I APPEAL NUMBER PART C -DECISION UNDER APPEAL The decision under appeal is the Ministry of Social Development and Poverty Reduction (the "ministry") reconsideration decision dated March 27, 2019, wherein the ministry denied the appellant's request for reimbursement of braces (bilateral thumb splints and bilateral wrist splints) because she does not meet the eligibility requirement that pre-authorization of the ministry is required for the medical equipment or device as set out in the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Schedule C section 3 (1)( b) (i). PART D -RELEVANT LEGISLATION EAPWAR sections 62, 69 and Schedule C sections 3 and 3 .10
I APPEAL NUMBER PART E -SUMMARY OF FACTS Information before the ministry at reconsideration included the following evidence: The appellant is in receipt of disability assistance. On November 22, 2018 the appellant's application for reimbursement of bilateral thumb splints and bilateral wrist splints was received by the ministry. On January 10, 2019 the ministry received the following documents: • In the Orthoses Request and Justification Form dated November 22, 2018 the appellant's general practitioner (GP) states that o the appellant's medical condition is described as "Bilal Carpal Tunnel". o The recommended type of orthosis is "Thumb push splint -Left & Right Custom made." • In a letter dated December 6, 2018 the appellant's GP writes: o "The patient needs right and left Slimfit Wrist Support for her carpal tunnel syndrome." • In a prescription note dated December 3, 2018 the appellant's specialist writes: o "[1] PUSH splints for bilateral 1' 1 CMC joint OA"f'[2] Splints for bilateral CTS (Life brand women's slim fit)." • Receipts prepared by "Vancouver Health Authority " o Receipt #1 dated December 2018 states that "Bil. Hybrid CMC splints -Custom hard plastic" and indicates that $50 was paid. o Receipt #2 dated December 11, 2018 indicates a $50 payment was made by Visa. • Receipt prepared by Shoppers Drug Mart dated December 16, 2016 o lists 2 splints ("LB SLMFT WRST") for $42.99 each -total with tax $96.30; and o indicates a payment of $96.30 was made by Visa. On February 5, 2019 the appellant's request was denied. On March 18, 2019 the ministry received the appellant's request for reconsideration. She provided the following: • In a letter dated February 25, 2019 the GP that writes: o "This patient has severe bilateral Osteoarthritis at the base of her thumbs. o The patient needs custom-made bilateral [hybrid] cmc splints for severe degenerative osteoarthritis in both of her thumbs." • Receipts prepared by Shoppers Drug Mart dated March 8, 2019 o Receipt #1 is handwritten and states "LB Slimfit Wrist Support [$42,99x2]." Total with tax: $96.30. o Receipt #2 lists 2 splints: "LB SLMFT WRST" for $42.99 each. Total with tax: $96.30. Indicates payment of this amount by Visa. At the hearing the appellant reported that she returned these braces after she had recovered her original braces which she had misplaced. In her self-report dated March 16, 2019 the appellant writes that she was not aware that the ministry pre authorization is required for funding of the requested splints and was encouraged by others to ask for ministry funding after she had purchased them. The carpal tunnel wrist splints provided immediate relief. She is no longer woken through the night by "pins/ needles" sensations. She has severe degenerative osteoarthritis of the thumbs and left index finger and experiences chronic pain in both hands. Her doctor and specialist recommended CMC splints to reduce pain. She cannot use anti-inflammatory medication due to chronic kidney disease -she uses ice and Tvlenol with codeine for pain relief but still continues to exnerience chronic pain. She has hvner-mobilitv of the
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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 i n t h i s a p p e a l i s w h e t h e r t h e m i n i s t ry ' s d e c i s i o b r a c e s ( b i l a t e r a l t h u m b s p l i n t s a n d b i l a t e r a l w r i s t s p l i n t s ) m i n i s t ry a s s e t o u t i n 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 l e g i s l a t i o n o r r e a s o n a b l y s u p p o rt e d b y t h e e v i d e n c 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 3 ( l ) S u b j e c t t o s u b s e c t i o n s ( 2 ) d e v i c e s d e s c r i b e d i n s e c t i o n s 3 . 1 t 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 ( a ) t h e s u p p l e m e n t s a r e s e c t i o n 6 2 [g e n e r a l h e a ( b ) a l l o f t h e f o l l o w i n g r ( i ) t h e f a m i l y u n i f o r t h e m e d i c a l ( i i ) t h e r e a r e n o c o s t o f o r o b t a i n ( i i i ) t h e m e d i c a l a p p r o p r i a t e m e d 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 rt h o s e s 3 . 