: APPFAI # PART C -Decision under Appeal The Appellant appeals the June 16, 2014 reconsideration decision of the Ministry of Social Development and Social Innovation ("Ministry"), in which the Ministry denied the Appellant's request for a long walker boot on the basis that the Appellant did not receive pre-authorization for the long walker boot from the Ministry, as required by subsection 3(1)(b)(i) of Schedule C of the Employment andA ssistance for Persons with Disabilities Regulation (EAPWDR). The Ministry also denied the Appellant's request on the basis that a walking boot is not an eligible health supplement under the legislation as it is neither a medical supply as set out in subsection 2(1)(a) of Schedule C of the EAPWDR nor medical equipment for the purposes of section 3 of Schedule C of the EAPWDR. PART D -Relevant Legislation Employment andA ssistance for Persons with Disabilities Regulation ("EAPWDR"), s. 62 and Schedule C, Health Supplements, sections 2 and 3. EM T003(10/06101)
APPEAL# '. PART E -Summarv of Facts The evidence before the Ministry at the reconsideration included the following: • A prescription note from the Appellant's surgeon dated February 21, 2014 for "long fracture boot for R [right] foot." • An invoice from a provincial health care provider/hospital dated February 20, 2014 for a long walker boot in the amount of $116.00. • An invoice for take-home supplies from the provincial health care provider/hospital with the words "walker boot long" and the price of $116.00 circled, dated February 20, 2014 and signed by the appellant. • The Appellant's request f o r reconsideration dated June 4, 2014, on which she has written, "My long fracture boot was prescribed by my surgeon [name] (see enclosed prescription). Calcium build-up behind my foot has damaged the tendon, and I am waiting for a surgery date. I have to wear this boot until I receive the surgery and I will need to wear it after the surgery as well. If you want more information feel free to contact [the surgeon]. With the income I receive, I am unable to pay this." The Appellant receives disability assistance and, as noted by the Ministry in its reconsideration decision, is eligible to receive health supplements under section 62 and Schedule C of the EAPWDR. At the hearing, the Appellant and the Ministry's representative agreed that a "long walker boot" and a "long fracture boot" are the same thing. The Appellant told the panel that she has a calcium build up behind her right foot which is very painful f o r her and which requires surgery. She said that she needs the long walker boot to help stretch the tendon and ease her pain before the surgery and she will also need the boot after the surgery. The Appellant told the panel that when she was at the hospital for an appointment with her surgeon, the hospital provided her with the long walker boot and told her to take the invoice to the Ministry when she received it. The Appellant did not speak with a Ministry worker before she received the long walker boot at the hospital. In her testimony at the hearing and in her notice of appeal, the Appellant said that she is not able to pay $116 f o r the boot from the money she receives in monthly disability assistance and that she has received a notice from the hospital that if she doesn't pay in 30 days, they will send the bill to a collection agency. EAA T003(10/06/01)
