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VOLUME 4, ISSUE 2  
 2021 

 

STAKEHOLDER  PERSPECTIVES 

Petlock A, DiMario K. (In) Access to Artificial Limbs: The Patient’s Perspective According to The War Amps of Canada. Canadian Prosthetics & Orthotics 

Journal. 2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

This article has been invited and reviewed by Co-Editor-In-Chief, Dr. Silvia Ursula Raschke. 
English proofread by: Karin Ryan, M.A., B.Sc., P.T.   
Managing Editor: Dr. Hossein Gholizadeh 
 

SPECIAL ISSUE 

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Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 
2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

 

 

 
STAKEHOLDER  PERSPECTIVES 

 

(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE ACCORDING TO THE WAR 

AMPS OF CANADA 

Petlock A.*, DiMario K. 
 

Advocacy Program, The War Amputations of Canada, Ottawa, Canada. 
 

 

 

 

  

 

 

 

 

 

INTRODUCTION 

The average Canadian would be shocked to know that if 

they or a family member lose a limb, they could be faced 

with a personal balance of thousands of dollars for even the 

most basic artificial limb that will restore only a semblance 

of their previous function. 

Insufficient access to funding for artificial limbs is a key 

barrier faced by Canadians with amputations. Across the 

country, both public and private funding agencies create 

and adhere to policies that do not reflect the reality of living 

with amputation and that, when applied, prevent amputees 

from being able to access prosthetic care that is medically 

prescribed and essential to their everyday functionality. 

For those who cannot afford to pay thousands out of pocket, 

few alternatives exist. For many, crowdfunding has proven 

necessary, a veritable canary in the coal mine pointing to a 

distressing state of affairs for Canada’s healthcare system.  

 

 

It is also only a stop-gap solution, given that amputees will 

understandably be reluctant or simply unable to repeatedly 

appeal to friends and family for the subsequent replacement 

limbs they will need during their lifetime. 

It is unimaginable in the 21st century that seriously disabled 

amputees would have to rely on their families and 

communities in this way to cope with the basic financial 

requirements. 

The purpose of this paper is to highlight the nature of the 

issues in the public and private realms, describe the 

attitudinal and legislative barriers that perpetuate these 

issues and suggest mechanisms for how patients, 

professionals and the public can work together to improve 

access to funding for artificial limbs, and, as a result improve 

the lives of Canadian amputees.  

1. FUNDING FOR ARTIFICIAL LIMBS IN 

CANADA: A MULTI-LEVEL BATTLEFIELD 

Across the country, there are over 40 public and private 

agencies that provide funding for artificial limbs. These 

range from federal, provincial and municipal governments 

to workers compensation regimes, employment and private 

insurance companies and charitable agencies, including 

The War Amps of Canada. Although there are various 

 
OPEN  ACCESS Volume 4, Issue 2, Article No.13. 2021 

 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

 

ABSTRACT 

Funding agencies, both public and private, do not adequately meet the needs of Canadian 

amputees. This often leaves amputees without access to appropriate prosthetic care due to 

outstanding balances that are to be paid out of pocket, or by charitable organizations. There are 

several factors that result in these inadequacies. As healthcare is a provincial responsibility in 

Canada, provinces and territories have the authority to create individual public regimes, each 

with their own weaknesses. In fact, there are a few provincial regimes which do not include 

prosthetic funding at all. Private healthcare is meant to offset the remaining balance; however, 

their lack of knowledge regarding amputation has resulted in the creation of policies with 

ambiguous language, limiting the funding available for prosthetic care. Attitudinal barriers and 

missed legislative opportunities further exacerbate the shortcomings of prosthetic funding 

provided by public and private funding agencies, requiring action. 

CITATION 

Petlock A, DiMario K. (In) Access to 

artificial limbs: the patient’s perspective 

according to the WAR AMPS of Canada. 

Canadian Prosthetics & Orthotics Journal. 

2021; Volume 4, Issue 2, No.13. 

https://doi.org/10.33137/cpoj.v4i2.35972 

KEYWORDS 

Health Economics, Prosthetic Care, 

Artificial Limb, Funding Agencies, 

Insurance, Public Healthcare 

 

 

* CORRESPONDING AUTHOR 

Annelise Petlock 
The War Amps Advocacy Program/ 2827 Riverside Drive Ottawa, 
Ontario, Canada.  

E-Mail: annelise.petlock@waramps.ca 

ORCID ID: https://orcid.org/0000-0002-7273-4527 

Special Issue: Health Economics in Prosthetics & Orthotics 

https://doi.org/10.33137/cpoj.v4i2.35972
https://jps.library.utoronto.ca/index.php/cpoj/index
https://doi.org/10.33137/cpoj.v4i2.35972
mailto:annelise.petlock@waramps.ca
https://orcid.org/0000-0002-7273-4527


 

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Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 
2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

ISSN: 2561-987X 
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agencies that provide funding towards the cost of artificial 

limbs, the funding received from even one source does not 

adequately support the average amputee in Canada. 

