Court File and Parties

CITATION: Rao v. The General Manager, Ontario Health Insurance Plan, 2019 ONSC 3204

DIVISIONAL COURT FILE NO.: 217/18

DATE: 2019-06-04

All personal information contained in the Divisional Court records is subject to s 38(1.1) of the Personal Health Protection Act and subject to the Freedom of Information and Protection of Privacy Act, 2007

ONTARIO

SUPERIOR COURT OF JUSTICE

DIVISIONAL COURT

Kiteley, Backhouse, Parayeski JJ.

BETWEEN:

VIVEK RAO, MD Applicant/Respondent on Appeal

– and –

THE GENERAL MANAGER, ONTARIO HEALTH INSURANCE PLAN Respondent/Appellant on Appeal

Counsel: Lonny J. Rosen and Erin Dobbelsteyn, for the Applicant/Respondent on Appeal Darrell Kloeze and Heather Burnett for the Respondent/Appellant on Appeal

HEARD at Toronto: March 26, 2019

REASONS FOR DECISION

BY THE COURT

Nature of Proceeding

[1] The appellant appeals from the March 14, 2018 decision of the Physician Payment Review Board (the “Board”) that found that five claims for payment submitted by the respondent that were denied by the appellant were not stale dated. The Board ordered the respondent to resubmit the claims to be considered afresh by the appellant. The appellant requests a finding that the decision that the claims were stale dated was made under s. 18(3) of the Health Insurance Act, R.S.O. 1990, c.H.6 (the “Act”), that the Board does not have jurisdiction to review decisions made under s. 18(3) and the appellant seeks an order rescinding the Board’s order.

[2] Following the Board’s decision, the parties reached an agreement pursuant to which the claims have been paid and this appeal continued on the issue of jurisdiction of the Board.

Background

[3] The appellant administers the Ontario Health Insurance Plan (the “Plan”) pursuant to the Act. The respondent is a physician who submitted claims to the Plan for insured services rendered to five patients between March and May, 2013. The claims were submitted within one month of the services being rendered. The claims were rejected and sent back to the respondent electronically on the basis that operating room (“OR”) notes were requested for four of the claims and there was an invalid version code of the patient’s health card with respect to the fifth claim.

[4] Once a claim is rejected by the Plan and sent back to the physician, it is treated as eliminated by the Ministry of Health and Long-Term Care (the “Ministry”) until the claim is resubmitted with the required information to process the claim.

[5] According to s. 2 of the Submission of Accounts Regulation under the Act[^1], claims must be submitted within six months of the date of service. As set out in the Ministry’s Resource Manual for Physicians, it is the policy of the Ministry that claims must also be re-submitted within six months of the date of service.

[6] The respondent’s office contacted the Ministry in late December, 2013 for an update regarding the claims. In an email dated January 3, 2014 the Ministry provided an update that indicated that four of the claims had been “rerouted for OR notes” and the fifth had been “sent back because of invalid version code”. In that email, the Ministry wrote as follows: “Please check your error reports and resubmit claims. Some claims may be stale dated (see stale-date policy guideline for appeal)”.

[7] In an email later that day, the respondent replied as follows:

Our error reports do NOT indicate whether OR notes are to be submitted. . . I only do so after such an email from you. I refuse to accept ‘stale-dated’ when the original claim was submitted on time. Happy to take this up your management chain. [my assistant] will provide OR notes for the claims requests. . . Ps – please indicate how OHIP requests OR notes on error claims (AMS error code simply means routed for medical review. . . does NOT indicate OR notes required)

[8] In an email dated January 6, 2014, the respondent’s assistant resubmitted the five claims with the OR notes or correct version code. This was beyond the 6 month period from the date of service.

[9] In his letter dated January 20, 2014, the respondent informed the Ministry that his office’s electronic billing software did not indicate when claims had been sent back by the Ministry through the electronic system and requested that the Ministry consider that “extenuating circumstance when reviewing these stale-dated claims and process the claims appropriately.”

[10] In a letter dated January 29, 2014, the Ministry advised as follows:

Re: Request for Payment of Stale Dated Claims

Your request for consideration for the processing of stale dated claims has been received and reviewed. Your request has been denied and returned because

The criteria of extenuating circumstances have not been met.

[11] In a letter dated February 10, 2014, the respondent appealed the denial to the OHIP Eligibility Review Committee. In that letter he pointed out that the original claims had been submitted within 30 days of the date of service.

