Kevin Smith

The General Manager of OHIP brought a motion to dismiss a physician's appeal for lack of jurisdiction.

The General Manager had denied the physician's claims for insured services, arguing the physician failed to submit supporting documentation within the prescribed six-month timeframe under s. 18(3) of the Health Insurance Act.

The General Manager contended that appeals of s. 18(3) decisions can only be heard by the Divisional Court on judicial review.

The physician argued the claims were submitted in compliance with the Act and should be assessed under s. 18(2), which the Board has jurisdiction to hear.

The Physician Payment Review Board dismissed the motion, finding it has jurisdiction to determine whether the General Manager appropriately interpreted the scope of 'prescribed requirements' under s. 18(3) and whether the refusal more properly falls under s. 18(2).

The General Manager of OHIP brought a motion to dismiss a physician's appeal for lack of jurisdiction, arguing the decision to demand repayment was made under s. 37.1(7) of the Health Insurance Act due to an absence of records, which is subject only to judicial review.

The physician argued the dispute concerned the interpretation of a fee code, granting the Physician Payment Review Board jurisdiction under s. 18.

The Board dismissed the motion, finding that the essential character of the dispute concerned the interpretation of a fee code, and that the General Manager's correspondence satisfied the notice requirements of s. 18.

The Board concluded it had jurisdiction to hear the appeal.