Ottawa facing court action over denied dental claim

by Leo Almazora30 Jan 2017
A First Nations family is waging a legal battle against the government after their application to get critical dental work covered under a non-insured health-benefits program was repeatedly denied.

The daughter in the family, identified in court documents as Josey Willer, first experienced problems when her teeth began to emerge sideways nine years ago. She was diagnosed with a functionally handicapping malocclusion four years later. Unable to chew properly and easily open her mouth due to constant pain and headaches, the girl was told that without braces, she’d need surgery.

Her mother, Stacey Shiner, applied for $6,000 to cover the cost of the braces under a benefits program offered by Health Canada to indigenous people; the federal government’s program pays for braces in cases of severe and functionally handicapping malocclusions.

However, implementers only refer to four criteria to approve claims: a clear crossbite, a severe overbite that causes a soft-tissue injury, a severe open bite, and a severe open jet. An affidavit filed by Shiner said government bureaucrats determined that her daughter had none of those symptoms.

She appealed the denial through the ranks of Health Canada’s non-insured health-benefits program all the way to the director-general, but always got rejected. According to Shiner’s affidavit, bureaucrats never considered any factors beyond those specified in their policy, which orthodontists have called “too severe and limited.”

Another orthodontist treated Willer in the summer of 2015, saying that she could only avoid surgery by getting braces while she’s still young. Shiner decided to pay out-of-pocket to get the orthodontic work done.

As of July 26, the government had spent more than $32,000 in legal fees defending its case. Since then, costs have increased and will continue to increase as the parties go before a judge later this year, according to Shiner’s lawyer, Sarah Clarke. “[T]he family made this decision to go to court because they feel they were treated unfairly… They don’t want other families to experience the same kind of outcome that they experienced,” she said.

The government has said that it can’t pay for the braces in this instance, because that would obligate it to pay for braces for other such cases involving First Nations children. Charlie Angus, NDP critic for indigenous affairs, has written to Health Minister Jane Philpott demanding coverage for the cost of the braces.

According to Angus, First Nations youth who apply to get emergency orthodontic procedures covered face denial rates of nearly 100%. “If they are going to deny every child who needs it, why even offer it? This is systemic denial,” he said.

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