Successful appeals against OHIP rare

By Jonathan Sher, The London Free Press

LONDON, Ont. -- Only one in 18 Ontarians won appeals last year against OHIP, dismal odds that are growing worse, figures obtained by QMI Agency suggest.

"You'd have a better chance of hell freezing over," said Perry Brodkin, a lawyer who used to work for the provincial health plan but left in disgust to represent Ontarians whose claims have been denied.

Those odds have lengthened because the Liberal government, trying to whip a projected $12.5-billion budget deficit this year, changed the rules to make it tougher to get OHIP coverage outside the province.

The latest change occurred nearly three years ago, when the government required OHIP to reject applications to leave the country for care unless an Ontario specialist backed the claim.

That change slammed the door on many patients who went abroad because no specialist in the province would even see them -- one of the critical reasons Ontarians look abroad for care.

The changes slowed the number of winning appeals to a trickle.

Three years ago, 26 Ontarians won appeals before the Health Services Appeal and Review Board. Two years ago that number fell to 13. Last year, the board sided with the patient only 10 times, board records show.

Seven months into the latest fiscal year, the board has backed a patient only once fully and ordered a partial payment for a second, Brodkin said.

Until last year, OHIP didn't track electronically how many patients were paid in a settlement before a hearing -- there were 11 last year -- but the trend is still clear: More and more patients are appealing, but fewer and fewer are winning to get their piece of an OHIP pot that last year totalled $13.5 billion.

The growth in claims shows there are too many gaps in care that leave Ontarians suffering, said New Democrat health critic France Gelinas.

"That should ring alarm bells," she said.

Gelinas blames the lack of timely care on a provincial government that has focused too much of its funding on seven types of surgery and tests at the exclusion of everything else.

Asked if the slim chances of winning an appeal are fair, a spokesman for Health Minister Eric Hoskins didn't address the issue, instead responding the government "is committed to ensuring that our public health-care system is there for Ontarians when and where they need it."

Brodkin said Ontarians face huge odds challenging OHIP, from rules that make appeals doubtful to an uneven playing field where the agency is supported by a giant bureaucracy and pricey lawyers and the patients are representing themselves.

Just 22 of 383 appellants this year hired a lawyer. Most go without because they can't afford the legal bills, especially if they've taken a second mortgage or used their savings to seek care outside Ontario.

Only 22 had lawyers two years ago and 31 three years ago.

Brodkin knows their financial pain first-hand: He says he's received calls this year from patients interested in filing an appeal, but none could afford to hire a lawyer.


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