Category: Reconsideration

S.K. v. Aviva Insurance Canada (18-003544)

The claimant sought reconsideration of the Tribunal’s refusal to remove her from the MIG. Adjudicator Lake rejected the reconsideration request, holding that claimant’s arguments were an attempt to reargue the case and to reweigh the evidence.

N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal’s decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal’s decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments are included in the applicable monetary limits when conducted “in connection with any benefit or payment”. Relying on his own decision in J.M. v. Aviva, Vice Chair Flude held that catastrophic impairment is a designation, not a benefit. As such, he held that catastrophic impairment assessments are not caught by section 18(5) and must be funded over and above the $50,000 medical/rehabilitation limit.

N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal’s decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal’s decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments are included in the applicable monetary limits when conducted “in connection with any benefit or payment”. Relying on his own decision in J.M. v. Aviva, Vice Chair Flude held that catastrophic impairment is a designation, not a benefit. As such, he held that catastrophic impairment assessments are not caught by section 18(5) and must be funded over and above the $50,000 medical/rehabilitation limit.

S.B. v. Aviva General Insurance Company (17-001414)

The claimant sought reconsideration of seven medical benefits following a determination that the MIG was improperly included as an issue in dispute (the claimant had been removed by the insurer, but the adjudicator held that the MIG applied). Adjudicator Watt considered each of the disputed medical benefits. He held that none of the disputed medical benefits was reasonable and necessary.

R.R. v. Aviva Insurance Company of Canada (17-006460)

The insurer sought reconsideration in relation to a chronic pain treatment program, which had been awarded by the Tribunal. Adjudicator Gosio allowed the reconsideration on a portion of the treatment plan for 27 sessions of psychotherapy. He held that 15 of the 27 sessions were not reasonable and necessary.

K.N. v. Aviva Insurance Company (19-003193)

The claimant sought reconsideration of the Tribunal’s decision to adjourn a preliminary motion to be heard by the hearing adjudicator. Associate Chair Batty held that the adjournment decision was not a final order and dismissed the reconsideration request.

K.B. v. Intact Insurance Company (19-005399)

The claimant’s counsel sought reconsideration of the Tribunal’s decision to allow the adjuster to represent himself, and an order putting the claimant on notice that failure to participate in the next Case Conference would result in a dismissal of the claim. Associate Chair Batty dismissed the reconsideration because it was not in relation to a final order.

M.R. v. Allstate Insurance Company (17-008969)

The claimant sought reconsideration of the Tribunal’s denial of ACBs and order barring the claim for medical benefits based on IE Non-Attendance; the Tribunal had awarded IRBs. Adjudicator Mazerolle held that the Tribunal denials did not meet the criteria in Rule 18 for reconsideration. However, Adjudicator Mazerolle found that the award of IRBs beyond the 104-week mark was an error and that the claimant had not led evidence to support IRBs on the “complete inability” test.

S.A. v. Aviva Insurance Company (18-006278)

The claimant sought reconsideration of the Tribunal’s denial of part of a chronic pain program, a bone growth stimulator, and an MRI. Adjudicator Lake dismissed the reconsideration. She held that the claimant failed to prove that the Tribunal made an error of law or fact. In essence, the claimant was seeking a re-weighing of the evidence, which was not the purpose of a reconsideration.

M.H. v. Western Assurance Company (18-009498)

The claimant sought reconsideration of the Tribunal’s decision that the claim for IRBs was barred by the limitation period. The claimant also sought further benefits, which were not addressed in the preliminary hearing. Associate Chair Batty dismissed the reconsideration request because it was not a final order disposing of the entire dispute.