[12] In a letter dated March 18, 2014, the Ministry gave Notice of Decision by the Eligibility Review Committee that the exemption of stale dated accounts submission had been denied.

[13] In his letter dated March 31, 2014 to the Eligibility Review Committee the Respondent took the position that he was not seeking extenuating circumstances. He insisted that the claims had been submitted within 30 days of the service date.

[14] In a letter dated December 4, 2014 the Respondent asked for a review by the Board of the decision to deny payment. In that letter, the respondent took the position that the claims had been submitted within 30 days of the service date and that the legislation does not define any time point for additional material to be submitted if the original claim was submitted within the 6 month timeframe.

[15] The review hearing was held on January 24, 2018 and the decision that is the subject of this appeal was issued March 14, 2018.

[16] The record before this court included correspondence between the respondent and the Ministry in the period between March 31, 2014 and the hearing before the Board. For example, in a letter dated May 12, 2015, the Respondent pointed out that, once he had been informed in late 2013 that his claims were stale-dated, he met with Ministry staff. He insisted that it was Ministry staff who requested that he rely on the “extenuating circumstance” course of action, despite his contention that the claims were valid and not stale-dated. In the proceedings before the Board, he took the position that the claims were not stale-dated. For example, at page 110 of the transcript he said the following:

Again, I reemphasize that my claim here is not under section 18.3 [sic should be 18(3)], that these claims were stale-dated, but rather 18.2 [sic should be 18(2)] that the MCPS [i.e. the Medical Claims Payment System] inappropriately, and without logic or rationale, denied payment of these claims . . . and therefore is under the jurisdiction of the PPRB [i.e. the Board].

Proceedings before the Board

[17] Prior to the hearing before the Board, the appellant brought a motion to have the Board rule on its jurisdiction to hear the respondent’s appeal. The Board dismissed the appellant’s motion on August 6, 2015. The Board reasoned that the matter concerned whether the appellant had appropriately interpreted the scope of “prescribed requirements” as set out in s. 18(3) of the Act. If that interpretation could not be upheld, then the question remained whether the appellant had a basis under s. 18(2) or any other provision to deny the claims. The Board held that “the basis for the refusal of the claims under the Act is not clear.” If the refusal was made under s. 18(2) then the Board would clearly have jurisdiction to review the denial of the claims. As such, the Board held that it had jurisdiction to determine whether the appellant had properly interpreted the scope of s. 18(3). If it had been misinterpreted and s. 18(3) did not apply, then the Board could determine whether the claims were appropriately refused under s. 18(2).

[18] On August 26, 2015, the appellant requested a reconsideration of the Board’s decision on the motion. On October 14, 2015, the Board denied the appellant’s request for reconsideration, holding that it did not err in finding that it had jurisdiction by virtue of the ambiguity regarding whether the appellant’s refusal properly fell under s. 18(2) or 18(3).

[19] The appellant then applied to Divisional Court for judicial review of the Board’s finding that it had jurisdiction to hear the matter. The Divisional Court heard the matter on September 18, 2017 and dismissed the application as premature[^2].

[20] The respondent’s appeal proceeded to a hearing before the Board on January 24, 2018. The Board released its decision on March 14, 2018. The Board summarized the issues to be determined as follows:

i. What is the basis for the [appellant’s] denial of the claims? More specifically, were the claims denied under s. 18(2) or 18(3) of the Act?

ii. If the [appellant] denied the claims under s. 18(2) of the Act, were the claims properly denied under s. 18(2)? If not, what is the appropriate remedy?

[21] With respect to the first issue, the Board held that if the provision upon which the appellant made its refusal is unclear, then the Board has jurisdiction to determine the basis upon which the decision was made: “The Board is not interpreting the requirements under s. 18(3) as submitted by the Ministry, but rather reviewing the evidence and circumstances of a case to determine the basis for the General Manager’s decision under the Act.” The Board agreed that if the decision was properly made under s. 18(3), then it would have no jurisdiction to review the decision. Nevertheless, the Board held that the appellant cannot simply state that the decision was made under s. 18(3) and end the matter there, since that would “negate a physician’s right of appeal to the Board and the intent and purpose of the Act.” The Board agreed with the respondent’s submission that if, based on the evidence and circumstances of a dispute with OHIP, the basis for the General Manager’s refusal is unclear and the physician has exhausted all internal dispute routes within the Ministry, the Board should fulfill its role in determining whether it can assist in resolving the dispute within its mandate which is consistent with the intent and purposes of the Act to ensure there is a fair and transparent medical audit and payment system.

