By David Brisebois, paralegal
It can be hard to differentiate what is reimbursable and what is not by the SAAQ when it comes to medication fees, treatment fees and other support equipment fees. Even though there are laws and regulations for this, it can happen that certain fees are forgotten or unclear. More precisely, when it comes to wheel chairs, there are many types of chairs and that complicates the process.
In a recent judgment rendered by the TAQ, the Tribunal clears this and establishes what can and what cannot be reimbursed by the SAAQ. As a matter of fact, in this decision, a car accident victim had a prescription for an Elevation type of wheel chair due to their condition after the accident. Following the refusal from the SAAQ and the SAAQ’s administrative review direction, the judge concluded that the SAAQ had to cover the fees related to the chair and the accessories as well as the fees for future reparation. Thus, the judge established that it was not the RAMQ that had to cover these fees.
To come to this conclusion, several laws and regulations were studied. According to the section 54.1 of the Regulation respecting the reimbursement of certain expenses, medical necessity must be demonstrated and the wheel chair must be prescribed by a physician. Once this was proven, the applicant had to prove that the SAAQ had to cover these fees. To do so, the section 83.2 of the Automobile Insurance Act was interpreted as follows : it is not possible to obtain the reimbursement of fees that have been covered by a social security system, which includes the RAMQ. However, while analyzing the regulation concerning wheel chairs that are covered by the RAMQ, we quickly notice that Elevation type of wheel chairs are not included and established in any other law or regulation. The TAQ therefore ordered the SAAQ to reimburse the applicant.