PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation ("Ministry") reconsideration decision dated August 7, 2014, in which the Ministry denied the Appellant's request for replacement of custom-made foot orthotics because the request did not meet the legislated replacement criteria, 3 years have passed set out in the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Regulations, Schedule C, sections 3(3) and 3.10(10) item 1. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Regulation ("EAPWDR"), section 62, Schedule C, sections 3(3) and 3.10(10).
P A R T E S u m m a r y o f F a c t s W i t h t h e c o n s e n t o f t h e p a rt i e s , t h e a p p e a l h e a r i n g s e c t i o n 2 2 ( 3 ) ( b } 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 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 ry a t t h e r e c o n s i d e o T h e A p p e l l a n t r e c e i v e s d i s a b i l i t y a s s i s t a n c e d e c i s i o n , i s e l i g i b l e t o r e c e i v e h e a l t h s u p p l e E A P W D R . o A r e q u e s t f o r i n s o l e r e f u r b i s h i n g a n d o rt h o p T h e m i n i s t r y a p p r o v e d $ 5 9 5 o n O c t o b e r 2 2 e T h e a p p e l l a n t ' s p e d o r t h i s t r e p o r t e d t h a t o r t h a n d s u p p o r t a d e p r e s s e d m e t a t a r s a l a r c h , t o p t i m a l f u n c t i o n i n g , i m p r o v e p r e s s u r e d i s t r i i n c r e a s e d a c t i v i t y . H e r e c o m m e n d e d t h a t e a o p t i m a l m e t a t a r s a l a r c h o r i e n t a t i o n . • O n O c t o b e r 1 2 , 2 0 1 2 , a n i n v o i c e w a s s u b m w h i c h w a s p a i d o n D e c e m b e r 1 4 , 2 0 1 2 , $ 6 0 t h e o r t h o t i c s . • O n M a y 7 , 2 0 1 4 , t h e a p p e l l a n t ' s o r t h o t i s t r e c o m p e n s a t e d b y i n t e r n a l r o t a t i o n o f t h e e n t i h i p p a i n l e a d i n g t o k n e e a n d h i p d i s e a s e . H s t a t e s o n M a y 1 2 , 2 0 1 4 t h a t " w e c a n m a k e p r o b l e m i s f u l l y c o r r e c t a b l e " b u t r e q u i r e s o r t f u n c t i o n i n g . H e r e p o r t s t h a t t h e c u r r e n t o r t h o • O n M a y 1 3 , 2 0 1 4 , a q u o t e f o r b i l a t e r a l c u s t o a t a c o s t o f $ 3 9 0 . • O n J u l y 1 6 , 2 0 1 4 , t h e m i n i s t r y c o m p l e t e d a f o r c u s t o m m a d e o r t h o t i c s d e n y i n g t h e a p p e m e e t t h e E A P W D R 3 . 1 0 ( 1 0 ) t i m e f r a m e f o r I n 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 d a t e d f r o m c h r o n i c p a i n a s t h e c u r r e n t o r t h o t i c s w e r e m a d o u t a n d h e m u s t t a k e m o r e m e d i c a t i o n d u e t o p a i n . I n h i s n o t i c e o f a p p e a l , t h e A p p e l l a n t s t a t e d t h a t t h e 2 0 1 1 a n d a p p r o v e d O c t o b e r 2 2 , 2 0 1 ? ( d a t e s d i f f i c u t h e s h o e s c a n b e r e a d y b y O c t o b e r 2 2 , 2 0 1 4 o t h e rw a p p l i c a t i o n p r o c e s s a l l o v e r a g a i n a n d w a i t u n t i l 2 0 1 a p p o i n t m e n t s a n d o u t o f p o c k e t e x p e n s e s . T h e p a n e l f i n d s t h a t t h e A p p e l l a n t ' s w r i t t e n s t a t e m e i t r e l a t e s t o h i s n e e d f o