PART C – Decision under Appeal
The decision under appeal is the Ministry of Social Development (ministry)’s reconsideration decision
dated October 31, 2016, finding the appellant is not eligible to receive payment for physiotherapy
sessions because he does not meet the legislative requirements in section 2(2) and 2(1)(c)(i) of
Schedule “C” of the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR)
that the services are to be provided in not more than 12 visits per calendar year and a medical
practitioner or nurse practitioner has confirmed an acute need for the service.
PART D – Relevant Legislation
The relevant legislation is sections 2(1) and (2) of Schedule “C” of the EAPWDR.
PART E – Summary of Facts
The evidence before the ministry at the time of the reconsideration decision consisted of the
following:
1.
A prescription dated September 23, 2016, completed by the appellant’s physician which
states:
NON-DRUG Rx – Physiotherapy
Details:
Above patient suffers from chronic back and neck pain due to degenerative Disc disease and
that due to this he has chronic soft tissue stiffness and discomfort. He will benefit from active
assisted rehabilitation, core strengthening and stretches. He might also benefit from
intramuscular stimulation. He will need weekly to 2 weekly visits for 3 months, though I feel the
physio should determine this after assessment.
2.
A screenshot of a page of the appellant’s MSP Teleplan Web Access site stating “Subsidy
Insured Service: SERVICES PD TO DATE – 10”.
PART F – Reasons for Panel Decision
The issue under appeal is the reasonableness of the ministry’s reconsideration decision finding the
appellant is not eligible to receive payment for physiotherapy sessions because he does not meet the
legislative requirements in sections 2(2) and 2(1)(c)(i) of Schedule “C” of the EAPWDR that a medical
practitioner or nurse practitioner has confirmed an acute need for the services and the services are to
be provided in not more than 12 visits per calendar year.
The relevant legislation is sections 2(1) and (2) of Schedule “C” of the EAPWDR:
General health supplements
2 (1) The following are the health supplements that may be paid for by the minister if provided to a family unit
that is eligible under section 62 [general health supplements] of this regulation:
…
(c) subject to subsection (2), a service provided by a person described opposite that service in the following
table, delivered in not more than 12 visits per calendar year,
(i) for which a medical practitioner or nurse practitioner has confirmed an acute need,
(ii) if the visits available under the Medical and Health Care Services Regulation, B.C. Reg. 426/97, for that
calendar year have been provided and for which payment is not available under the Medicare Protection Act,
and
(iii) for which there are no resources available to the family unit to cover the cost:
Ite
Service
Provided by
Registered with
m
1
acupuncture
acupuncturist
College of Traditional Chinese Medicine under the Health
Professions Act
2
chiropractic
chiropractor
College of Chiropractors of British Columbia under the Health
Professions Act
3
massage
massage
College of Massage Therapists of British Columbia under the
therapy
therapist
Health Professions Act
4
naturopathy
naturopath
College of Naturopathic Physicians of British Columbia under
the Health Professions Act
5
non-surgical
podiatrist
College of Podiatric Surgeons of British Columbia under the
podiatry
Health Professions Act
6
physical therapy
physical
College of Physical Therapists of British Columbia under the
therapist
Health Professions Act
(2) No more than 12 visits per calendar year are payable by the minister under this section for any combination
of physical therapy services, chiropractic services, massage therapy services, non-surgical podiatry services,
naturopathy services and acupuncture services.
The Appellant’s Position
In his appeal submission the appellant writes:
…If medical practicioner deems chronic then acute is part of cycle and in need of long term
assistance.
At the hearing the appellant’s advocates did not argue that the appellant meets the legislative criteria
but stated that without this physiotherapy his condition would not improve.
The Ministry’s Position
The ministry relied on its reconsideration decision. In that decision the ministry found that the
appellant was not eligible to receive payment for the physiotherapy because his physician describes
a chronic rather than an acute need for the physiotherapy and prescribes more than the maximum of
12 visits per year.
The Panel’s Decision
The ministry’s position is that as the appellant’s physician prescribes more than 12 treatments he
does not meet the legislative requirement in section 2(2) of Schedule “C” of the EAPWDR. The panel
finds that this is not a reasonable interpretation of the legislation because this provision is a limit
rather than a prerequisite. That is, this legislative provision does not state that no more than 12 visits
per year may be prescribed, but rather that, if the ministry does fund the services, it can fund no more
than 12 visits per year.
At the hearing neither the appellant nor the appellant’s advocate argued that the ministry’s decision
was unreasonable. In his appeal statement, the appellant states if his condition is chronic then “acute
is part of the cycle”. However, in this case the appellant’s physician clearly indicates that the
appellant requires the physiotherapy in order to help address his long-term health issues which can
only be described as “chronic”. Therefore, appellant does not meet the legislative requirement in
section 2(1)(c)(i) of Schedule “C” of the EAPWDR.
Accordingly, the Panel finds that the ministry’s reconsideration decision was a reasonable
interpretation of the legislation and confirms the ministry’s reconsideration decision.
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.