Coverage for Treatment: Helping to Keep a Veteran Pain-Free

Sometimes an OVO investigation finds unfairness in VAC’s decision process for medical expenses. How a policy is interpreted can lead to denial of coverage for treatments that otherwise might be covered. This was the case of a Veteran who contacted our office. 

A  Canadian Armed Forces Veteran with a VAC recognized  knee condition was receiving regular injections to relieve his pain.  VAC covered the cost of this treatment.  Unfortunately he developed a reaction, including severe swelling, limiting his mobility and disrupting his daily routine. His orthopaedic surgeon prescribed a new injection treatment at the same cost.       

To the Veteran’s relief, the new treatment worked to ease his pain without causing any reaction. However, VAC refused to reimburse the cost as it was not covered by their policy.  After multiple refusals from VAC, and having to pay out-of-pocket for the treatment, the Veteran contacted us for help. 

The OVO looked at the regulations, policy, and research that VAC used to make their decision. 
We found that in this case VAC did not consider the Veteran’s situation or accept the evidence provided by his orthopaedic surgeon. They also did not provide clear reasoning for their decision.

The OVO found that there was unfairness in the way that VAC considered policy and made their decision.  We recommended that  the Veteran be reimbursed for his prescribed treatment expenses and that VAC  adjust the application of its policy so it better aligns with the regulations. In the end, VAC reimbursed the Veteran for his out-of-pocket expenses and agreed to provide coverage for the new treatment.

If you are dealing with Veterans Affairs Canada, you have the right to be treated with respect, dignity, fairness and courtesy. The Veterans Bill of Rights sets out your right to fair treatment by VAC.  If you feel that any of your rights have not been upheld or a decision is unfair, you have the right to make a complaint to the Veterans Ombud. 

The Veterans Ombud operates independently of VAC and we are impartial. We don’t take sides. We will listen to you. We will review your file with you and communicate with you in clear language so you can understand your options.  We will evaluate how you were treated, how the process was followed and whether the outcome is fair. If we find that there is something unfair in your case, we will advocate for fairness on your behalf.  

Coverage for Treatment