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 a l o n g w A p p e l l a n t d i d n o t r e c e i v e p r e a u t h o r i z a t i o n f r o m t h s u b s e c t i o n 3 ( 1 ) ( b ) ( i ) o f S c h e d u l e C o f t h e E A P W D o n t h e b a s i s t h a t a w a l k i n g b o o t i s n o t a n e l i g i b l e h n e i t h e r a m e d i c a l s u p p l y u n d e r s u b s e c t i o n 2 ( 1 ) ( a ) e q u i p m e n t f o r t h e p u r p o s e s o f s e c t i o n 3 o f S c h e d u A p p l ic 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 2 G e n e r a l h e a l t h s u p p l e m e n t s ( 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 m i n i s e c t i o n . . . 3 [ m e d ic a l e q u ip m e n t a n d d e v ic e s ] o f S 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 , S c h e d u l e C o f t h e E A P W D R s e t s o u t t h e r e q u i r e m d i s a b i l i t i 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 h e a l t h s s e c t i o n 2 a s f o l l o w s : 2 . G e n e r a l h e a l t h s u p p l e m e n t s ( 1 ) T h e f o l l o w i n g a r e t h e h e a l t h s u p p l e m e n t s t h a t m u n i t t h a t i s e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e r a l h e a l t h ( a ) m e d i c a l o r s u r g i c a l s u p p l i e s t h a t a r e , a t t h e 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 l l o f t h e f o l l o w i n ( i ) t h e s u p p l i e s a r e r e q u i r e d f o r o n e o f t h [ s u b s e c t i o n s A F s e t o u t t h e l i s t o f w o f m u s c l e f u n c t i o n , c a t h e t e r i z a t i o n , i n c a r e ] ; ( i i ) t h e s u p p l i e s a r e A . p r e s c r i b e d b y a m e d i c a l p r a c t i t i o n 8 . t h e l e a s t e x p e n s i v e s u p p l i e s a p p r o C . n e c e s s a ry t o a v o i d a n i m m i n e n t a ( i i i ) 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 p a n e l n o t e s t h a t n o n e o f s u b s e c t i o n s 2 ( 1 ) ( a . 1 ) A p p e l l a n t ' s r e q u e s t f o r t h e l o n g w a l k e r b o o t a n d t h a a p p l y t o h e r r e q u e s 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 r m e d i c a l e q u i p m e n t a 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 : E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )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 J u n e 1 6 , a l k e r b o o t b e c a u s e t h e M i n i s t r y d e t e r m i n e d t h e e M i n i s t r y f o r t h e l o n g w a l k e r b o o t a s r e q u i r e d b y R . T h e M i n i s t r y a l s o 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 e a l t h s u p p l e m e n t u n d e r t h e l e g i s l a t i o n a s i t i s o f S c h e d u l e C o f t h e E A P W D R , n o r m e d i c a l l e C o f t h e E A P W D R 6 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 : 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 i n 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 e n t s f o r h e a l t h s u p p l e m e n t s f o r p e r s o n s w i t h u p p l e m e n t s t h a t a r e m e d i c a l s u p p l i e s a r e s e t o u t i n a y b e p a i d f o r b y t h e m i n i s t e r i f p r o v i d e d t o a f a m i l y s u p p l e m e n t s ] o f t h i s r e g u l a t i o n : m i n i s t e r ' s d i s c r e t i o n , e i t h e r d i s p o s a b l e o r r e u s a b l e , i f g r e q u i r e m e n t s a r e m e t : e f o l l o w i n g p u r p o s e s : o u n d c a r e , o n g o i n g b o w e l c a r e r e q u i r e d d u e t o l o s s c o n t i n e n c e ; s k i n p a r a s i t e c a r e o r l i m b c i r c u l a 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 , p r i a t e f o r t h e p u r p o s e , a n d n d s u b s t a n t i a l d a n g e r t o h e a l t h ; 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 o b t a i n t h e o r ( a . 2 ) o r ( 1 ) ( c ) o r ( 2 ) o r ( 2 . 1 ) a r e a p p l i c a b l e t o t h e t t h e A p p e l l a n t d o e s n o t a s s e r t t h a t t h e s e c t i o n s n d d e v i c e 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