r c u s t o m o r t h o t i c s , t h e r e f o r e 2 2 ( 4 ) ( b } 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 A c t a s w a s 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 t h e r e c o n s i d e H o w e v e r , i n t h e s e c o n d p a r t o f t h e r e a s o n s f o r t h e t h e o r t h o t i c s " s o t h e s h o e s c a n b e r e a d y b y O c t o b e a p p l i c a t i o n p r o c e s s a l l o v e r a g a i n a n d w a i t u n t i l 2 0 1 e x p e n s e s " . T h i s r e q u e s t a n d q u e s t i o n s a r e N O T e v w a s c o n d u c t e d i n w r i t i n g i n a c c o r d a n c e w i t h c e A c t . r a t i o n i n c l u d e d t h e f o l l o w i n g : a n d , a s n o t e d b y t h e M i n i s t r y i n i t s r e c o n s i d e r a t i o n m e n t s u n d e r s e c t i o n 6 2 a n d S c h e d u l e C o f t h e e d i c f o o t w e a r w a s s u b m i t t e d o n A u g u s t 3 , 2 0 1 1 . , 2 0 1 1 f o r c u s t o m m a d e o r t h o t i c s a n d f o o t w e a r . o t i c s w e r e n e c e s s a r y t o c o n t r o l e x c e s s p r o n a t i o n o i m p r o v e t h e b i o m e c h a n i c s o f t h e f e e t t o a l l o w b u t i o n , t o r e d u c e c h r o n i c p a i n a n d t o p r o m o t e c h f o o t b e p l a s t e r w r a p p e d a n d m o l d e d t o a c h i e v e i t t e d f o r r e p a i r s a n d f o o t w e a r t o t a l i n g $ 1 8 5 . 0 0 f o r r e p a i r s a n d $ 1 2 5 f o r f o o t w e a r t o a c c o m m o d a t p o r t s a d i a g n o s i s o f r i g h t f o o t h a l l u x l i m i t a t u s t h a t i s r e r i g h t l i m b w h i c h w i l l e v e n t u a l l y c a u s e k n e e a n d e r e c o m m e n d s h a n d c a s t o r t h o t i c s . T h e o r t h o t i s t h i m m o r e f u n c t i o n a l w i t h l e s s p a i n " , t h a t " t h e h o t i c s t o p r e v e n t s u r g e ry a n d i m p r o v e p h y s i c a l t i c s w e r e m a d e i n c o r r e c t l y . m m a d e f o o t o r t h o t i c w a s s u b m i t t e d t o t h e m i n i s t r y 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 c i s i o n s u m m a r y l l a n t ' s r e q u e s t f o r o r t h o t i c s b e c a u s e h e d i d n o t r e p l a c e m e n t o r t h o t i c s . A u g u s t 1 , 2 0 1 4 t h e a p p e l l a n t r e p o r t e d s u f f e r i n g e i n c o r r e c t l y . T h i s h a s c a u s e d h i s t o e n a i l s t o f a l l s t a r t d a t e f o r h i s f i r s t p a i r o f o r t h o t i c s w a s A u g u s t l t t o r e a d ) a n d i s r e q u e s t i n g a p p r o v a l n o w s o t h a t i s e h e q u e s t i o n s i f h e h a s t o r e s u b m i t h i s 5 f o r t h e o r t h o t i c s w h i c h w i l l r e q u i r e m o r e n t s i n h i s N o t i c e o f A p p e a l i s a d m i s s i b l e b e c a u s e t h e p a n e l a d m i t s t h i s i n f o r m a t i o n u n d e r s e c t i o n w r i t t e n t e s t i m o n y i n s u p p o r t o f i n f o r m a t i o n t h a t r a t i o n d e c i s i o n . a p p e a l , t h e a p p e l l a n t ' s r e q u e s t s p r e a p p r o v a l f o r r 2 2 , 2 0 1 4 " a n d h e a s k s i f h e " h a s t o r e s u b m i t h i s 5 , p l u s m o r e a p p o i n t m e n t s a n d o u t o f p o c k e t i d e n c e .