[22] The Board held that the respondent submitted the claims within the deadline and in fulfillment of the prescribed requirements under s. 18(3). The Board further held that the claims were accepted and the request for OR notes was a determination that the claims required further assessment. Thus, the Board reasoned that the appellant did not deny the claims on a basis under s. 18(3), and held that the demand for OR notes related to a consideration under s. 18(2), such that it was “an interim or temporary decision”. The Board concluded that the appellant “had not completed its review of the claims and it was therefore premature to deny them.”

[23] The Board reasoned that there is no statutory requirement that claims be fully processed within six months, and to require otherwise would be unsustainable as the processing of many claims could take longer than six months. The Board held that physicians are only required by the Act “to submit the initial threshold required information within six months of the date of service.” The respondent had submitted the initial threshold required information when his office first submitted the claims. OR notes are not a prescribed requirement under s. 18(3) of the Act or any other provision. While the appellant has the authority to request additional information under s. 37(2), the Act does not require the production of that additional information to be made within the six month period. The Act does not provide or contemplate deadlines for the “resubmission” of claims. Thus, since the threshold requirements had been satisfied, there was no basis to refuse the claims as stale-dated.

[24] The appellant had argued that the Resource Manual for Physicians published by the Ministry provides that claims be resubmitted within six months of the date of service. However, the Board held that the Manual is only a guideline that has no statutory or binding authority. In any event, the Board considered “the substantial good faith, reasonable and diligent efforts of [the respondent] and his office to address OHIP’s concerns and requests as soon as he understood the concerns.”

[25] The Board concluded as follows:

67. In summary, the Board finds that the Claims were not stale dated and the General Manager denied the Claims on a basis not covered by s. 18(3) of the Act. With the assignment of the AMS error code to the Claims, an interim determination had been made by a claims assessor for the General Manager that the Claims needed to be resubmitted with operating room notes to further assess the nature of the Claims for considerations outlined under s. 18(2) of the Act (and there are no prescribed timelines under the Act for the resubmission of claims with additional information). Given that the General Manager had yet to formally make or communicate to Dr. Rao that it had made a decision relating to considerations under s. 18(2), OHIP argues there is no decision for the Board to review. We agree with OHIP’s submission that the General Manager has yet to make its final decision as to whether the Claims comply with s. 18(2).

[26] The Board ordered the respondent to resubmit the claims with operating room notes[^3] so that the claims would be processed and assessed by the Ministry “as if the Claims were submitted afresh”.

Framework

A. The [Health Insurance Act](https://www.canlii.org/en/on/laws/stat/rso-1990-c-h6/latest/rso-1990-c-h6.html)

[27] Pursuant to s. 4(1), the General Manager is appointed by the Lieutenant Governor in Council. Pursuant to s. 4(2), the General Manager has the power to make payments by the Plan for insured services, including the determination of eligibility and amounts.

[28] Pursuant to s. 17(1) physicians are required to prepare accounts for insured services in the form required by the General Manager and the accounts must meet the prescribed requirements. Pursuant to s. 17(3), the physician must submit an account within such time after the service is performed as may be prescribed.

[29] The authority of the General Manager is found in the following subsections of the Act:

18 (2) The General Manager may refuse to pay for a service provided by a physician, practitioner or health facility or may pay a reduced amount in the following circumstances:

1. If the General Manager is of the opinion that all or part of the insured service was not in fact rendered.

2. If the General Manager is of the opinion that the nature of the service is misrepresented, whether deliberately or inadvertently.

3. For a service provided by a physician, if the General Manager is of the opinion, after consulting with a physician, that all or part of the service was not medically necessary.

4. For a service provided by a practitioner, if the General Manager is of the opinion, after consulting with a practitioner who is qualified to provide the same service, that all or part of the service was not therapeutically necessary.

5. For a service provided by a health facility, if the General Manager is of the opinion, after consulting with a physician or practitioner, that all or part of the service was not medically or therapeutically necessary.

6. If the General Manager is of the opinion that all or part of the service was not provided in accordance with accepted professional standards and practice.

7. In such other circumstances as may be prescribed.

18 (3) The General Manager shall refuse to pay for an insured service if the account for the service is not prepared in the required form, does not meet the prescribed requirements or is not submitted to him or her within the prescribed time. However, the General Manager may pay for the service if there are extenuating circumstances.

