Simon's Megalomaniacal Legal Resources

Medical - Health Services Appeal and Review Board (HSARB)

. Ontario (Health Insurance Plan) v. K.S.

In Ontario (Health Insurance Plan) v. K.S. (Div Court, 2024) the Divisional Court dismissed an OHIP appeal under Health Insurance Act [s.24(1,4)], where the primary issue was that a "vaginoplasty without penectomy" was "not a listed procedure in the Schedule of Benefits" "and is, therefore, not an insured service."

Here the court considers the HSARB's OHIP appellate remedies:

[49] On an appeal, the Board has the power to direct the General Manager of OHIP to take such action as the Board considers the General Manager should take in accordance with the Act and the regulations: Act, s. 21(1). OHIP argues the Board exceeded its jurisdiction by ordering the General Manager to fund K.S.’s surgery without considering the other eligibility criteria.