PART F -Reasons for Panel Decision The issue is whether the reconsideration decision of the Ministry of Social Development and Social Innovation in which the Appellant's request for replacement of custom -made foot orthotics was denied because the request did not meet the legislated time frame criteria set out in the EAPWDR, Schedule C, sections 3(3) and 3.10(10) is reasonably supported by the evidence or a reasonable application of the applicable legislation in the circumstances of the appellant. APPLICABLE LEGISLATION Medical equipment and devices Section 3 (1) Subject to subsections (2) to (5) of this section, the medical equipment and devices described in sections 3.1 to 3.11 of this Schedule are the health supplements that may be provided by the minister if (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. (3) Subject to subsection (6), the minister may provide as a health supplement a replacement of medical equipment or a medical device, previously provided by the minister under this section, that is damaged, worn out or not functioning if (a) it is more economical to replace than to repair the medical equipment or device previously provided by the minister, and (b) the period of time, if any, set out in sections 3.1 to 3.12 of this Schedule, as applicable, for the purposes of this paragraph, has passed. Medical equipment and devices -orthoses Section 3.1 O (1) In this section, off-the-shelf • in relation to an orthosis, means a prefabricated, mass-produced orthosis that is not unique to a 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 ) o f f t h e s h e l f o r t h o p a e d i c f o o t w e a r ; ( f ) a n a n k l e b r a c e ; ( g ) a n a n k l e f o o t o r t h o s i s ; ( h ) a k n e e a n k l e f o o t o r t h o s i s ; ( i ) a k n e e b r a c e ; U ) a h i p b r a c e ; ( k ) a n u p p e r e x t r e m i t y b r a c e ; ( I ) 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 u t i n s u b s e c t i o n ( 7 ) ; ( m ) a t o r s o o r s p i n e b r a c e ; ( n ) a f o o t a b d u c t i o n o r t h o s i s ; ( B . C . R e g . 1 9 7 / 2 0 1 2 ) ( o ) a t o e o r t h o s i s . ( B . C . R e g . 1 9 7 / 2 0 1 2 ) ( B . C . R e g . 1 4 4 / 2 0 1 1 ) ( 1 0 ) T h e p e r i o d o f t i m e r e f e r r e d t o i n s e c t i o n 3 ( 3 ) ( b ) o f t h i s S c h e d u l e w i t h r e s p e c t t o r e p l a c e m e n t o f a n o r t h o s i s i s t h e n u m b e r o f y e a r s f r o m t h e d a t e o n w h i c h t h e m i n i s t e r p r o v i d e d t h e o r t h o s i s b e i n g r e p l a c e d t h a t i s s e t o u t i n C o l u m n 2 o f T a b l e 2 o p p o s i t e t h e d e s c r i p t i o n o f t h e a p p l i c a b l e o r t h o s i s i n C o l u m n 1 . ( B . C . R e g . 6 1 / 2 0 1 0 ) T a b l e 2 1 c u s t o m m a d e f o o t o rt h o t i c 3 y e a r s ( B . C . R e g . 1 4 4 / 2 0 1 1 ) 2 c u s t o m m a d e f o o t w e a r 1 y e a r 3 m o d i f i c a t i o n t o f o o t w e a r 1 y e a r 4 a n k l e b r a c e 2 y e a r s 5 a n k l e f o o t o r t h o s i s 2 y e a r s 6 k n e e a n k l e f o o t o r t h o s i s 2 y e a r s 7 k n e e b r a c e 4 y e a r s 8 h i p b r a c e 2 y e a r s 9 u p p e r e x t r e m i t y b r a c e 2 y e a r s 1 0 c r a n i a l h e l m e t 2 y e a r s 1 1 t o r s o o r s p i n e b r a c e 2 y e a r s 1 2 o f f t h e s h e l f f o o t w e a r 1 y e a r ( B . C . R e g . 1 4 4 / 2 0 1 1 )
1 3 o f f t h e s h e l f o r t h o p a e d i c f o o t w 1 4 t o e o r t h o s i s T h 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 ( 1 0 ) s e t s o r e p l a c e m e n t o f a c u s t o m m a d e f o o t o r t h o t i c i s 3 y e a t h e o rt h o s i s b e i n g r e p l a c e d . T h e m i n i s t r y ' s r e l i e d o n t h e f a c t s a s s t a t e d i n t h e r e t h a t t h e a p p e l l a n t i s r e c e i v e d a h e a l t h s u p p l e m_ e n t u 3 . 