[30] The difference between a decision under s. 18(2) and a decision under s. 18(3) is important to this appeal. If the discretionary decision is made under s. 18(2), both the physician and the General Manager can give notice to the Board requesting that it hold a hearing to review the General Manager’s exercise of that discretion. However, the parties agree that, if the mandated decision is made under s. 18(3), the Board has no oversight role. In that case, the physician’s recourse is through a Notice of Application to this court for judicial review of the decision of the General Manager.

[31] Pursuant to s. 18.3(1) and (2), in matters for which it has jurisdiction, a panel of the Board may determine all issues relating to payments for insured services and may make orders for payments from the Plan that are authorized under the Act.

[32] Pursuant to s. 37(1), every physician and practitioner shall give the General Manager such information as may be prescribed and pursuant to s. 37(3) the physician shall provide the information in such form and within such time as the General Manager may require.

[33] Pursuant to s. 5.1(1) the Board was established and was directed to perform such duties as are set out in the Act and in Schedule 1. Schedule 1 to the Act establishes procedures for the Board to hold hearings on payment matters within its jurisdiction that cannot be resolved between the General Manager and a physician through the provision of education and other assistance, and to provide for an appeal process from its decisions. Schedule 1 of the Act includes the following:

When the Review Board receives a notice that requests a hearing under section 18, 18.2 or 40.3 of the Act and proof of service of the notice, the chair of the Review Board or, in his or her absence, a vice chair shall select a panel in accordance with section 6 to hear and determine the matter before it.

B. Submission of Accounts Regulation, [O. Reg. 22/02](https://www.canlii.org/en/on/laws/regu/o-reg-22-02/latest/o-reg-22-02.html)

[34] Pursuant to s. 2, for insured services rendered in Ontario, the physician shall submit an account no later than six months after the service is rendered.

C. Ministry Policy

[35] The Ministry’s policy statement dated November 2014 defines “Extenuating Circumstances” as

… extraordinary and unusual events that arise suddenly and unexpectedly, which are beyond the control of the provider, facility, or insured person, are unforeseen and cannot be reasonably anticipated, thereby affecting their ability to submit their claim to the ministry within the prescribed timelines.

[36] The Ministry has provided extensive lists of circumstances that have been found to be and found not to be “extenuating”. “Billing software issues” is in the list of not extenuating circumstances.

D. General, R.R.O. 1990, Reg. 552

[37] Pursuant to s. 38.3 to 38.5, the physician must submit claims in the form and by the medium as set out in s. 38.3 to 38.5. Pursuant to s. 38.0.1(1) the s. 18(2)7 “other circumstances” are listed.

E. Resource Manual for Physicians

[38] The Ministry’s Resource Manual provides information with respect to claims submission including the technical requirements for submitting claims electronically. Physicians are referred to the Technical Specifications Interface to Health Systems manual. In s. 4.4 under the heading of “Resubmission of Unpaid Claims” appears the following:

In accordance with the Health Insurance Act, all claims must be submitted within six months of the date of service. This includes original claims, resubmitted claims and Remittance Advice (RA) payment inquiries. Claims submitted more than six months following the date of service are termed stale dated claims.

Jurisdiction

[39] The appellant brings this appeal pursuant to s. 12 of the Physician Payment Review Process being Schedule 1 to the Act. The section provides:

12 (1) A party to a hearing before the Review Board may appeal from its order to the Divisional Court in accordance with the rules of the court, but,

(a) personal health information contained in any document or evidence filed or adduced with regard to the appeal, or in any order or decision of the court shall not be made accessible to the public; and

(b) the Divisional Court may edit any documents it releases to the public to remove any personal health information.

(4) An appeal under this section may be made on questions of law or fact or both and the court may affirm or may rescind the order of the Review Board and may exercise all powers of the Review Board to direct the General Manager to take any action which the Review Board may direct the General Manager to take and as the court considers proper, and, for such purposes, the court may substitute its opinion for that of the Review Board.

[40] In the factum, the appellant asks for a determination that the Board does not have jurisdiction to review decisions made by the General Manager under subsection 18(3) of the Act; a determination that the General Manager’s decision to deny payment of the claims was made under subsection 18(3) of the Act; an order rescinding the order of the Board and an order declaring that the Board does not have jurisdiction to review decisions made by the General Manager under subsection 18(3) of the Act[^4].

Key Issues

[41] The appellant submits the following issues on appeal:

i. Does the Board have jurisdiction to review payment refusals made under subsection 18(3) of the Act?

ii. Did the Board err in failing to find that the appellant’s refusal was made under s. 18(3) of the Act?

iii. Did the Board err in finding that it had jurisdiction to review the appellant’s refusal?

iv. Was the Board’s finding that the appellant improperly refused to pay the claims under subsection 18(3) unreasonable?

