4.5.4 Access to Treatment Benefits

In addition to disability benefits, clients are also eligible for treatment benefits for the disabling condition in relation to which they receive a disability award or disability pension. The effective date for payment of a disability pension is the later of the application date or the date three years prior to the date of the favourable decision. Pursuant to the Veterans Health Care Regulations, the client is eligible for reimbursement of treatment retroactive to the date the pension is payable. Under the NVC, however, the effective date of the disability award is the date of decision and treatment benefits under the Veterans Health Care Regulations can only be paid prospectively from this date.

It should be noted that peacetime clients who are still-serving are not eligible for treatment benefits until release as their health care is covered by DND until that time. For other still–serving members of the Canadian Forces, VAC will provide treatment benefits to “top up” those that DND provides. Between April 2006 and February 2010, approximately 6% (1,078) of CF clients in receipt of a disability award were still serving members. In addition, NVC clients who participate in the Rehabilitation Program are able to receive treatment for their condition(s) through this program regardless of the status of any disability award application. Clients with a condition for which no award is granted may be eligible for the entire suite of medical, psychosocial and vocational rehabilitation. As of February 2010, approximately 7.5% (1,327) of CF clients with a disability award were eligible for or had completed the Rehabilitation Program.

Until such time as a former member receives a favourable decision in respect to their application for a disability award, they are responsible for accessing treatment for the condition and paying the applicable costs to the extent that treatment is not an insured service under a provincial health care system or available to them as a former member of the forces. Also, these persons may not be seeking the treatment they need during this time, and delaying treatment, particularly of mental health conditions, can be very detrimental to their ability to achieve wellness. As discussed in section 4.3.3, in 2008-09, approximately 40% (4,405) of clients were waiting more than 24 weeks from date of application to date of decision. These delays can have a significant impact on the health of clients who are waiting for treatment.

Conclusion

Although both the disability pension and the disability awards allow for payment of treatment benefits related to the assessed condition, the two Acts and their supporting regulations allow for different effective dates for the reimbursement of treatment benefits. Disability award clients are eligible to be reimbursed for treatment benefits from the effective date from which the pension is payable, the later of the application date or three years prior to the date of decision. These persons are not eligible for reimbursement of treatment benefits, in respect to the disabling condition, that they may incur between their application date and the date of their award. Program Management is currently aware of this gap between the programs and will be considering it within the context of future program changes.

R4 It is recommended that the Director General, Policy and Research Division consider an analysis of the need for and feasibility of reimbursing treatment benefits for disability award recipients retroactive to the date of application. (Essential)

Management Response:

Management agrees that concerns have been expressed that CF Veterans eligible for a disability pension have earlier access for the reimbursement of treatment benefits than CF Veterans eligible for a Disability award. A policy analysis is currently underway to examine this issue, including what changes to legislation and/or regulation could be recommended to extend eligibility to treatment benefits to begin at the same time for clients receiving a disability pension or a disability award.

Any proposal for legislative or regulatory change(s) that the Department might develop for Government consideration would need to be costed (on a cash and accrual basis) and considered in light of other priorities. Within this context, management will consider what further action may be appropriate as part of the NVC Review and in relation to the recommendations flowing from the Independent Assessment.

Management Action Plan
Corrective Actions to be taken OPI (Office of Primary Interest) Target Date
4.1 Complete policy analysis. DG P&R July 2010
4.2 Consider whether authority change(s) and costing should be pursued under the NVC Review. DG P&R December 2010
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