Client Update: Benefits plans really do not have to cover the sun, the moon and the stars (and medical cannabis)
Rick Dunlop and Richard Jordan
Employers, and benefit providers on their behalf, make policy decisions as to what drugs or benefits (including monetary limits) will be covered by benefit plans. The Board of Trustees in Board of Trustees of the Canadian Elevator Industry Welfare Trust Fund v. Skinner, 2018 NSCA 31 made the policy decision not to cover medical cannabis. The Nova Scotia Court of Appeal found that this policy decision was not discriminatory and set aside a Nova Scotia Human Rights Board of Inquiry (“BOI”) decision (discussed here), which found that the decision was discriminatory.
Benefit plans are limited and that’s OK
Stewart McKelvey represented the intervenor, Nova Scotia Private Sector Employers Roundtable (“Employers Roundtable”), in support of the Trustees. The Court recognized the Employers Roundtable’s fundamental concern that the BOI decision meant that “every denial of health benefits could trigger a human rights review with attendant obligations to justify or accommodate”. The Court accepted the Employers Roundtable’s submission that a benefit limitation is not prima facie discriminatory. The Court eloquently explains:
Benefit plans are necessarily limited in many ways. In this case, Mr. Skinner invokes one of those limits to claim prima facie discrimination. The logical consequence of his argument is that every under-inclusive benefits plan results in prima facie discrimination which the plan administrators must justify if a physician prescribes the medication because approved drugs are ineffective. Every request for medication not covered under a plan could be subject to a human rights complaint and require justification for refusal. Human rights boards would become arbiters of private benefit plans. Scarce plan resources would be consumed with justification hearings because justification would usually turn on the particular circumstances of each case.
* * *
Whether to provide a particular benefit, in this case a particular drug, could be based on many factors. Disability would be common to all applicants, because it is a prerequisite to any beneficial entitlement. That alone cannot make it a factor in the decision. As the Employers Roundtable argues, the Board’s recognition that Welfare Plans need not cover the ‘sun, the moon and the stars’ is an implicit admission that non-coverage decisions – and their effects – do not necessarily make disability a factor in those non-coverage decisions. But the Board’s decision side-steps the third Moore criterion so that the existence of a disability by default makes disability a factor.
A prima facie case for discrimination must be a connection between the disability and denial of medical cannabis coverage
The Court appropriately recognized Mr. Skinner’s sympathetic circumstances, but faulted the BOI for its legal analysis relating to the third part of the prima facie case for discrimination. This part of the test required Mr. Skinner to show that there was a connection between his disability and the Trustees’ decision not to cover medical cannabis.
The mere existence of a disability does not establish a connection. The BOI’s conclusion that “because Mr. Skinner was denied coverage, his disability was a factor in the decision” was flawed. The Court reasoned that it “is not enough to conclude that Mr. Skinner experienced an adverse effect arising from non-coverage of medical marijuana…It is necessary to link that exclusion with Mr. Skinner’s membership in an enumerated group…”
Sympathetic personal circumstances do not override statutory criteria
The Court agreed with the BOI’s declaration that benefit plans “need not cover ‘the sun, the moon and the stars…”, but that the BOI based its decision “on Mr. Skinner’s personal needs rather than the statutory criteria.” The statutory criteria required Mr. Skinner to establish a connection between his disability and the Trustees’ decision not to cover medical cannabis. The Court concluded that no such connection could reasonably be made.
Workers’ Compensation Appeal
This decision comes a month after the Court of Appeal’s decision in Skinner v. Nova Scotia (Workers’ Compensation Appeals Tribunal), 2018 NSCA 23. In that case, the Court of Appeal upheld a Workers’ Compensation Appeals Tribunal decision which found that Workers’ Compensation Board (“WCB”) did not have to pay Mr. Skinner’s medical cannabis expenses under the Board’s medical aid assistance program.
Peter McLellan, QC, Rick Dunlop and Richard Jordan successfully represented the Employers Roundtable
Rory Rogers, QC, successfully represented the WCB
Archive
Chad Sullivan and Kathleen Nash Overview The issue of hateful and harassing social media communication has garnered much attention in both the media and, more recently, in the courtroom. In Caplan v Atas,¹ Justice Corbett…
Read MoreDaniel MacKenzie and James Galsworthy On January 15, 2021, the United Kingdom’s Supreme Court (“Court”) issued a decision which is likely to be viewed as good news for policy holders who have endured business interruption…
Read MoreGrant Machum, ICD.D and Mark Tector 2020 was a challenging year for many people and businesses. And while we are all happy to have 2020 in the rearview mirror, we anticipate that there will continue to…
Read MoreKevin Landry and William Wojcik On December 11, 2020, the federal government announced Canada’s strengthened climate plan in a document titled A Healthy Environment and a Healthy Economy (“Plan”). The Plan proposes to increase the carbon…
Read MoreKenneth McCullogh, QC and Conor O’Neil, P.Eng. On December 18, 2020, the Legislative Assembly of New Brunswick passed the Construction Remedies Act. The new legislation will not take effect until a date to be named…
Read MoreMark Tector In a recent decision, an adjudicator upheld the dismissal of an employee/complainant who made inappropriate and offensive remarks on a call with a customer (Crawford v Canadian Imperial Bank of Commerce). The complainant…
Read More2020 brought us all challenges that have been unprecedented in our time. The COVID-19 global pandemic has impacted us in ways that were unimaginable. As Atlantic Canada navigated the challenges of changing worlds, and workplaces,…
Read MoreKathleen Leighton On December 31, 2020, the Honourable Marc Garneau, Minister of Transport, announced new pre-boarding COVID-19 testing requirements that would be coming into effect in short order. In particular, as of January 6, 2021…
Read MoreDaniela Bassan, QC, has published an article in volume 36 of the Canadian Intellectual Property Review. She comments on an Italian case granting copyright protection for a retail store in the cosmetics industry, and considers…
Read MoreRob Aske In late December 2020, the Supreme Court of Canada (“SCC”) issued a key decision elaborating on the duty of honesty in relation to termination of a commercial contract. This duty was primarily established…
Read More