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).