Generally, persons with amputations have three potential 

routes to access funding for prosthetic care (excluding 

crowdfunding): provincial healthcare funding, private 

insurance, and charitable sources. Other than small 

grassroots and locally based amputee groups like the 

Ottawa Amputee Society, The War Amps is the only large 

charitable organization in support of amputees in Canada.  

The War Amps, a charitable organization that does not 

receive government grants, fills the gaps in funding where it 

can; however, as a charitable organization that relies on 

public donations, these funds can only go so far. As such, 

The War Amps mandate stipulates that funding can only be 

accessed after other government and insurance agency 

contributions are exhausted.  

Unfortunately, provincial healthcare and private insurance 

regimes miss the mark, leaving large outstanding balances 

to be funded by the amputee themselves or a charitable 

organization. 

Table 1: Provincial Funding Issues. 

Province(s) Description of funding issues 

Newfoundland and New 
Brunswick 
 

No funding available unless in receipt of social assistance. Working residents receive no provincial support for 
artificial limbs. 
 
For those receiving social assistance, the maximum provincial contribution is often insufficient to cover the total 
cost of the prosthesis. 

Prince Edward Island 
No policy exists. Amputees receive coverage if they receive care at the one public prosthetic clinic in the 
province. No coverage is available if they receive care elsewhere. 

Nova Scotia 

Limited funding is available. If prosthetic care is received at the one publicly run centre in the province, then full 
coverage is possible. Wait times are extensive. 
 
When care is received at a private clinic, the province covers approximately 1/3 of the cost. 

Quebec 
 

Some funding available according to a fee schedule. Fee schedule is extremely outdated and includes items 
that are no longer prescribed and excludes basic prosthetic components. 
 
If persons with amputations require components not listed on the fee schedule, then they receive no provincial 
funding. All components must be from their approved list or no coverage is received.  

Ontario 
 

Some funding available according to a fee schedule which has not been updated since 2006. Fee schedule 

includes items no longer prescribed and excludes basic prosthetic components. Still, Ontario claims to cover 
75% of prosthetic care costs, but since the fee schedule is badly outdated, it is often typically 10-30%. 

Manitoba 
Funding is available. Lack of transparency for what is covered. No written policy is available. No updates have 
been made to the fee schedule in many years and there is no mechanism for ongoing updates to policy or fee 
schedule. 

Saskatchewan 
 

Funding is available and generally covers what is required for amputees. Care is only offered in two centers in 
the province leading to long wait times. If care is required sooner, often amputees choose to go out of province 
(to Alberta). If they do so, coverage can be less than 1/3 of the cost. 

Alberta 

Funding is currently available. On Dec 23, it was announced that private insurance must be exhausted before 
provincial support can be accessed, which is unusual, unprecedented and will generate significant complexity 
in 2021. In addition, fee schedules for reimbursement amounts for prosthetic componentry are outdated and not 
reflective of current cost structures. 
 
Movement toward privatization may bring further regression and spur some of the issues with the insurance 
industry we are familiar with.  

Yukon and the Territories 
 

Persons with amputations living in remote communities’ travel to the nearest prosthetic clinic in a neighboring 
province. Territories generally cover the cost of care and the travel out of province. The issues arise when we 
attempt to locate policies or standards which govern the decisions to approve or deny prosthetic care: none 
appear to exist. Hence, amputees are faced with ambiguity about whether the territory will cover the cost of 
care. We have seen circumstances where standard care seems to be arbitrarily denied, with no policy basis.   

British Columbia 

Funding is limited to items that restore “basic functionality”. This term is ambiguously defined, narrowly applied, 
and fails to realize that artificial limbs do not provide functionality equivalent to the missing limb. As a result, 
prosthetic care and componentry that is considered “standard” by the prosthetic profession, industry and 
medical community are arbitrarily excluded.  For example, myoelectric hands, which have been an integral 
aspect of prosthetic care for over 30 years are not covered. Due to the ambiguous definition, there is uncertainty 
regarding what will be and what will not be covered from fitting to fitting.   

 

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Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 
2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

ISSN: 2561-987X 
(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE   

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 1.1. Public Healthcare in Canada 

Due to Canada’s constitutional framework, healthcare is a 

provincial responsibility. The Canada Health Act mandates 

that all provinces must cover the cost of “essential 

healthcare services”, defined as those administrated by 

doctors in hospitals. Anything outside of essential services 

are deemed to be provided “at the discretion of the 

province”. 

