Further to my blog yesterday on the Health Services Appeal and Review Board (HSARB), I’d like to discuss the process of appealing a decision rendered by the Ontario Health Insurance Plan (OHIP).

OHIP pays for certain health-care services for eligible insured persons. OHIP administratively decides whether you are eligible and whether the health services addressed are covered. If you are not satisfied with OHIP’s decision, you may appeal to the HSARB.

To appeal, you must inform both OHIP and the HSARB of your intention to appeal within 15 days of receiving OHIP’s decision. If you need more time, you must ask the Board in writing for an extension and provide the reasons.

Once the Board has received your request for an appeal, the Board will send you an acknowledgement letter and Form 1 requesting certain information. The Board will have access only to the information provided. It does not otherwise have access to your health records or your OHIP file.

You can request to have the hearing conducted in person, over the telephone, or in writing. However, it’s up to the Board to decide which type of hearing it will hold to hear your appeal.

After the Board has received your completed Form 1 within the prescribed period, the General Manager of OHIP will be asked to provide a response to your request. You do not have to answer OHIP’s response.

A pre-hearing conference will be held after the Board has received documents from both you and OHIP. At the conference the Board will explore settlement opportunities and/or attempt to narrow the scope of the appeal.

The hearings are generally open to the public. However, the Board may order that a hearing be held privately if circumstances warrant such an order.

Note: Please keep in mind that this article is provided for information and educational purposes. It does not constitute legal advice and should not be regarded as such. The law may have changed since the publication of the article.

PSWLaw fights on your behalf in OHIP appeals.