Doris LaTour v. Public Service Health Care Plan Administration Authority, 2017 HRTO 1672

Human Rights Tribunal of Ontario

Between:

Doris LaTour Applicant

-and-

Public Service Health Care Plan Administration Authority Respondent

Decision

Adjudicator: Jo-Anne Pickel Date: December 18, 2017 Citation: 2017 HRTO 1672 Indexed as: LaTour v. Public Service Health Care Plan Administration Authority

Appearances

Doris LaTour, Applicant Alexandra Arden, Representative

Public Service Health Care Plan Administration Authority, Respondent Clio Godkewitsch, Counsel

1The applicant alleged that the respondent discriminated against her because of disability contrary to the Human Rights Code, R.S.O. 1990, c. H. 19, as amended (the "Code"). Specifically, the applicant alleged that she was discriminated against when she was denied coverage for her medical marijuana prescription under her employer's health care plan. In her Application, the applicant named as a respondent "Sunlife Financial, Appeals Committee, Federal PSHCP Administration Authority" and provided the address of the Federal Public Service Health Care Plan Administration Authority ("Authority"). The Tribunal delivered a Notice of Application addressed to "Sunlife Financial, Appeals Committee, Federal PSHCP Administration Authority" at the address provided by the applicant.

2By letter dated May 31, 2017, which was copied to the applicant and her representative, the Authority advised that it oversees the administration and interpretation of the Public Service Health Care Plan ("Plan"). It also advised that the administrator of the Plan is Sun Life Assurance Company of Canada ("Sun Life"). It noted that the Authority has an Appeals Committee, but that Sun Life is a separate legal entity. The Authority advised that if Sun Life was intended to be a party, notice of the proceeding should be provided to Sun Life.

3The respondent filed a Response requesting early dismissal of the Application on the basis that it falls within exclusive federal jurisdiction. It submitted that it is a federally-regulated entity as the Authority was established by the federal government to oversee the administration of a benefits plan provided to federally-regulated employees.

4The applicant filed a Form 11 Response to the respondent's request to dismiss the Application. She submitted that Sun Life is the administrator of the pension plan and that she had been advised by "Canadian Human Rights" that Sun Life is not federally-regulated and therefore falls within the jurisdiction of the Tribunal.

5By Case Assessment Direction, the Tribunal directed a preliminary hearing to determine whether the Tribunal should dismiss the Application for one or both of the following reasons: (1) because the subject matter of the Application falls under federal jurisdiction and/or (2) because the Tribunal does not have the power to review decisions under benefit programs, including those based on disability, to determine if they are correct under the legislation, regulations, or policies governing the program.

Factual Background

6It was not disputed that the applicant is an employee of Correctional Services Canada, a federal government ministry. The applicant is covered by the Plan, which is a private health care plan offered to employees and retirees of the federal public service. The Authority is incorporated by letters patent issued in accordance with the federal Financial Administration Act and charged with overseeing the administration of the Plan.

7The respondent filed a copy of the Plan Document with the Tribunal. According to the Plan Document, the Plan is administered through a Trust on a self-insured basis. An Administrator is responsible for the adjudication and payment of eligible claims in accordance with the Plan Document. The Plan Document states that, where a member does not agree with a decision of the Administrator, he or she may file an appeal with the Trustees of the Plan. This appeal process is the final level of review under the Plan.

8Sun Life is the Administrator of the Plan. The applicant made a claim to Sun Life for reimbursement of the cost of medical marijuana under the Plan. When Sun Life denied her claim, she appealed Sun Life's decision to the Authority's Appeals Committee which denied her appeal by letter dated December 20, 2016. The Appeals Committee advised the applicant that the Drug Benefit in the Plan covers eligible expenses which include drugs that legally require a prescription and are identified in the Monographs section of the Compendium of Pharmaceuticals and Specialities as a narcotic, controlled drug or requiring a prescription. The Appeals Committee informed the applicant that it could not provide reimbursement for medical marijuana as it is not identified in the Monographs section of the Compendium of Pharmaceuticals and Specialities and because it is not dispensed by a physician or pharmacist.

9The applicant filed this Application to challenge the denial of her appeal by the Appeals Committee. In her Application, she stated that she had submitted an appeal to the "Sun Life Appeal Committee" regarding her prescription for medical marijuana and that it was denied.

10At the preliminary hearing, the applicant submitted that her Application did not fall under federal jurisdiction because someone at the Canadian Human Rights Commission informed her that Sun Life was not on its list of federally-regulated entities. She also indicated that other health care plans cover medical marijuana and exceptions have been made under the Plan.

Analysis and Findings

11The Tribunal only has jurisdiction over matters that fall under provincial, rather than federal, jurisdiction. The Authority is created under a federal statute to oversee the administration of a benefit plan for federal employees. As such, the Authority falls under federal jurisdiction.

12Some confusion arose for the applicant by the fact that she appears to have thought that she was appealing Sun Life's decision to an appeal committee of Sun Life. However, it is clear from the Appeals Committee's letter that the Appeals Committee is a Committee of the Authority, not Sun Life. Further, it is clear from the Plan Document and the Authority's Letters Patent that the Authority acts as the final level of appeal for decisions under the Plan.

13Since this matter falls under federal jurisdiction, the applicant's recourse is to the Canadian Human Rights Commission.

Order

14For the reasons set out above, the Application is dismissed as being outside the Tribunal's jurisdiction.