[42] The Respondent reframes the issues on appeal as follows:

i. Does the Board have jurisdiction to determine the true basis for the appellant’s denial of the claims? I.E. whether the claims were denied under s. 18(2) or s. 18(3)?

ii. Was the Board’s analysis of, and finding with respect to, the true basis for the appellant’s denial of the claims reasonable?

[43] We revise their issues as follows:

i. What is the standard of review?

ii. Does the Board have jurisdiction to determine the “true basis” for the appellant’s denial of the claims? I.E. to determine whether the claims were denied under s. 18(2) or s. 18(3)?

iii. Did the Board’s decision reflected in paragraph 67 above meet that standard of review?

Issue #1: What is the Standard of Review?

[44] The appellant takes the position that its issues (i), (ii) and (iii) engage true questions of jurisdiction that should be reviewed on a standard of correctness while issue (iv) should be reviewed on a standard of reasonableness. The respondent submits that the issues he frames are reviewable on a standard of reasonableness.

[45] Since the standard of review for appeals from this Board has not yet been determined, this court is required to engage in a contextual analysis to determine the proper standard of review for each determination, taking into consideration the following factors that were outlined by the Supreme Court in Dunsmuir v. New Brunswick: (1) the presence or absence of a privative clause; (2) the purpose of the Board as determined by the interpretation of its enabling legislation; (3) the nature of the question at issue; and (4) the expertise of the Board.

[46] The Act contains no privative clause which could suggest a less deferential standard of review. However, the remaining factors in the contextual analysis favour a standard of reasonableness.

[47] The second factor in the standard of review analysis, the purpose of the tribunal, supports that a reasonableness review is appropriate on appeal. The purpose of the Board is to provide an independent appeal process, and to provide an efficient and expeditious method of resolving certain payment disputes as an alternative in certain circumstances to judicial determination between physicians and the appellant. The Supreme Court concluded in Dunsmuir[^5] that this legislative purpose supported a more deferential approach to the decision of a tribunal.

[48] The third factor in the standard of review analysis, which involves consideration of the type of issues determined by the Board, also militates strongly in favour of a reasonableness standard of review. In determining under what section of the Act the appellant’s refusal had in fact been made, the Board was required to consider the evidence before it and apply findings of fact to its interpretation of its enabling statute. This determination required consideration of intertwined legal and factual issues which is the hallmark of the type of decision that normally attracts the reasonableness standard of review[^6].

[49] With respect to the fourth factor, the Board is an adjudicative tribunal with expertise and experience in the interpretation of the Act. This factor also points to a standard of reasonableness for review of the Board’s determinations.

[50] The issues are more properly characterized as issues of statutory interpretation of the Board’s home statute than true questions of jurisdiction[^7].

[51] Accordingly, we have concluded that the reasonableness standard is the appropriate standard for the review of the Board’s decision.

[52] The reasonableness standard is a deferential one and requires the court to assess both the Board’s reasons and the final outcome. Generally the reviewing court cannot intervene unless it is satisfied that the Board’s reasons are not transparent, justified or intelligible and that the result reached by the Board does not fall within the range of acceptable outcomes in light of the facts and applicable law[^8].

Issue #2: Did the Board have jurisdiction to determine the “true basis” for the appellant’s denial of the claims? i.e. did the board have jurisdiction to determine whether the claims were denied under s. 18(2) or s. 18(3)?

[53] During submissions, counsel for the appellant conceded that the Board does have jurisdiction to determine the “true basis” for the appellant’s denial of the claims[^9]. We agree that the Board has that jurisdiction and agree that it was reasonable for the Board to so find.

Issue #3: Was the Board’s decision as to the true basis of the decision denying the claim reasonable?

[54] When the respondent’s assistant called the Ministry to inquire about the claims in late December, 2013, the Ministry sent an email dated January 3, 2014 advising as to the status of the claims and indicating that they might be stale-dated. In his email later on January 3 the respondent asserted that the claims had all been submitted within time. The respondent’s resubmission of the claims on January 6, 2014 with OR notes was made after the 6 month period. In his January 20, 2014 letter, the respondent asked for a remedy pursuant to s. 18(3), namely that the appellant allow the claims filed beyond the 6 month period because of his extenuating circumstances, namely his computer software issues. In the January 29, 2014 denial letter to the respondent, the appellant did not refer to s. 18(3) but uses the language of s. 18(3), namely “stale dated claims” and “extenuating circumstances”. All of that documentation makes it clear that the denial by the appellant was pursuant to s. 18(3). The Board misapprehended the evidence. The decision of the Board as reflected in paragraph 67 above is not reasonable.

