Manitoba Health

Although Manitobans benefit from a high-quality health care system that is among the world’s best, issues occasionally arise that require resolution. To ensure that the residents of Manitoba had access to an independent and “arm’s-length” review process, the provincial government established the Manitoba Health Appeal Board on April 1, 1993.  If a person is not satisfied with certain decisions of Manitoba Health and Healthy Living involving a financial or operational matter in the health care system, he or she may appeal some of those decisions to the board.

What is the Manitoba Health Appeal Board?

The Manitoba Health Appeal Board is a quasi-judicial tribunal whose members are appointed by the legislature and are not employees or officials of Manitoba Health and Healthy Living.   The board is responsible for making decisions on appeals under The Health Services Insurance Act, The Emergency Medical Response and Stretcher Transportation Act and The Mental Health Act. The board also performs other duties as assigned by acts of legislature or by the Minister of Health, including appeals regarding decisions made under a regional health authority’s Home Care Program and Manitoba’s Hepatitis C Financial Assistance Program. The board’s mandate is set out in The Health Services Insurance Act.

What kinds of appeals does the board hear?

The board hears a wide range of appeals. You may appeal a decision if you have been:

• refused registration as an insured person under The Health Services Insurance Act
• denied entitlement to a benefit under The Health Services Insurance Act (e.g.: out-of-province medical service claims)
• assessed authorized charges (daily rates) in a personal care home, hospital or other designated health facility
• issued a decision regarding your eligibility, type or level of service under the Manitoba Home Care Program
• denied financial assistance under the Manitoba Hepatitis C Financial Assistance Program

Other appeals may deal with persons who are:

• refused an approval to operate a laboratory or a specimen collection centre, or conditions have been imposed on the approval, or the approval has been revoked
• refused an approval to operate a personal care home, or conditions have been imposed on the approval, or the approval has been revoked
• refused a license to operate an emergency medical response system or a stretcher transportation service or had their license suspended or cancelled.

The board may also hold public hearings to deal with requests for changes in regional health district boundaries.

How does a person appeal a decision?

If you are not satisfied with a decision of Manitoba Health and Healthy Living on the above issues, you can appeal that decision to the board in a letter outlining your grounds for appeal. The letter must be mailed or delivered within 30 days of receiving notice of this decision (or at a later date, if the board permits).

If you not satisfied with a decision made by the Manitoba Home Care Program regarding your eligibility, level or type of service, you can appeal that decision by completing a Notice of Appeal.

For more information on appeals and the appeal process, contact the Manitoba Health Appeal Board office at (204) 788-6704.

When and where does the board meet?

The board meets regularly on Thursdays and holds its hearings in a boardroom located at Room 4015 – 300 Carlton Street in Winnipeg. Occasionally, meetings are held in other locations, and periodically, the board holds public hearings in rural Manitoba when regional health boundaries are involved.

If you are unable to attend the hearing in person in Winnipeg, you may request to participate by way of teleconference call or videoconference (where available).  You must contact the board office well in advance of the hearing date to request these arrangements. 

How does the board ensure a fair process?

To ensure a fair and unbiased appeal process for everyone involved, the board members remain at arm’s length from the appellant (the person appealing the decision) and the respondent (the person who originally authorized the decision) until the actual appeal hearing.  The Appellant and Respondent are referred to as “parties” to the hearing.  Board members and its staff do not participate in the preparation of appeals for any party.  However, the board’s staff can be contacted to discuss an issue related to the appeal and/or the procedures for appeals.  The board’s staff will remain in contact with all parties regarding hearing dates and times.

Who can attend the appeal hearing?

You have a right to attend the hearing in person and are entitled to be represented by legal counsel.  If you are unable to attend the hearing and choose not to be represented by legal counsel, you may be represented by another person who has been designated in writing as your agent.  You may bring witnesses with you to the hearing but they must be individuals who can provide relevant information to the board regarding the issues under appeal.

You must also advise the board office in advance of the hearing date of the name of the legal counsel, designated agent or support person and any witnesses who will be attending your hearing.  The board will not be responsible for any costs associated to your attendance at and/or representation by others at your hearing nor for the attendance of any witnesses.

You will be advised in advance of the hearing as to the names of persons and/or witnesses who will be attending the hearing on behalf of the Respondent.

What is the board’s procedure for hearing appeals?

The board follows established Rules of Procedure for appeal hearings [link to Rules of Procedure form].  All parties are entitled to submit written documentation (evidence) in advance of the hearing but within the time limits that are established by the board.  The Board provides parties with an information checklist to assist in preparing material for the hearing.  All written material provided for the hearing by one party must also be provided to the other party and to the board in advance of the hearing date.  Upon the approval of the board, further written evidence may also be presented at the time of the hearing.

At an appeal hearing, the appellant is allowed to present his/her case and make an oral submission first, followed by questions by the respondent and the board.  The respondent is then provided with an opportunity to present their case, followed by questions by the appellant and the board.  All questions and answers must be directed through the Chairperson.  If a party does not attend the hearing, the board will consider all written evidence that was provided by that party.  After the hearing, the parties leave the room and the board meets in private (in camera) to discuss what they have heard and read and makes a decision as to whether the appeal should be allowed or dismissed.  If the appeal is allowed, the board must decide whether to confirm, set aside or vary the original decision. The board may also refer the matter back to the agency that made the initial decision for further consideration with or without instructions.  Generally, within two to three weeks after a hearing, the parties are provided with the board’s written decision.

Who takes part in the decision-making process?

Only board members and the board’s administrator are present during the deliberation process This way, members of the board cannot be influenced by the presence of the appellant or the respondent or their representatives.  Decisions on appeals are made by Board members only and the Administrator does not take part in making the decision.

Are the board’s decisions final?

Yes, the board’s decisions are final.  However, a request for a judicial review of the process can be made to the Court of Queen’s Bench.

Disclaimer:  This website is for public information only.  Where any information contained herein may be in conflict with the legislation, the legislation will prevail.