The General Manager of OHIP appealed a decision of the Health Services Appeal and Review Board (HSARB) that granted the respondent reimbursement for non-emergency out-of-country hip surgery.
The surgery was performed before the General Manager issued a final decision denying the funding application.
The Divisional Court allowed the appeal, finding that the HSARB unreasonably interpreted a request for further information as a denial of services.
Furthermore, the Court held that under the Health Insurance Act regulations, prior written approval from the General Manager is a mandatory prerequisite for reimbursement of non-emergency out-of-country medical services, and neither the General Manager nor the HSARB has the authority to retroactively approve such expenses.