PART C – Decision under Appeal
The decision under appeal is the reconsideration decision dated May 16, 2017, made by the Ministry
of Social Development and Social Innovation (the ministry), which determined that the appellant was
not eligible to receive funding for physiotherapy treatments because a medical practitioner has not
confirmed that her condition is “acute” and the appellant has not provided evidence that she is not
eligible to have her treatments paid for under the Medicare Protection Act (MSP) in accordance with
section 2(1)(c) of the Employment and Assistance for Persons with Disabilities Regulation
(EAPDWR).
PART D – Relevant Legislation
The relevant legislation is section 62 and section 2(1)(c) of Schedule C of the EAPDWR.
PART E – Summary of Facts
The appellant is in receipt of disability assistance.
The evidence before the ministry at the time of the reconsideration decision consisted of:
(1) A prescription dated March 29, 2017, from a physician which states: “Due to this patient’s
musculoskeletal issues, she requires ongoing physiotherapy.”
(2) A letter from the Workers Compensation Appeal Tribunal dated April 20, 2017, notifying the
appellant that the tribunal has extended its statutory time limit to render a decision in her case to
August 2, 2017.
(3) A prescription dated April 24, 2017, from a physician which states: “Physio required for ongoing
musculoskeletal issues related to work related injury 2012.”
(4) A request for reconsideration dated May 2, 2017, in which the appellant writes:
This is not a first time process for me. I was injured at work May 22/2012. I’ve been
dealing with Worksafe B.C. and WCAT and a lawyer for a long time now. Please read
file – all information is there. … Currently living on PTSD pension. The longer I go
without physio the more pain I experience. Progress is lost, pain increase, becomes
unbearable.
This appeal was held by written hearing by consent of the parties in accordance with section 22(3)(b)
of the Employment and Assistance Act.
NEW EVIDENCE
At appeal, the appellant submitted a prescription from a physician dated June 15, 2017, which states:
“1) Physio for acute low back pain”.
Section 22(4) of the Employment and Assistance Act provides that a panel may admit as evidence
only the information and records that were before the minister when the decision being appealed was
made and oral or written testimony in support of the information and records. In this case, the ministry
did not object to the new evidence. The panel considers that the evidence here is in support of the
information and records before the ministry at the time of the reconsideration decision in that it simply
confirms the appellant’s need for physiotherapy. Accordingly, the panel finds the evidence
admissible.
PART F – Reasons for Panel Decision
The issue under appeal is whether the ministry’s determination that the appellant is not eligible to
receive funding for physiotherapy treatments was reasonably supported by the evidence or a
reasonable application of the legislation in the circumstances of the appellant.
The relevant legislation is section 62 and section 2(1)(c) of Schedule C of the EAPDWR:
General health supplements
62 The minister may provide any health supplement set out in section 2 [general health
supplements] or 3 [medical equipment and devices] of Schedule C to or for
(a) a family unit in receipt of disability assistance,
(b) a family unit in receipt of hardship assistance, if the health supplement is
provided to or for a person in the family unit who is a dependent child, or
(c) a family unit, if the health supplement is provided to or for a person in the
family unit who is a continued person.
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:
Item
Service
Provided by
Registered with
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 therapy
massage
College of Massage Therapists of British Columbia under
therapist
the 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
podiatry
the Health Professions Act
6
physical therapy
physical
College of Physical Therapists of British Columbia under
therapist
the Health Professions Act
THE APPELLANT’S POSITION
In her Notice of Appeal the appellant writes: “I am in constant pain and discomfort with injury
sustained at work, this is an ongoing case with WCB, WCAT, myself and my lawyer. Social services
is only resource at present to obtain physio visits. Please reconsider.”
THE MINISTRY’S POSITION
In its appeal submission, the ministry states that despite the prescription the evidence before the
ministry does not make out that the appellant’s condition is “acute”. Both previous prescriptions and
the appellant’s own submissions state that her condition is long-standing, chronic and ongoing. This
does not meet the legislative requirement of section 2(1)(c)(i) of Schedule C of the EAPWDR that the
condition being treated is “acute”.
The ministry also states that the appellant has not provided evidence that she is not eligible to receive
10 treatments under the MSP as required by the legislation so that the ministry cannot determine
whether the appellant meets the legislative requirement of section 2(1)(c)(ii) of Schedule C of the
EAPWDR.
THE PANEL’S DECISION
Section 2(1)(c)(i) of Schedule C of the EAPWDR requires that the minister be satisfied that a medical
professional has confirmed that the condition being treated is “acute”. In this case, despite the
prescription submitted at appeal, all of the other evidence indicates that the appellant’s condition is
long-standing, chronic and ongoing. Given the predominance of the evidence in this regard, the panel
finds that it was reasonable for the ministry to find that the requirement of section 2(1)(c)(i) of
Schedule C of the EAPWDR was not met.
As there was and is no evidence as to whether the appellant has utilized the treatments available to
her under the MSP, it was reasonable for the ministry to find that they could not determine whether
the appellant meets the legislative requirement of section 2(1)(c)(ii) of Schedule C of the EAPWDR.
Based on the above analysis, the panel finds that the ministry’s determination that the appellant did
not meet the legislative requirements to receive funding for physiotherapy was a reasonable
interpretation of the legislation and confirms the ministry’s decision. The appellant is not successful in
her appeal.
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.