As a result, provinces and territories in Canada have used 

their discretionary authority to create no less than 13 

different public regimes for covering the cost of prosthetic 

care (one for every province and territory). Each one of 

these systems fails, in a unique (and creative) manner to 

adequately respond to the reality of living with amputation 

and relying on prosthetic care. As a result, the lack of 

access to quality mobility aids, devices and assistive 

technology at an affordable cost remains a barrier to 

accessibility for Canadian amputees. See Table 1, for an 

overview of how these systems fail to meet the mark. 

1.2. Case examples 

Ontario 

The outdated fee-schedule utilized by Ontario’s Assistive 

Devices Program (ADP) leaves many amputees with a large 

outstanding balance to fund out-of-pocket. See Table 2 and 

Table 3 below for an overview of the lack of coverage 

provided by ADP. 

Table 2:  ADP Coverage for an above knee prosthesis with a 

microprocessor knee unit. 

Cost of Prosthesis: $56,102.42 

ADP Amount Covered: $12,286.00 

Remaining Balance: $43,816.42 

Percentage of ADP Coverage: 21.9% 

 

Table 3: ADP Coverage for the replacement of a left below elbow 

myoelectric socket due to growth. 

Cost of Prosthesis: $7,701.06 

ADP Amount Covered: $2,188.00 

Remaining Balance: $5,513.06 

Percentage of ADP Coverage: 28.4% 

 

Saskatchewan 

A five-year-old bilateral above the knee child amputee was 

unable to receive timely and effective treatment in 

Saskatchewan. They were forced to seek care at a centre 

with more experience with children and multiple 

amputations out of province. As prosthetic treatment was 

obtained out-of-province, the province offered 

reimbursement just over $6,000 towards the total cost of the 

prescribed bilateral transfemoral prosthesis just over 

$20,000.  

British Columbia  

The British Columbia Ministry of Health issued approvals for 

a number of amputees to receive osseointegration surgery 

in Australia. After they received the surgery, they returned 

to BC to find that the province refused to cover the cost of 

their prosthesis. Pharmacare, a branch of the Ministry of 

Health explained that there was no policy to cover the cost 

of osseointegration prosthetic care. The amputees who 

received the surgery, paid for by the province, were left with 

no coverage for their prosthesis for nearly a year. 

Most provinces offer some coverage for artificial limbs, but 

each system has serious flaws, which move away from a 

patient centered approach, and regularly negatively impact 

the health and well-being of a very vulnerable group of 

Canadians, persons with amputations. Amputation and 

prosthetic care are a complex and highly specialized area 

of healthcare. Thus, provinces may be generally unaware of 

how badly they are failing Canadian amputees. For this 

reason, it is important for public funding agents to be 

informed of the reality of living with amputation, and the 

ways in which their failures impact amputees.   

1.3. Private Funding for Prosthetic care 

To supplement inadequate provincial healthcare funding, 

the insurance industry plays a large role in providing funding 

for artificial limbs in Canada. Unfortunately, the insurance 

industry lacks federal or provincial legislation which builds 

in protections for vulnerable groups like amputees who 

require insurance funding for adequate prosthetic care. 

Hence, the diversity of insurance policy framework is even 

more vast than public funding frameworks. As the variety of 

insurance policy language that pertains to artificial limb 

coverage is studied, findings suggest that the arrow misses 

the target by immeasurable margins, with insidious results. 

Table 4 highlights the arbitrary language utilized in insurance 

policies which contribute to inadequate prosthetic funding. 

2. ATTITUDINAL BARRIERS 

In studying this issue, findings suggest a number of key 

attitudinal barriers that act to compound, perpetuate, and 

reinforce insufficient access to funding for artificial limbs.  

Both the Canadian public and key stakeholders including 

insurers, and government agents exhibit a lack of 

understanding of a very complex area of health care and 

medicine, underestimate the cost of prosthetic technology, 

and assume that prosthetic technology is more advanced 

than it is, also known as Sci Fi Syndrome. 

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Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 
2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

ISSN: 2561-987X 
(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE   

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2.1. Lack of Understanding into a Complex Area of 

Healthcare 

Government agencies and insurance companies do not fully 

comprehend the impact of amputation and the role the 

prosthesis plays in reducing the incidence of other medical 

conditions that can develop with amputation. Adequate 

prosthetic care will also assist in restoring some of the 

functionality required for them to access services in, and 

contribute to, their community and workplace. If an amputee 

does not have access to the proper prosthesis or develops 

repetitive strain injuries as a result of a lack of appropriate 

prosthetic care, the potential cost to the governments and 

insurers could be immense.1,2 

While the up-front cost of an appropriate, medically 

necessary prosthesis appears expensive, in the long term it 

will save costs.3 Prostheses have been demonstrated to 

increase safety and security, and to reduce the incidence of 

the comorbidities associated with amputation. 

