- Health care (attendance allowance)
- Jurisdiction, Tribunal (final decision of Board)
- Merits and justice
- Health care (home purchase)
The issues under appeal were: a) the quantum of funding for the purchase of the worker's home; and, b) the quantum of the Personal Care Allowance (PCA) award. The Panel noted that the circumstances of this claim were unusual and exceptional. The worker suffered a catastrophic work injury at a young age, and now lives in a vegetative state, requiring 24-hour care daily by 2 care providers.
The appeal was allowed, in part. The Panel determined that it did not have jurisdiction over the quantum of the PCA award in relation to the category of attendant care under which the hours of attendant care should be classified, or entitlement to a Home Care Program (HCP) because there were no final Board decisions on these issues at the time of the hearing. The central issue was whether the worker was entitled to a contribution towards the purchase price of the new home in lieu of the cost of modifications to the apartment. The formula for determining "equivalent funds" previously used by the ARO was: cost of 2013 modifications to the apartment minus total cost of all outstanding accessibility features in the new home. It was submitted that the ARO erred in instructing the operating area to calculate the home modifications at the apartment and then to subtract that amount from the principal residence home modification budget. The Panel agreed that this formula was problematic. Since the modifications to the house ordered by Decision No. 1374/17 and Decision No. 1062/20 would be larger and more expensive than modifications to the apartment, subtracting the cost of the house modifications from the apartment modifications would result in zero. It was noted that OPM Document No. 17-06-08 does not contain this formula used by the ARO. The policy does not require that the cost of modifications to the new house be deducted from the cost of the modifications to the apartment prior to paying "equivalent funds … towards the purchase of a new home".The Panel determined that it was not possible for the worker's apartment to be modified to meet her needs due to her compensable impairment, necessitating the purchase of a new home to meet her needs. In these circumstances, on the merits and justice, the Panel found it reasonable for the Board to calculate the cost of modifications to the apartment, and to pay those to the worker as a contribution towards the purchase of the new home. This is consistent with OPM Document No. 17-06-08, which states that where modifications to existing structures are not feasible or practical, the equivalent funds may be applied towards the purchase of a new home. This is also consistent with subsections (e) and (h) of the definition of "health care" which indicate that health care includes home modifications and other measures to facilitate independent living, and other measures to improve the quality of life of severely impaired workers. As noted in Decision No. 2511/06, "measures" is to be broadly interpreted.Lastly, section 123 of the Act provides that the Tribunal has jurisdiction only over final Board decisions. The power of attorney provided submissions concerning the Board's internal processes with respect to the worker's claim. It was noted that Tribunal decisions have consistently held that Tribunal appeals are hearings de novo, and the Tribunal does not have jurisdiction over the adequacy of the Board's internal processes or internal administrative decisions leading to Board decisions.