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 ( 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 s 3 . 1 t o 3 . 1 2 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 i f ( a ) t h e s u p p l e m e n t s a r e p r o v i d e d t o a f a m i l y u n s u p p l e m e n t s ] o f t h i s r e g u l a t i o n , a n d ( b ) a l l o f t h e f o l l o w i n g r e q u i r e m e n t s a r e m e t : ( i ) t h e f a m i l y u n i t h a s r e c e i v e d t h e p r e a e q u i p m e n t o r d e v i c e r e q u e s t e d ; ( i i ) 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 q u i p m e n t o r d e v i c e ; ( i i i ) 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 i s t h d e v i c e . T h e p a n e l n o t e s t h a t s u b s e c t i o n s 3 ( 2 ) , ( 2 . 1 ) , ( 3 ) , ( 4 t h e l o n g w a l k e r b o o t a n d t h e A p p e l l a n t d o e s n o t a s m e d i c a l d e v i c e s a r e l i s t e d i n S c h e d u l e C o f t h e E A 3 . 1 ) ; w h e e l c h a i r s ( s . 3 . 2 ) ; w h e e l c h a i r s e a t i n g s y s t e a n d t o i l e t i n g a i d s ( s . 3 . 5 ) ; h o s p i t a l b e d ( s . 3 . 6 ) ; p r e d e v i c e s ( s . 3 . 8 ) ; b r e a t h i n g d e v i c e s ( s . 3 . 9 ) ; h e a r i n g g l u c o s e m e t e r s ( s . 3 . 1 2 ) . T h e A p p e l l a n t ' s r e q u e s t r e q u i r e m e n t s o f a n y o f t h e s e s e c t i o n s o f S c h e d u l e S e c t i o n 3 . 1 0 o f S c h e d u l e C o f t h e E A P W D R s e t s o 3 . 1 0 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 ( 1 ) I n t h i s s e c t i o n , " o r t h o s i s " m e a n s a n y o r a l l o f t h e ( a ) a c u s t o m m a d e f o o t o r t h o t i c ; ( b ) c u s t o m m a d e f o o t w e a r ; ( c ) a p e r m a n e n t m o d i f i c a t i o n t o f o o t w e a r ; ( d ) a n a n k l e b r a c e ; ( e ) a n a n k l e f o o t o r t h o s i s ; ( f ) a k n e e a n k l e f o o t o r t h o s i s ; ( g ) a k n e e b r a c e ; ( h ) a h i p b r a c e ; ( i ) a n u p p e r e x t r e m i t y b r a c e ; 0 ) a c r a n i a l h e l m e t u s e d f o r t h e p u r p o s e s s e t o ( k ) a t o r s o o r s p i n e b r a c e ( 2 ) S u b j e c t t o s u b s e c t i o n s ( 3 ) t o ( 1 1 ) o f t h i s s e c t i o n p u r p o s e s o f s e c t i o n 3 o f t h i s S c h e d u l e i f ( a ) t h e o r t h o s i s i s p r e s c r i b e d b y a m e d i c a l p r a c t i t i o n ( b ) 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 t h e o r t h o s i s i s m e d i f u n c t i o n a l i t y , ( c ) 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 t h e o r t h o s i s i s r e q u i ( i ) t o p r e v e n t s u r g e ry ; ( i i ) f o r p o s t s u r o i c a l c a r e ; E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L I I I , 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 h s 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 t t h a t i s e l i g i b l e u n d e r s e c t i o n 6 2 [ g e n e r a l h e a l t h u t h o r i z a t i o n o f t h e m i n i s t e r f o r t h e m e d i c a l 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 o b t a i n t h e m e d i c a l 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 e d i c a l e q u i p m e n t o r ) a n d ( 5 ) d o n o t a p p l y t o t h e A p p e l l a n t ' s r e q u e s t f o r s e r t t h a t t h e y d o . S p e c i f i c m e d i c a l e q u i p m e n t a n d P W D R a s f o l l o w s : c a n e s , c r u t c h e s a n d w a l k e r s ( s . m s ( s . 3 . 3 ) ; s c o o t e r s ( s . 3 . 4 ) ; w h e e l c h a i r s ; b a t h i n g s s u r e r e l i e f m a t t r e s s e s ( s . 3 . 7 ) ; f l o o r o r c e i l i n g l i f t i n s t r u m e n t s ( s . 3 . 1 1 ) ; a n d n o n c o n v e n t i o n a l f o r t h e l o n g w a l k e r b o o t d o e s n o t m e e t t h e C . u t t h e r e q u i r e m e n t s f o r o r t h o s e s a s f o l l o w s : f o l l o w i n g : u t i n s u b s e c t i o n ( 7 ) ; , a n o rt h o s i s i s a h e a l t h s u p p l e m e n t f o r t h e e r o r a n u r s e p r a c t i t i o n e r , c a l l y e s s e n t i a l t o a c h i e v e o r m a i n t a i n b a s i c r e d f o r o n e o r m o r e o f t h e f o l l o w i n g p u r p o s e s :
