WHAT HAPPENED?
Assured Income for the Severely Handicapped (AISH) is a program that offers financial and health benefits for eligible Albertans with a permanent medical condition that prevents them from otherwise earning a living. An individual receiving AISH applied for an additional personal benefit to fund a specialized treatment to relieve symptoms of a severe medical condition. AISH denied the request with no option to appeal.
WHAT DID THE OMBUDSMAN’S OFFICE DO?
The Ombudsman investigated the complaint and identified several areas of concern. AISH did not follow its policy for requesting the information required to make an informed decision about this file. The decision also did not provide adequate reasons. To address this, the Ombudsman made two recommendations for AISH to:
• review its practice for making personal health benefit decisions to improve fairness, and
• ensure all personal benefit decisions provide adequate reasons.
Importantly, the Ombudsman found that the decision-maker in this case did not have the authority to make the decision about the complainant’s benefit. This key finding justified a third recommendation from the Ombudsman for AISH to:
• rehear the matter and issue a new decision.
WHAT WAS THE OUTCOME?
AISH accepted all recommendations and agreed to start the process over for the individual. Upon rehearing the matter, AISH decided to fund the required treatment, granting a benefit in excess of $6,000.
WHY DOES IT MATTER?
Decisions made by government departments should be made by those with the authority to do so and include reasons to support their decision. This is especially true when a decision has a major impact on a vulnerable Albertan. The Ombudsman does not comment on whether a decision is right or wrong; rather, our office will ask an authority to follow a fair process, which sometimes results in a different outcome. In this case, both the individual and future AISH recipients have access to a fairer process going forward.
