The General Manager of OHIP brought a motion to dismiss a physician's appeal regarding the denial of sixteen claims for fee code W010.
The claims were denied because they were not submitted with the correct enrollment information within the prescribed six-month timeframe.
The Physician Payment Review Board found that the claims were refused under s. 18(3) of the Health Insurance Act for failing to meet prescribed requirements, rather than under s. 18(2).
Consequently, the Board concluded it lacked jurisdiction to hear the appeal, as decisions under s. 18(3) can only be challenged by way of judicial review to the Divisional Court.
The motion was granted and the appeal dismissed without costs.