Subsequently, a decrease in comorbidities translates to a 

decrease in the costs associated with those comorbidities, 

which include but are not limited to expensive medication 

for mental health and pain management, paramedical 

treatments, treatment for injuries caused by falls, the cost of 

home modifications, vehicle modifications and daily living 

aids, as well as additional income replacement costs as the 

individual is not able to return to work without the 

appropriate prosthesis.  

Public and private funding agencies do not realize the above 

when they build limiting prosthetic policies or issue 

coverage denials. Indeed, the choice is to pay now for the 

prosthesis, or pay later for the comorbidities. Of course, it is 

the amputee who pays the most.  

2.2. Underestimate the cost of Prosthetic care 

The Canadian public is generally unaware of the often 

prohibitively high cost of artificial limbs. They assume that 

costs are only a fraction of the actual cost and do not 

understand the unique nature of the prosthetic industry. For 

example, prostheses have a very custom nature to reflect 

the needs of each individual amputee and their level of 

amputation, and the engineering of prosthetic components 

requires significant research and development to ensure 

functionality. 

As a result of this lack of understanding, public and private 

agencies balk at the cost. “Sticker shock” can trigger 

denials, and this coupled with Sci Fi syndrome, described 

below, creates attitudinal barriers to access funding for 

care.  

In addition, the Canadian public often assumes that artificial 

limbs are fully covered by provincial funding agencies. As 

Canadians give credit to provinces for care they do not 

provide, this “credit” further reduces the incentive to make 

meaningful improvements to prosthetic funding. 

 

Table 4: Arbitrary Policy Phrasing. 

Policy Phrasing Explanation 

“One limb for life” 
Children grow, people have weight fluctuations and components break or wear out. People need 
replacement artificial limbs roughly every three years. One artificial limb for life is not reflective of the reality 
of amputation and prosthetic care. 

$1,000 maximum With costs for prostheses ranging from $8,000 to $100,000, this amount is grossly insufficient. 

No direct billing or “assignment of benefits” 
Few people have $8,000 to $100,000 in liquid assets or credit that they can use to purchase their prosthesis 
and then wait for reimbursement. For this small demographic, there must be some arrangement where the 
provider can be paid directly. 

“Myoelectrical limbs are excluded” 

Myoelectric hand technology is over 40 years old, yet this clause remains common. We suspect that these 
exclusions were put in place when this technology was new, but after 40 years, it is time for an update. 
 
In application, insurers will commonly deny other prosthetic care on the ground that it is myoelectric, when it 
is not (such as a microprocessor-controlled knee unit). A myoelectric-controlled prosthesis is an externally 
powered (i.e. powered by battery) artificial limb that uses the existing muscles in a person’s residual limb to 
control its functions; however, a microprocessor-controlled knee unit is a body-powered component (i.e. the 
forces and movement generated come from the user of the device) that allows the knee position to change 
slightly by adjusting hydraulic resistance levels to support stability when standing, and when on slopes 
and/or uneven terrain. 
 

Unreasonable and rigid replacement 
frequency limits: 5 years, no exception 

A lot can happen in five years and these policies offer no room for accommodation. If an amputee 
experiences volume fluctuation due to a pregnancy, a revision surgery or growth (as in the case of children), 
they may be precluded from receiving their insurance support for a number of years.  

“Subject to usual and customary limits” 

This is perhaps the most pernicious phrase to the amputee seeking private insurance to help cover the cost 
of their prosthetic care. Often, insurers will approve coverage for prosthetic care “subject to usual and 
customary limits” as defined by their internal polices.  
 
In application, this means that an amputee seeking coverage for their $60,000 prosthesis, which may have 
coverage of 80% written in their policy, may be shocked when they submit their receipt to insurers and the 
insurer indicates that $5,000 is the “usual and customary limit”. The insurer will not pay a penny more.  

 

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Petlock A, DiMario K. (In) Access to artificial limbs: the patient’s perspective according to the WAR AMPS of Canada. Canadian Prosthetics & Orthotics Journal. 
2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

ISSN: 2561-987X 
(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE   

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2.3. Sci Fi Syndrome 

Hollywood and the media have raised the expectation of 

what is possible in prosthetic technology in the eyes of the 

public, the amputee and their support system, and the 

funding agencies. All too often, the realities fall short of 

these expectations, which can have a devastating impact on 

the amputee and their rehabilitation. The images, the 

terminology, the stories, and the hype all contribute to the 

unrealistic expectations.  

A number of movies and television shows have featured 

artificial hands that have more basis in special effects than 

real prosthetic technology available to the consumer: Star 

Wars; Robocop; Terminator; The Six-Million Dollar Man, 

and more. Through entertainment in television, these 

portrayals set false expectations of the functionality of 

prosthetic devices, allowing us to ignore the limitations of 

them. As a result, given the lack of familiarity with prosthetic 

limbs or with amputation, the public and policy decision-

makers often assume that prosthetic limbs provide more 

functionality than the reality. Sometimes, even assuming 

that they can offer functionality “greater than the real limb”. 

