QUEBEC TRIBUNAL LANDMARK RULING SETS PRECEDENT FOR PROVINCE’S AMPUTEES
September 6, 2017 – A landmark decision by the Tribunal Administratif du Québec ruling that the Société de l’assurance automobile du Quebec (SAAQ) must pay for an essential artificial limb for a Quebec amputee has brought to an end a four-year battle by The War Amps and set a precedent for the province’s amputees.
François Lauzon lost his left leg above the knee in a 2011 motorcycle accident. Doctors had strongly advised that he be fitted with a microprocessor (computerized) knee unit in order to walk safely and be able to return to the workforce, however, the SAAQ repeatedly denied coverage, stating that it was not medically necessary.
A frustrated Mr. Lauzon contacted The War Amps Advocacy Program for help. “Simple things such as climbing stairs or going for groceries are difficult with the leg the SAAQ approved – it is like walking on a door hinge. It’s upsetting that I was refused coverage for a component that will allow me to be as mobile and as safe as possible,” he said.
Since 2013, The War Amps made numerous submissions to the SAAQ, attended a mediation, and finally appeared before the Tribunal in May of this year to explain Mr. Lauzon’s amputation, present evidence from his medical professionals and explain the necessity of an adequate artificial leg for his safety and well-being. The Tribunal rendered a decision in Mr. Lauzon’s favour on August 15, 2017.
“It’s unfortunate that the SAAQ didn’t recognize the medical necessity immediately, when the evidence was readily available,” said Annelise Petlock, The War Amps Advocacy Program Manager. “This put Mr. Lauzon through a needless four year wait, only to ultimately receive the limb originally prescribed for him, thanks to the Tribunal, which recognized the critical role this prosthetic care will play in protecting his health.”
She added that Mr. Lauzon’s situation is reflective of serious issues with provincial prosthetic coverage in Quebec, including long response times, shocking amounts of red tape and a culture of “nickel and diming” for needed components. “Essentially, it’s a bureaucratic obstacle course to the detriment of Quebec’s amputees,” she said.
She points out, however, that the Tribunal’s decision is a potential game changer that will now serve as precedent. “This should guide the SAAQ in future decisions about artificial limb coverage, and prevent others from going through what Mr. Lauzon went through. It will also direct it to reduce the amount of red tape and hurdles amputees have to navigate to access medically prescribed care.”
Since its founding at the end of the First World War, The War Amps has fought to protect the rights of amputee veterans and address the inequalities they face. As a natural evolution, the Association has over time expanded its advocacy work to provide a voice for all amputees in Canada.
“Through our Advocacy program, we navigate and address the bureaucratic barriers and misunderstandings often confronted by amputees in Canadian society,” said Brian Forbes, Chairman of The War Amps Executive Committee. He views Mr. Lauzon’s case as a classic example of why the program is needed.
“We’re certain that many Canadians would be shocked to know that those who suffer the loss of a limb are not adequately covered by their provincial government health plans,” he said. “In desperate circumstances, even crowdfunding has proven necessary, which is a shameful state of affairs for Canada’s healthcare system.”
He added, “Our years of experience with provincial agencies, government departments and insurance companies have revealed that they do not fully comprehend the impact of amputation. Through Advocacy, we identify the gaps in support for amputees and work to effect change in areas such as insufficient prosthetic coverage, insurance and legal issues, human rights and government benefits to improve their lives.”
The War Amps was founded in 1918 with a philosophy of “amputees helping amputees,” and continues this legacy in the modern-day association that exists today. A nation-wide registered charitable organization, it assists war amputees and all Canadian amputees, including children.
- 30 -
For More Information
Executive Director, Communications
1 877 606-3342