[55] Up to the point of the denial decision, there is no reference to s. 18(2) as the basis for the refusal. This was not a situation where the appellant denied the claim relating to a consideration under s. 18(2) of the Act.

[56] There is nothing in the Act to support the Board’s finding that sending back claims with instructions to correct errors or provide additional documents amounted to the appellant making an interim or temporary decision. No such “interim” payment decision exists under the Act or the Regulations. By denying the claim at first instance, s. 18(2) was not engaged.

[57] Based on the voluminous documents before the Board and in this appeal, and based on the transcript of the hearing, the focus of the hearing was inappropriately enlarged to facilitate the respondent taking the position that the decision had been made pursuant to s. 18(2). In those documents and in his evidence at the hearing and in his submissions, the respondent raised many other grievances before and after the January 29, 2014 decision that he has with the OHIP payment system. None of that is relevant to the decision the Board was called upon to make, namely the “true basis” upon which the appellant denied the claim.

[58] The Board found that the decision was not made pursuant to s. 18(3) and then found that the appellant had not made a decision under s. 18(2). In order to arrive at that unreasonable decision, the Board, in effect, conducted a review of the decision. The Board appeared to justify the analysis on the basis that its function was to “assist in resolving payment disputes” even though it had no jurisdiction to resolve this particular payment dispute. As indicated at paragraph 67 above, the Board found that the claims were not stale-dated; that the claims assessor had made an interim determination; that the appellant had not yet made a decision; and that there were no prescribed timelines under the Act. In light of s. 3(1) of Schedule l, it was not open to the Board to make such findings. In effect, the Board decided what the appellant had not done and then conducted an analysis of its processes. The Board did not have the jurisdiction to do so. Furthermore, the Board’s analysis as to the authority of the Physician Resource Manual is not relevant.

[59] The essence of the Board’s decision is its disagreement with the appellant’s basis for finding the claims stale-dated. That is a decision that the appellant was entitled to make without review by the Board. If the appellant is wrong on a decision under s. 18(3) that a claim was not submitted within the prescribed time, the remedy is judicial review. This is not a case of the appellant labelling a particular decision as having been made under s. 18(3) and thereby unilaterally ousting the Board’s jurisdiction. The Legislature gave the appellant the right to decide if claims were not within the prescribed time without review by the Board. It is unreasonable of the Board to label such a decision “unclear” and thereby take jurisdiction to review it, when what it really meant was that it disagreed with the decision.

[60] In our view, the Board’s decision that the claims were not denied under s. 18(3) of the Act on the basis that they were stale-dated was not transparent, justified or intelligible. It led to the Board reviewing and overturning a decision of the appellant which she was entitled to make without review by the Board. The finding did not fall within the range of acceptable outcomes in light of the facts and applicable law. Accordingly, we find it unreasonable.

[61] In the result, the appeal is allowed and the March 18, 2018 decision of the Board is set aside. A declaration shall issue that the Board does not have jurisdiction to review decisions made under s. 18(3) of the Act.

[62] The parties have agreed that there shall be no order as to costs.

Kiteley J.

Backhouse J.

Parayeski J.

Released: June 04, 2019

[^1]: O. Reg. 22/02 under the Act [^2]: Ontario (Health Insurance Plan, General Manager) v. Rao, 2017 ONSC 5548 [^3]: The order of the Board dealt only with the four claims for which OR notes were not required. The Board made no order with respect to the fifth claim where the version code was in error. In view of the conclusion we reach, it is not necessary to address that omission. [^4]: The relief sought in the Notice of Appeal was somewhat different. [^5]: Dunsmuir v. New Brunswick, 2008 SCC 9 at para. 69 [^6]: Dunsmuir, supra at paras. 51 and 53 [^7]: Canada (Canadian Human Rights Commission) v. Canada (Attorney General) 2018 SCC 31 at paras. 31-41 [^8]: Dunsmuir, supra at para. 47 [^9]: Goldenberg v. The General Manager, Ontario Health Insurance Plan file no. 11-PPRB-0002; Savin v. The General Manager, Ontario Health Insurance Plan file no. 16-PPRB-0002