Manitoba Appeal Court grants narrow scope to appeal a decision that found MPI doesn’t have to pay for auto injury victim’s surgery in Germany

Manitoba’s Court of Appeal has granted a very narrow scope to appeal a decision that found the Manitoba Public Insurance Corporation (MPIC) is not obligated to pay for an auto accident victim’s out-of-province surgical procedure in Germany.

Erdman Harder was injured in an October 2005 auto accident in Manitoba. He became aware of a surgical procedure available in Germany and advised MPIC that he would be travelling there for the treatment.

After the surgery in Germany, Harder said he made a “remarkable recovery” and has been back to work full time for two and one-half years. He applied to Manitoba Health for reimbursement of the expenses related to his surgery.

Manitoba Health denied his claim, saying he had failed to show the service was not available in Manitoba. Before it reimburses out-of-province medical expenses, Manitoba Health requires applicants to show they could not have had the procedure done in Manitoba.

Harder then sought compensation from MPIC, which also denied the claim.

MPIC argued that Manitoba Health is the first payer of insured services such as the surgery in Germany. It further noted that there “are no provisions to cover the cost of [out of province] surgery or related expenses under the Personal Injury Protection Plan.”

Harder appealed the decision to the Automobile Injury Compensation Appeal Commission. The commission rejected his appeal, saying that Harder’s “literal interpretation” of one section of the province’s Reimbursement of Expenses (Universal Bodily Injury Compensation) Regulation ignored the relationship between The Manitoba Public Insurance Corporation Act and the province’s Health Services Insurance Act.

The purpose of those acts is intended to ensure Manitoba Health is the first payer of “insured services” in Manitoba, the commission found.

MPIC argued the purpose of reading the two acts together is to avoid a situation in which “Manitobans injured in an accident could ‘choose to obtain medical care anywhere’ at MPIC’s cost.”

Such an interpretation would “lack the necessary controls and oversight to ensure financially responsible management of bodily injury claims services,” MPIC argued.

The Appeal Court agreed substantially with this position, but noted Harder brought new evidence on appeal. Harder said Section 6 of the regulation answered MPIC’s concern.

Section 6 says out-of-province expenses are “subject to a maximum of such amount as the corporation considers reasonable and proper for the care.”

The Appeal Court believed the commission should at least address this part of Harder’s argument. The commission did not address this argument in its decision.

It is now up to a panel of the court to determine whether it will dismiss or accept this limited scope of the appeal.

The full case can be read at:

http://canlii.ca/en/mb/mbca/doc/2012/2012mbca20/2012mbca20.html