1 0 ( 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 ( k ) a n u p p e r e x t r e m i t y G e n e r a l h e a l t h s u p p l e m e n t s 6 2 T h e m i n i 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 s u p p l e m e n t s ] o r 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 ( a ) a f a m i l y u n i t i n r e c e ( b ) a f a m i l v u n i t i n r e c e I A P P E A L N U M B E R n t o d e n y t h e a p p e l l a n t ' s r e q u e s t fo r r e i m b u r s e m e n t o f b e c a u s e 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 o f t h e h e EA P W D R w a s a r e a s o n a b l e a p p l i c a t i o n o f t h e t o ( 5 ) o f t h i s s e c t i o n , t h e m e d i c a l e q u i p m e n t a n d 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 h s u p p l e m e n t s s t e r i f p r o v i d e d t o a f a m i l y u n i t t h a t i s e l i g i b l e u n d e r l t h 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 e q u i r e m e n t s a r e m e t : t h a s r e c e i v e d t h e p r e a 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 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 ; r e s o u r c e s a v a i l a b l e t o t h e f a m i l y u n i t t o p a y t h e 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 ; e q u i p m e n t o r d e v i c e i s t h e l e a s t e x p e n s i v e i c a l e q u i p m e n t o r d e v i c e . b r a c e ; e n t s e t o u t i n s e c t i o n 2 [g e n e r a l h e a l t h e s ] o f S c h e d u l e C t o o r f o r i p t o f d i s a b i l i t y a s s i s t a n c e , i p t o f h a r d s h i n a s s i s t a n c e i f t h e h e a l t h s u n n l e m e n t
I APPEAL NUMBER is provided to or for a person in the family unit who is under 19 years of age, or ... Health supplement for persons facing direct and imminent life threatening health need 69 The minister may provide to a family unit any health supplement set out in sections 2 (1) (a) and (f) [general health supplements] and 3 [medical equipment and devices]of Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that (a)the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need, (b)the health supplement is necessary to meet that need, The appellant argues that she needs the ministry to reimburse her for her braces because she needs the money to get by. The ministry's position is that as the appellant has paid for both the bilateral thumb splints and bilateral wrist splints in full without receiving pre-authorization from the ministry according to Schedule C section 3.1(b)(i) of the EAPWDR she is not eligible under this section. The ministry noted that in the policy that applies to general requirements for all orthoses it states: "The request must be pre-approved by the ministry prior to purchase" I "The ministry will not accept payment responsibility, except in cases of a life-threatening emergency, for orthoses purchased without prior approval." Based on the information provided it cannot be established that the appellant required either bilateral thumb splints or bilateral wrist splints due to a life-threatening emergency. Therefore the above noted policy cannot be applied. Panel decision While the appellant argues that due to her difficult financial circumstances she needs the ministry to reimburse her for her thumb and wrist braces the panel finds that section 3.1 (b) (i) clearly sets out that pre-authorization of the ministry is required to determine eligibility for a health supplement such as upper extremity braces. Consequently the panel finds the ministry was reasonable in its determination that the appellant is not eligible under this section. While the appellant had argued that there was no time to wait for ministry approval because she was in too much discomfort and pain the panel finds there is insufficient evidence that the appellant was facing a direct and imminent and life-threatening health need as set out in section 69 of the EAPWDR and, consequently, the ministry was reasonable when it found that ministry policy respecting life-threatening emergency does not apply in the appellant's circumstances. The panel notes that ministry policy on life-threatening emergency mirrors section 69 of the EAPWDR. Conclusion The panel finds that the ministry's determination that the appellant is not eligible for re-imbursement of upper extremity braces is reasonably supported by the evidence and is a reasonable application of the legislation in the appellant's circumstances. The ministry's reconsideration decision is confirmed and the appellant is not successful on appeal.
P A R T G O R D E R T H E P A N E L D E C I S I O N ! S : ( C h e c k o n e ) � U N A N I M O U S O B Y M A J O R I T Y T H E P A N E L � C O N F I R M S T H E M I N I S T R Y D E C I S I O N □ R E S C I N D S T H E M I N I S T R Y D E C I S I O N l f t h e m i n i s t ry d e c i s i o n i s r e s c i n d e d , i s t h e p a n e l d e c i s i o n r e f e r r e d b a c k t o t h e M i n i s t e rf o r a d e c i s i o n a s t o a m o u n t ? □ Y e s □ N o L E G I S L A T I V E A U T H O R I T Y F O R T H E D E C I S 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 A c t S e c t i o n 2 4 ( 1 ) ( a ) � a n d S e c t i o n 2 4 ( 1 ) ( b ) � a n d S e c t i o n 2 4 ( 2 ) ( a ) � o r S e c t i o n 2 4 ( 2 ) ( b ) D P A R T H S I G N A T U R E S P R I N T N A M E I n g e M o r r i s s e y S I G N A T U R E O F C H A I R D A T E { Y E AR / M O N T HID A Y) 2 0 1 9 / 0 4 / 2 6 P R I N T N A M E B o b F e n s k e S ! G N A T U R E O F M E M B E R D A T E ( Y E A R/ M O N T H / D A Y ) 2 0 1 9 / 0 4 / 2 6 P R ! N T N A M E D o n S t e d e f o r d S I G N A T U R E O F M E M B E R D AT E ( Y E A R / M O N T HID A Y ) 2 0 1 9 / 0 4 / 2 6
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