In response to this assumption, decision-makers often 

assert that the amputee only needs “a basic limb” and not 

anything “sophisticated”. They do not realize that in truth, no 

technology available today comes close to replicating 

functionality lost with the loss of a limb.  

The “Sci Fi syndrome” mentality negatively affects 

amputees by limiting access to technologies which will 

prevent them from falling, reduce overuse and strain 

injuries, or help them to maximize their functional ability.  

In order for amputees to have access to funding, we must 

overcome these attitudinal barriers held by the Canadian 

public, and public and private funding agencies, which are 

reinforced by Hollywood and the media portrayals.  

3. LEGISLATIVE OPPORTUNITIES 

Current legislative frameworks that could ensure access to 

funding for prosthetic care are underutilized. Underutilized 

legislative frameworks is a contributing factor to the failure 

of the Canadian system to provide appropriate prosthetic 

funding. Despite Canada’s role as a signatory to the United 

Nations Convention on the Rights of Persons with 

Disabilities, and recent steps to enhance and define 

accessibility legislation, Canada still lags significantly 

behind other comparable countries and persons with 

amputations continue to be unprotected by high level legal 

mechanisms.  

3.1. United Nations Convention on the Rights of 

Persons with Disabilities 

Internationally, it is The War Amps’ position that Canada is 

in violation of its international obligations under the United 

Nations Convention on the Rights of Persons with 

Disabilities. Article 20 of this convention has set out that 

state parties must take steps to facilitate access to quality 

mobility aids, devices, and assistive technologies, including 

making them available at affordable costs.  

“States Parties shall take effective measures to ensure 

personal mobility with the greatest possible independence 

for persons with disabilities, including by: 

• Facilitating the personal mobility of persons with 

disabilities in the manner and at the time of their choice, and 

at affordable cost; 

• Facilitating access by persons with disabilities to 

quality mobility aids, devices, assistive technologies and 

forms of live assistance and intermediaries, including by 

making them available at affordable cost;” 4 

Further, article 32 states that State Parties will:  

• “[Provide], as appropriate, technical and economic 

assistance, including by facilitating access to and sharing of 

accessible and assistive technologies, and through the 

transfer of technologies.” 5 

Canada ratified this Convention in 2010, while seeming to 

completely overlook this obligation. Amputees, and others 

who rely on assistive technology for their mobility, do not 

have access to the mobility aids they need at an affordable 

price. Canada’s failure to appropriately fund artificial limbs 

for amputees is even more shameful when we consider that 

the World Health Organization (WHO) has identified 

artificial limbs as a “Priority Assistive Product” through the 

GATE Initiative (Global Co-operation on Assistive 

Technology). The Priority Assistive Product list serves as a 

model for member states to build their own priority areas 

and implement by priority. Also included on this list are 

hearing aids, wheelchairs, communication aids, spectacles, 

pill organizers and memory aids, among others. 

In collaboration with the Convention, the WHO is clear that 

assistive technologies like artificial limbs should form an 

integral part of universal health coverage for State Parties 

who have ratified the Convention. As we know, this is simply 

not so in Canada. If Canada were to truly follow through on 

their commitment as a signatory to this convention, it is our 

position that they would be obligated to make sweeping 

changes to funding for artificial limbs across the country. As 

it stands, this Convention remains an important and 

underutilized tool to improve funding for artificial limbs in 

Canada.  

3.2. Accession to the Optional Protocol to United 

Nations Convention on the Rights of Persons with 

Disabilities 

As of December 2018, Canadians can make a complaint 

directly to the United Nations if it is felt that their rights as 

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indicated by this convention have been violated.6 If the 

United Nations Committee feels the complaint has merit, 

they can conduct an investigation and make an order to 

compel the state party (the country) to comply.7   

Before this tool for change can be leveraged, we must 

“exhaust all domestic options”, which means we must 

pursue opportunities for change and improvement at the 

provincial and federal level. If this is done with no 

improvement, then a complaint can be mounted to the 

United Nations.  

Hence, as part of The War Amps’ Crusade for Reform for 

prosthetic funding, we are holding all funding agencies to 

account and working to advise of the issue and, case by 

case, challenge inadequate funding. In the next few years, 

if we do not see meaningful change, we intend to appear 

before the United Nations Committee on behalf of Canadian 

amputees.  

As a registered Non-Governmental Organization within the 

Economic and Social Council of the United Nations, The 

War Amps has a long history of leveraging United Nations 

Convention Optional Protocols to ensure that the rights of 

Canadians are upheld. Since the First World War, we have 

fought to protect the rights of amputees and veterans and 

address the inequities they face. In that time, we have taken 

on many important battles in support of amputees and our 

veterans, including: Hong Kong Veterans and Victims of 

Thalidomide. 