( i i i ) t o a s s i s t i n p h y s i c a l h e a l i n g f r o m s u r g e r y , i n j u r ( i v ) t o i m p r o v e p h y s i c a l f u n c t i o n i n g t h a t h a s b e e n ( 1 1 ) T h e f o l l o w i n g i t e m s a r e n o t h e a l t h s u p p l e m e n ( a ) a p r o s t h e t i c a n d r e l a t e d s u p p l i e s ; ( b ) a p l a s t e r o r f i b e r g l a s s c a s t ; ( c ) a h e r n i a s u p p o r t ; ( d ) a n a b d o m i n a l s u p p o rt ; ( e ) a w a l k i n g b o o t fo r a f r a c t u r e ; S u b m i s s i o n s o f t h e P a r t i e s T h e A p p e l l a n t a r g u e s t h a t t h e r e q u e s t e d l o n g w a l k t e n d o n a n d r e d u c e h e r p a i n a n d d i s c o m f o r t w h i l e s b e h i n d h e r f o o t ( a n d t h a t s h e w i l l r e q u i r e t h e w a l k i n p r o v i n c i a l h e a l t h c a r e p r o v i d e r / h o s p i t a l a r e f o r a " w F e b r u a r y 2 0 , 2 0 1 4 f o r $ 1 1 6 . T h e A p p e l l a n t a r g u e s a u t h o r i z a t i o n f o r t h e l o n g w a l k e r b o o t b e c a u s e t h e a p p o i n t m e n t w i t h h e r s u r g e o n a n d t o l d h e r t o t a k e A p p e l l a n t s a y s t h a t s h e i s u n a b l e t o a f f o r d t h e $ 1 1 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 a u t h o r i z a t i o n o f t h e M i n i s t r y f o r t h e l o n g w a l k e r b o o t h e E A P W D R . T h e M i n i s t r y n o t e d i n t h e r e c o n s i d e r w a l k e r b o o t i s n o t a m e d i c a l s u p p l y t h a t c a n b e p r o 2 ( 1 ) ( a ) o f S c h e d u l e C . T h e M i n i s t r y fo u n d t h a t t h e o r n u r s e p r a c t i t i o n e r w i t h h e r r e q u e s t t o e s t a b l i s h t h p u r p o s e s s e t o u t i n s u b s . 2 ( 1 ) ( a ) o r t h a t i t i s n e c e s h e a l t h ( a s r e q u i r e d b y s u b s . 2 ( a ) ( i i ) ( C ) ) . T h e M i n i s A p p e l l a n t ' s r e q u e s t e d l o n g f r a c t u r e b o o t i s n o t e l i g i t h e i t e m s s e t o u t i n s e c t i o n s 3 . 1 t h r o u g h 3 . 1 2 , a n d r e q u e s t d o e s n o t e s t a b l i s h t h e c r i t e r i a s e t o u t i n s u f r a c t u r e b o o t i s a n i n e l i g i b l e i t e m u n d e r s e c t i o n 3 . 1 f o r a f r a c t u r e " i s n o t a h e a l t h s u p p l e m e n t fo r t h e p u P a n e l 's D e ci s i o n T h e p a n e l n o t e s t h e A p p e l l a n t d o e s n o t d i s p u t e t h a M i n i s t r y f o r t h e l o n g w a l k e r b o o t h e r e v i d e n c e i s t b o o t a n d t o l d h e r t o t a k e t h e i n v o i c e t o t h e M i n i s t r y r e a s o n a b l e t h e M i n i s t ry ' s d e n i a l o f t h e A p p e l l a n t ' s r a u t h o r i z a t i o n f r o m t h e M i n i s t r y f o r t h e l o n g w a l k e r b t h e E A P W D R . T h e M i n i s t r y a l s o 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 o n e l i a i b l e m e d i c a l s u n n l v u n d e r s e c t i o n 2 / 1 ) ( a ) o f S c h E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # y o r d i s e a s e ; i m p a i r e d b y a n e u r o m u s c u l o s k e l e t a l c o n d i t i o n . t s f o r t h e p u r p o s e s o f s e c t i o n 3 o f t h i s S c h e d u l e : i n g b o o t i s m e d i c a l l y n e c e s s a r y t o s t r e t c h h e r h e w a i t s f o r s u r g e r y t o r e m o v e t h e c a l c i u m d