I’ll Be Saving My Receipts

Authority Ministry of Social Development and Social Innovation
Details

John, a senior, had been in receipt of disability assistance for over a decade. When he turned 65, John moved to Old Age Security. However, as a designated Person with Disabilities, John could still have certain medical costs covered by the ministry.

After turning 65, John found that his medical reimbursement requests were being rejected. He was surprised to learn that the ministry had closed his file. John visited the ministry office several times, hoping to have his file reopened, but the ministry refused to do so. 

After four years, the ministry responded to his request to reopen his file and told him to reapply, which he did successfully. John followed up, sending the accumulated receipts for four years of medical costs, totalling around $1800. He believed these costs would have been covered had the ministry not mistakenly closed his file. John was surprised when his reimbursement request was denied, first at the ministry office, then through the ministry’s reconsideration process, and then at appeal. He contacted us.

The ministry’s legislation and policy authorizes continued medical coverage for former recipients of disability assistance who turn 65, continue to reside in British Columbia, and go onto a qualifying federal benefit such as Old Age Security. Ministry policy requires that staff review cases where a person on disability assistance is turning 65, send them a Medical Services Only (MSO) notification letter, and update the file. For reasons that could not be explained from the file records, this process was missed in John’s case. 

We determined the file should not have been closed. This meant that at least some of the medical costs that John incurred in that time period would have been covered if the ministry’s MSO coverage had continued.

The ministry agreed to review John’s saved receipts and ministry records. As a result of our investigation, the ministry confirmed that $1725 of the costs that John submitted were costs that would have been covered under his MSO had his file not been mistakenly closed. It mailed John a cheque for the full amount. When we followed up, John said he was at a loss for words and very thankful for our assistance.

Names in our case summaries have been changed to protect the privacy of individuals. This case study can also be found in the 2016-2017 Annual Report.

Category Seniors
Type Case Summary
Fiscal Year 2016
Location The Lower Mainland