Hong Kong Veterans 

In 1987, The War Amps, in association with the Hong Kong 

Veterans’ Association of Canada, petitioned The United 

Nations Commission on Human Rights to demand 

compensation to Canada’s Hong Kong Prisoners of War 

following the “gross violation of human rights” committed by 

the government of Japan during the Second World War, 

which has caused devastating and lifelong health impacts.  

The government of Japan did not respond favourably. Thus, 

The War Amps targeted the Canadian government for its 

failure to protect the interests of the Hong Kong veterans as 

part of the Peace Treaty entered into between Allied 

countries (including Canada) and Japan following the 

Second World War. Hence, The War Amps initiated a 

Communication under the Optional Protocol of the 

International Covenant on Civil and Political Rights alleging 

a form of discrimination exercised by Canada in its failure to 

protect the interest of the Hong Kong veterans’ prisoners of 

war against Japan. 

The War Amps successfully entered into negotiations with 

the Canadian government and worked out a financial 

settlement which resulted in appropriate compensation 

being paid in the form of an ex-gratia payment from the 

Canadian government to the individual Hong Kong 

veterans. 

Victims of Thalidomide  

The War Amps, along with the Thalidomide Victims 

Association of Canada, also sought proper compensation 

from the Commission on Human Rights for Canada’s 

Thalidomide victims (survivors) as a direct consequence of 

the Federal government’s distribution of the drug in Canada. 

Thalidomide was administered to pregnant women in 

Canada, which resulted in well over 100 children being born 

with birth defects and serious medical issues, which they 

continue to confront today. 

In September 1989, The War Amps petitioned the United 

Nations Human Rights Committee under the Optional 

Protocol pursuant to the International Covenant on Civil and 

Political Rights. The petition led to direct negotiations with 

the Federal government and, more particularly, the Ministry 

of Health, resulting in a settlement which addressed the 

plight of the Thalidomide survivors to that point in time.  

Unquestionably the triggering of the Optional Protocol under 

the International Covenant on Civil and Political Rights was 

a key element to having the Thalidomide victims claim 

recognized by the Canadian government.  

In both instances, The War Amps exhausted legal remedies 

in Canada, and yet, no justice had been served. It was only 

by leveraging these Optional Protocols that these very 

vulnerable groups received the support and compensation 

they needed to move forward after such devastation. 

3.3 Federal Government Inaction 

There are many ways the federal government, in 

conjunction with the provinces, can ensure that Canada is 

meeting its international obligation to provide affordable 

access to prosthetic care. They must: 

1. Set a national standard for appropriate prosthetic funding 

at the provincial level.  

2. Build legislation to prevent insurers from being able to 

create and sell insurance policies that have arbitrary caps 

on prosthetic funding. 

3. Include considerations for access to funding into 

Accessibility legislation. 

A national standard for prosthetic funding 

As evidenced from the above, Canada is lacking a national 

standard which facilitates access to assistive technologies 

at an affordable cost, for persons with disabilities. Such 

standards have been implemented in other countries. This 

includes but is not limited to Germany, Australia, and 

England. Germany transitioned to a national standard for 

prosthetic funding in 2004,8 and Australia initiated the 

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process of implementing a national standard in 2019.9 As 

for England, an executive body was created in 2012, NHS 

England.10 Although NHS England provides a national 

standard for prosthetic funding,11 such a standard may have 

been prior present to its establishment in 2012.  

Though a provincial power, the Canada Health Act sets the 

national standard for physician services provided in 

hospitals. Assistive devices are seldom provided in hospital 

by a physician. Prostheses are prescribed by a physician, 

but dispensed by Prosthetists inside a hospital or outside, 

in a privately run certified clinic. Hence, the provinces may 

execute discretion on the level of support they decide to 

provide. Sadly, as we summarized above, provincial funding 

contributions fall short of the actual cost across the country, 

with some provinces containing no funding at all.  

While constitutionally a provincial power, it is not unfamiliar 

for the federal government to set national standards in areas 

of provincial jurisdiction, especially as it relates to health 

care. In fact, it has largely been regarded as a critical role of 

the federal government in Canada to set these standards to 

ensure that Canadian values are upheld. This obligation is 

set out in the Constitution and is affirmed each time the 

federal government becomes a signatory to a United 

Nations Declaration. The responsibility and the obligation 

are clear: the federal government must ensure that national 

standards are set and upheld, especially in areas affecting 

vulnerable people such as those with disabilities, including 

persons with amputations. It is an accessibility issue and an 

issue of national importance. 

We feel that the federal government has the responsibility 

and the obligation to be proactive in setting national 

standards, especially if these national standards affect 

vulnerable minority groups and groups protected under the 

Canadian Human Rights Act and are connected to 

commitments made on the international stage.  

