o m e v i t a l i n f o r m a t i o n r e g a r t h o s e i n t h e F e b r u a r y 2 0 1 4 s t a t e m e n t i n t h e a m o u n d e t e r m i n e i f t h e s e e x p e n d i t u r e s a r e t o p r o v i d e f o r b a p p e l l a n t h a s n o t e x p l a i n e d t h e s e e x p e n d i t u r e s i n F r e g a r d i n g t h e n a t u r e o f t h e w i t h d r a w a l s a s s e t o u t i b a l a n c e i n h e r b a n k a c c o u n t o f $ 1 , 5 2 4 . 6 3 . T h e p a n t h a t t h e r e i s n o t s u f f i c i e n t i n f o r m a t i o n p r o v i d e d f o r t e x p e n d i t u r e s a r e t o p r o v i d e f o r b a s i c l i v i n g n e c e s s i T h e m i n i s t r y a l s o s t a t e d t h a t w h i l e t h e a p p e l l a n t r e q c o u l d b e m a d e b y p u r c h a s i n g o n e p a i r o f s t o c k i n g s c o u l d b e p u r c h a s e d , a n d t h e r e w a s n o i n f o r m a t i o n e x p l o r e d t h i s , o r o t h e r o p t i o n s , a s a n a l t e r n a t e w a y 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 r e a s o n a b l y c o n c l u e s t a b l i s h t h a t 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 s u p p l i e s , t h e r e b y n o t m e e t i n g t h e r e q u i r e m e n t i n S e 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 : 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 ' s p o s i t i o n i s t h a t t h e r e i s n o e v i d e n c e o c o m p r e s s i o n s t o c k i n g s , o r e v i d e n c e o f a n y c o m o r b i i m m i n e n t d a n g e r t o l i f e . A p p e ll 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 , a s s t a t e d i n h e r R e q u e s t f o c o m p r e s s i o n s t o c k i n g s . T h e a p p e l l a n t p r o v i d e d a p w r o t e t h a t t h e a p p e l l a n t r e q u i r e s b i l a t e r a l l e g c o m p r p r e v e n t i o n o f d e e p v e i n t h r o m b o s i s a n d t h a t s h e h a f i t i s u n s u i t a b l e d u e t o b o d y h a b i t u s . P a n e l ' s d e c i s i o n W h i l e 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 n e e d s t h e c o m p p o s i t i o n t h a t t h e c u s t o m c o m p r e s s i o n s t o c k i n g s a r e 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 . A l t h o u g h t h e p h y s i c t h e c u s t o m c o m p r e s s i o n s t o c k i n g s t o p r e v e n t d e e p c o n d i t 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 r e a s o n a b p r o v i d e d t o d e m o n s t r a t e s a ' d i r e c t a n d i m m i n e n t ' l i f e 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 . C o n c l u s i o n I n 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 ry ' s d e c s u p p l e m e n t t o c o v e r t h e c o s t o f c u s t o m c o m p r e s s i o 2 ( 1 ) ( a ) ( i i i ) o f S c h e d u l e C o f t h e E A P W D R w a s n o t m a n d , t h e r e f o r e , c o n f i r m s t h e m i n i s t ry ' s r e c o n s i d e r a t i o A P P E A L # I n t a r g u e d t h a t h e r r e n t a s o f A p r i l 1 , 2 0 1 4 i s e r v i c e s , s h e h a s $ 1 5 0 p e r m o n t h d i s p o s a b l e d s h e d o e s n o t h a v e t h e r e s o u r c e s t o p a y f o r t h e o u t i n t h e d e c i s i o n t h a t t h e a p p e l l a n t ' s f i n a n c i a l d i n g t h e w i t h d r a w a l s f r o m h e r a c c o u n t , s u c h a s t s o f $ 8 0 a n d $ 7 0 0 , t o a l l o w t h e m i n i s t ry t o a s i c l i v i n g n e c e s s i t i e s . T h e p a n e l f i n d s t h a t t h e e b r u a r y 2 0 1 4 , n o r p r o v i d e d f u l l i n f o r m a t i o n n t h e M a r c h 2 0 1 4 s t a t e m e n t , w h i c h s h o w s a n e n d e l f i n d s t h a t t h e m i n i s t r y r e a s o n a b l y c o n c l u d e d h e m i n i s t r y t o d e t e r m i n e t h a t t h e a p p e l l a n t ' s t i e s , a s o p p o s e d t o n o n e s s e n t i a l c o s t s . u e s t e d t w o p a i r o f s t o c k i n g s , a c c o m m o d a t i o n a t a c o s t o f $ 3 7 7 . 1 O t o s t a r t u n t i l a s e c o n d p a i r p r o v i d e d b y t h e a p p e l l a n t t o s h o w t h a t s h e h a d t o m e e t h e r n e e d f o r t h e c o m p r e s s i o n s t o c k i n g s . d e d t h a t t h e r e w a s n o t s u f f i c i e n t e v i d e n c e t o e f a m i l y u n i t t o p a y t h e c o s t o f o r t o o b t a i n t h e c t i o n 2 ( 1 ) ( a ) ( i i i ) o f S c h e d u l e C o f t h e E A P W D R . f a d i r e c t a n d l i f e t h r e a t e n i n g n e e d f o r c u s t o m d i t i e s t h a t w o u l d s u b s t a n t i a t e a d i r e c t a n d r R e c o n s i d e r a t i o n , i s t h a t s h e n e e d s t h e r e s c r i p t i o n l e t t e r f r o m a p h y s i c i a n i n w h i c h h e e s s i o n s t o c k i n g s f o r p e r i p h e r a l e d e m a a n d s t r i e d o f f t h e s h e l f c o m p r e s s i o n s t o c k i n g s b u t t h e r e s s i o n s t o c k i n g s , s h e d i d n o t d i r e c t l y a d v a n c e a r e q u i r e d b e c a u s e s h e f a c e s a d i r e c t a n d i a n ' s l e t t e r i n d i c a t e d t h a t t h e a p p e l l a n t r e q u i r e s v e i n t h r o m b o s i s , w h i c h i s a s e r i o u s h e a l t h l y c o n c l u d e d t h a t t h e r e i s i n s u f f i c i e n t i n f o r m a t i o n t h r e a t e n i n g n e e d f o r t h e s t o c k i n g s , a s r e q u i r e d 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 a n s t o c k i n g s b e c a u s e t h e r e q u i r e m e n t i n S e c t i o n e t , 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 c e n 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.