1 0 ( 1 0 ) f o r c u s t o m m a d e f o o t o r t h o t i c s a n d o f f t h e D e c e m b e r 1 4 , 2 0 1 2 , $ 1 8 5 w a s a p p r o v e d , $ 6 0 f o r r e n o t e l i g i b l e f o r a n e w o r t h o t i c u n t i l 3 y e a r s h a v e p a s c o n d i t i o n o f h i s c u r r e n t o r t h o t i c t h e m i n i s t r y q u e s t i o n o r t h o t i c s r a t h e r t h a n t o r e p a i r t h e m . T h e A p p e l l a n t d i d n o t m a k e a n y w r i t t e n s u b m i s s i o n w r i t e s t h a t h e i s s u f f e r i n g c h r o n i c p a i n w e a r i n g h i s c s h o e s p r o b l e m s s i n c e d a y o n e a n d t h a t t h e i n f o r m a b u i l t i n c o r r e c t l y . H e c a n n o t w a i t a n y l o n g e r a s h i s t o f o o t p r o b l e m s t o d a t e a n d t h a t h e h a s h a d t o i n c r e a n e w p a i r o f o r t h o t i c s o n O c t o b e r 2 2 , 2 0 1 4 a n d q u e s d o t h e a p p l i c a t i o n p r o c e s s a l l o v e r a g a i n , i n v o l v i n g m t o h a v e t h e o rt h o t i c s a p p r o v e d . P a n e l D e c i s i o n T h e m i n i s t r y f o u n d t h a t t h e A p p e l l a n t m e t t h e r e q u i r a s h e r e c e i v e s d i s a b i l i t y a s s i s t a n c e . W h i l e t h e a p p e p a i n , a n d w e r e m a d e i n c o r r e c t l y t h e r e i s n o p r o v i s i o y e a r s h a v e p a s s e d a s s p e c i f i e d i n t h e E A P W D R . T h e r e f o r e 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 t i m e f r a m a d h e r e d t o , t h e m i n i s t r y h a d n o o p t i o n b u t t o a p p l y t s e c t i o n s 3 ( 3 ) a n d 3 . 1 0 ( 1 0 ) . T h e d o c u m e n t s i n t h e r e c o n s i d e r a t i o n r e q u e s t c l e a r a p p r o v e d b y t h e m i n i s t r y w a s O c t o b e r 2 2 , 2 0 1 1 . I n t t h a t t h e a p p e l l a n t w i l l b e n o t b e e l i g i b l e f o r r e p l a c e m a l s o c o n s i d e r e d t h e a p p e l l a n t ' s r e q u e s t u n d e r i t s p o o r t h o t i c s b e f o r e t h e l e g i s l a t e d t i m e p e r i o d h a s e x p i r e b e c a u s e o f g r o w t h o r a c h a n g e i n m e d i c a l c o n d i t i o n d e t e r m i n e d t h a t i n f o r m a t i o n h a d n o t b e e n p r o v i d e d t e x i s t . 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 r e c o n s i d e r a t i o n d e c s u p p o rt e d b y t h e e v i d e n c e a n d f i n d s t h e m i n i s t ry ' s c m e t i s r e a s o n a b l e . T h e p a n e l t h e r e f o r e c o n f i r m s t h e e a r 1 y e a r ( B . C . R e g . 1 4 4 / 2 0 1 1 ) 1 y e a r ( B . C . R e g . 1 9 7 / 2 0 1 2 ) u t t h a t t h e p e r i o d o f t i m e w i t h r e s p e c t t o t h e r s f r o m t h e d a t e o n w h i c h t h e m i n i s t e r p r o v i d e d 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 ' s p o s i t i o n i s n d e r E A P W D R , S c h e d u l e C s e c t i o n s 3 ( 3 ) a n d s h e l f f o o t w e a r o n O c t o b e r 2 2 , 2 0 1 1 . F u r t h e r , o n p a i r s a n d $ 1 2 5 f o r n e w o f f t h e s h e l f s h o e s . H e i s s e d . A s n o i n f o r m a t i o n w a s p r o v i d e d o n t h e s w h e t h e r i t i s m o r e e c o n o m i c a l t o r e p l a c e t h e f o r t h e a p p e a l . I n t h i s r e c o n s i d e r a t i o n r e q u e s t , h e u r r e n t s h o e s a n d t h a t h e h a s a h i s t o r y o f o n g o i n g t i o n h e p r o v i d e d w i l l s h o w t h a t t h e s h o e s w e r e e n a i l s h a v e f a l l e n o u t r e s u l t i n g i n o t h e r o n g o i n g s e p a i n m e d i c a t i o n . H e c l a i m s t h a t h e i s d u e a t i o n s i f h e w i l l h a v e t o r e s u b m i t t h e r e q u e s t a n d o r e a p p o i n t m e n t s , e x p e n s e s a n d w a i t u n t i l 2 0 1 5 e m e n t s o f b a s i c e l i g i b i l i t y f o r h e a l t h s u p p l e m e n t s l l a n t s t a t e s t h a t h i s c u r r e n t o r t h o t i c s c a u s e h i m n i n t h e r e g u l a t i o n s t o r e p l a c e t h e o rt h o t i c s u n t i l 3 e o f 3 y e a r s f o r r e p l a c e m e n t o r t h o t i c s m u s t b e h e t i m e p e r i o d i n t h e E A P W D R S c h e d u l e C l y s h o w t h a t t h e d a t e t h e p r e v i o u s o r t h o t i c s 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 e m i n i s t r y s t a t e d e n t o r t h o t i c s u n t i l O c t o b e r 2 2 , 2 0 1 4 . T h e m i n i s t r y l i c y w h i c h a l l o w s f o r t h e p r o v i s i o n o f r e p l a c e m e n t d i f t h e r e p l a c e m e n t o r t h o t i c s a r e r e q u i r 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 r e a s o n a b l y o e s t a b l i s h t h a t e i t h e r o f t h e s e c i r c u m s t a n c e s i s i o n o f A u g u s t 7 , 2 0 1 4 w a s r e a s o n a b l y o n c l u s i o n t h a t t h e 3 y e a r p r o v i s i o n h a s n o t b e e n m i n i s t r y ' s 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.