Build legislation to prevent insurers from being able to 

create and sell insurance policies that have arbitrary 

caps on prosthetic funding 

Due to the serious lack of adequate funding for assistive 

technology at the provincial healthcare level, many persons 

with disabilities, especially amputees, rely heavily on their 

extended benefits or private insurance to help to ensure that 

the assistive devices they require are affordable. Sadly, too 

many of these insurance and extended benefits packages 

contain arbitrary limits on contributions for essential medical 

devices, including artificial limbs.  

The insurance industry in Canada is, in this way, 

underregulated. We need legislation, similar to the Statutory 

Accident Benefits Schedule for motor vehicle insurance, 

which sets out base limits on what insurance companies 

must cover for artificial limbs.  

The War Amps successfully persuades insurers at the 

grassroots level, case by case, and through higher level 

negotiations and educational strategy to demonstrate that it 

is in their best interest to appropriately cover the cost of 

prosthetic care. Sadly, without the strong arm of legislation, 

we do not feel that sufficient and widespread change will 

occur.   

Accessibility Legislation  

Across the country, at the federal and provincial level, 

sweeping progress has been made to enact comprehensive 

accessibility legislation. The definition of accessibility has 

expanded in recent years from a narrow view focusing on 

ramps and elevators to digital access and universal design.  

In order for accessibility legislation in Canada to truly meet 

its objectives, the legislation must guarantee the availability 

of appropriate coverage for artificial limbs for all Canadians 

who require it. 

Assistive technology, including prosthetic care, is a critical 

element of accessibility for amputees. Without these tools, 

persons with disabilities are barred from completing their 

activities of daily living, as well as accessing communities 

and workplaces. The disability community needs a standard 

which facilitates affordable access to assistive devices, as 

without this, accessibility will not be achieved.  We believe 

that, through accessibility legislation, both federal and 

provincial governments have the major responsibility to set 

and uphold an appropriate standard for artificial limbs, as 

per their commitment to accessibility, the United Nations 

and all Canadians. 

DISCUSSION 

Federal and provincial funding agencies, as well as private 

insurers provide insufficient funding for prosthetic care.  

Their prosthetic funding policies are missing the mark and 

failing to address the reality of living with amputation. Each 

province and territory have their own regime, failing in their 

own unique way to adequately respond to the reality of living 

with amputation and relying on prosthetic care.  In turn, we 

see vast diversity of insurance policy frameworks pertaining 

to artificial limbs which perniciously miss the mark, leaving 

the amputee without the insurance coverage they thought 

they had paid for. After the traumatic loss of a limb, if an 

amputee cannot afford to purchase their prosthesis, they 

are re-victimized, as navigating the repeated red tape, 

denials and confusion of the process can re-trigger the 

trauma and direct focus to the loss. 

Attitudinal barriers and missed legislative opportunities 

compound the issue.  Both the Canadian public and key 

stakeholders including insurers, and government agents 

exhibit a lack of understanding of a very complex area of 

health care and medicine, chronically underestimate the 

cost of prosthetic technology and exhibit Sci Fi Syndrome, 

which all lead decision-makers to build policies that are not 

reflective of the reality of living with amputation.  

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Current legislative frameworks that could ensure access to 

funding for prosthetic care are underutilized, including the 

United Nations Convention on the Rights of Persons with 

Disabilities, which sets out that state parties must take steps 

to facilitate access to affordable prosthetic care. The 

enforcement mechanism of this Convention can be 

leveraged after all Canadian remedies have been 

exhausted.  

The federal government has also failed to set a national 

standard for appropriate prosthetic funding at the provincial 

level, enact legislation to prevent insurers from being able 

to create and sell insurance policies that have arbitrary caps 

on prosthetic funding, and include considerations for access 

to funding for assistive devices into accessibility legislation. 

As such, they are allowing Canada to lag significantly 

behind other comparable countries. They are allowing 

vulnerable persons with amputations to be unprotected by 

high level legal mechanisms.  

Hence, holding funding agencies accountable and 

advocating on behalf of amputees is important in this 

regard.  

CONCLUSION 

Recent years have demonstrated that prosthetic funding 

provided by public and private funding agents fails to meet 

the needs of amputees, creating a large barrier to access to 

care. Both The War Amps and medical professionals are 

committed to collaborating to respond to the urgent, 

complex and multi-faceted issue of insufficient prosthetic 

funding in Canada. Medical professionals can assist further 

by enrolling all amputees with The War Amps Child or Adult 

Amputee Programs, challenging issues with insufficient 

prosthetic funding, and continuing to initiate discussion to 

educate other medical professionals, the public and the 

patient population about the issue to generate and leverage 

the “shock” in response to the serious inadequacies with 

prosthetic funding in this country.  

The issues with access to prosthetic funding are significant, 

complex, and not well known or understood. As the voice 

representing the needs of all amputees in Canada, The War 

Amps is committed to crusading for reform on this issue. 