e p o s i t g b o o t a f t e r s u r g e r y ) . T h e i n v o i c e s f r o m t h e a l k e r b o o t l o n g " p r o v i d e d t o t h e A p p e l l a n t o n t h a t s h e d i d n o t c o n t a c t t h e M i n i s t r y t o s e e k p r e h o s p i t a l p r o v i d e d h e r w i t h t h e b o o t a f t e r h e r t h e i n v o i c e t o t h e M i n i s t r y f o r p a y m e n t . T h e 6 t o p a y f o r t h e w a l k i n g b o o t . i n e d t h a t t h e A p p e l l a n t h a d n o t r e c e i v e d t h e p r i o r t , a s r e q u i r e d b y s e c t i o n 3 ( 1 ) ( b ) ( i ) o f S c h e d u l e C o f a t i o n 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 r e q u e s t e d l o n g v i d e d u n d e r t h e E A P W D R a s d e f i n e d i n s e c t i o n A p p e l l a n t d i d n o t s u b m i t i n f o r m a t i o n f r o m a m e d i c a l a t t h e l o n g f r a c t u r e b o o t i s r e q u i r e d f o r o n e o f t h e s a r y t o a v o i d a n i m m i n e n t a n d s u b s t a n t i a l d a n g e r t o t r y n o t e d i n t h 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 a t t h e b l e a s m e d i c a l e q u i p m e n t b e c a u s e i t i s n o t a m o n g t h e i n f o r m a t i o n p r o v i d e d b y t h e A p p e l l a n t w i t h h e r b s e c t i o n 3 ( 1 ) ( b ) . T h e M i n i s t r y a l s o n o t e d t h a t a l o n g 0 ( 1 1 ) , w h i c h e x p r e s s l y s t a t e s t h a t " a w a l k i n g b o o t r p o s e s o f s e c t i o n 3 o f S c h e d u l e C o f t h e E A P W D R . t s h e d i d n o t r e c e i v e p r e a u t h o r i z a t i o n f r o m t h e h a t t h e h o s p i t a l p r o v i d e d h e r w i t h t h e l o n g w a l k e r w h e n s h e r e c e i v e d i t . A c c o r d i n g l y , t h e p a n e l f i n d s e q u e s t o n t h e b a s i s t h a t s h e d i d n o t r e c e i v e p r e o o t a s r e q u i r e d b y s u b s . 3 ( 1 ) ( b ) ( i ) o f S c h e d u l e C o f t h e b a s i s t h a t a " l o n g f r a c t u r e b o o t " i s n o t a n e d u l e C o f t h e E A P W D R a n d , f u r t h e r , i s s p e c i f i c a l l v
APPEAL# � excluded as a health supplement by subsection 3.10(11) of Schedule C of the EAPWDR. The panel notes that there was no evidence that the Appellant provided information from a medical or nurse practitioner with her request to establish that the long fracture boot is required for one of the purposes set out in subs. 2(1) (a) or that it is necessary to avoid an imminent and substantial danger to health (as required by subs. 2(a)(ii)(C)). Accordingly, the panel finds reasonable the Ministry's denial of the Appellant's request for a long fracture boot as it did not meet the requirements of section 2(1 )(a) of Schedule C of the EAPWDR. Further, the panel notes that the invoices provided by the provincial health care provider/hospital indicate that on February 20, 2014 the Appellant received a "walker boot long" for the cost of $116.00 and that the Appellant's surgeon indicated in the February 21, 2014 prescription that it was for a "long fracture boot for R [right] foot." The panel finds that the information provided by the Appellant and her surgeon, as well as set out in the invoices, indicate that she requires a walker boot. Accordingly, the panel finds reasonable the Ministry's denial of the Appellant's request on the basis that the requested "walking boot" is excluded as a health supplement under subsection 3.10(11) of Schedule C of the EAPWDR. The panel confirms the Ministry's denial of the Appellant's request for a walking boot as reasonable based on the evidence and a reasonable application of the legislation in the circumstances of the Appellant. EAAT003(10/06/01)
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