With a collaborative and multi-faceted approach, we can 

continue to move the ball forward to remedy this significant 

gap. Persons with amputation have experienced significant 

trauma. A small and vulnerable, yet often resilient 

demographic, persons who have lost limbs deserve access 

to prosthetic care. Access to appropriate prosthetic 

coverage will help restore some of what they lost with the 

loss of their limbs, without the fear, anxiety and veritable 

humiliation that accompanies insufficient funding for 

prosthetic care. 

ADVOCACY FOR AMPUTEES: A CALL TO 

ACTION 

Due to the limitations of the funding regimes available to 

Canadian amputees, action is required to improve funding 

regimes for artificial limbs, and subsequently the lives of all 

amputees. Since 2013, The War Amps has been proactively 

extending support and sharing expertise with the 

government and insurers, as well as employers, and works 

with the profession to improve the standards of funding for 

artificial limbs through a Crusade for Reform. By educating 

public health care and private insurance agencies on the 

necessity of artificial limbs, the goal is to reform and improve 

the system so that amputees will be able to receive the 

limbs they need for their independence, safety, and 

security.  

Collaboration between prosthetists, physiatrists, amputees, 

and charitable organizations will help with the identification 

of systemic issues in relation to inadequate prosthetic 

funding in an effort to improve funding for artificial limbs in 

Canada. Key steps that patients and professionals can take 

to contribute include:  

1) Enrolling all amputees with The War Amps Child or 

Adult Amputee Programs 

One barrier to improving prosthetic funding is the lack of 

data and statistics regarding the number of amputees in 

Canada. Statistics Canada and other agencies do not 

collect this information. Hence, by enrolling all amputees, 

we can help address this knowledge gap by ensuring that 

data we collect on amputees is as representative as 

possible as a basis for argument and decision-making in 

support of prosthetic funding.  

2) Challenge Inadequacies 

If medical professionals, in practice, encounter an issue with 

funding, whether government or insurance, we encourage 

them to take steps to challenge it. Across the country, 

prosthetists have built this step into the support they offer to 

their patients with demonstrated success, but we 

understand the administrative burden this can present to a 

small business.  

Hence, The War Amps is available to assist with challenging 

these issues. We can appeal individual denials, or partial 

approvals. We can educate insurers, and provincial funding 

agencies on their inadequacies. We have successfully 

persuaded a number of funding agencies to apply 

appropriate funding on appeal through the use of alternative 

dispute resolution mechanisms (i.e., the submission of 

letters and appeals to the insurer), and we simply will not 

relent until we receive adequate response.  

In this way, we will continue to exert the required pressure 

toward change, and when the time is right, use these efforts 

as evidence towards the need for us to take the next step: 

to bring this issue into the international arena by way of the 

United Nations Convention of the Rights of Persons with 

Disabilities.  

3) Educate and Initiate 

Medical professionals can continue to keep The War Amps 

abreast of issues they are facing and call on The War Amps 

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2021; Volume 4, Issue 2, No.13. https://doi.org/10.33137/cpoj.v4i2.35972 

ISSN: 2561-987X 
(IN) ACCESS TO ARTIFICIAL LIMBS: THE PATIENT’S PERSPECTIVE   

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for support to help strengthen the overall position and 

argument in favour of increased prosthetic funding.  

Conversations must be initiated between contacts, 

acquaintances and other medical professionals who work 

with amputees to educate them on the issue. Most 

Canadians are unaware of the serious issues with 

prosthetic funding and, hence assume that appropriate 

funding is granted to all Canadians. Generating and 

leveraging this “shock” will help elevate The War Amps’ 

Crusade in the minds of the Canadian public and thus, 

government agencies.  

The three actions listed above are first steps in this major 

Crusade and may seem minor, but they play keystone roles 

in improving funding in Canada. 

ACKNOWLEDGEMENTS 

None. 

DECLARATION OF CONFLICTING 

INTERESTS 

The authors declare no conflict of interest. 

SOURCES OF SUPPORT 

None. 

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AUTHORS SCIENTIFIC BIOGRAPHY 

Annelise Petlock is a lawyer with an 

MBA who serves as the Manager of 

The War Amputations of Canada’s 

Advocacy Program. Annelise has an 

in-depth understanding of amputation 

and the whole-body impact it has on 

the lives of individuals living with 

amputation, including the role of the 

artificial limb. The War Amps is a 

charity devoted to improving the lives 

of amputees in Canada, including 

children.  The War Amps provides 

financial assistance for artificial limbs, peer support and information 

on all aspects of living with amputation. 

Keana DiMario serves as a Case 

Coordinator of The War Amputations of 

Canada’s Advocacy Program. Keana 

addresses issues facing amputees 

across all areas including insufficient 

prosthetic funding.  

  

 

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