Category: Reconsideration

B.H. v. Certas Home and Auto Insurance Company (17-006967)

The insurer sought reconsideration of the Tribunal’s decision that the denial letter for a psychological assessment was deficient and that the insurer was barred from applying the MIG; the assessment was also found reasonable and necessary. Vice Chair Lester dismissed the reconsideration. She held that the Tribunal had not violated the rules of procedural fairness or natural justice. She also held that the Tribunal had not made a significant error of law or fact such that a different result would have been reached.

Applicant v. Wawanesa Mutual Insurance Company (18-003314)

The claimant sought reconsideration of the Tribunal’s decision on narrow issue of the quantum of attendant care awarded. The Tribunal awarded the claimant $3,047.27 in monthly attendant care, despite the claimant’s Form 1 listing $6,000 in monthly attendant care and the respondent’s Form 1 listing $3,243.95 in monthly attendant care. The claimant argued that the Tribunal breached the rules of natural justice or procedural fairness in providing relief that was neither sought, nor presented at the hearing. Adjudicator Hines dismissed the claimant’s request for reconsideration, concluding that the Tribunal’s decision provided a careful and detailed analysis for its findings, and compared both parties Form 1’s to establish what was reasonable and necessary based on the facts and the evidence. That the quantum the Tribunal found payable ended up being less than the respondent’s Form 1 was not proper grounds for reconsideration.

L. Y. v Aviva Insurance Company (17-008847)

The insurer sought reconsideration of the Tribunal’s decision, arguing that it had made a significant error of law or fact by referring to evidence not before it, placed the onus on the insurer, and failing to adhere to case law. On reconsideration, Adjudicator Norris held that he did not err in law in his decision. Adjudicator Norris held that he had reviewed the evidence and preferred the evidence of the claimant’s treating psychologist with respect to the reasonable cost of the proposed psychological assessment. Adjudicator Norris also held that the case law submitted by the insurer was unsupportive and therefore, did not apply.

P.Y. v Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal’s decision based on there being new evidence that the claimant could not have reasonably obtained earlier and based on the insurer’s concession at the close of the proceedings that the MIG did not apply. Adjudicator Grieves granted the claimant’s reconsideration request. Adjudicator Grieves accepted that the new evidence, being a s. 25 psychological report, was not reasonably available to the claimant at the time of the hearing and would have affected the Tribunal’s result with respect to its MIG finding. Adjudicator Grieves also criticized the parties for not advising the Tribunal that the insurer had agreed at the close of proceedings to remove the claimant from the MIG, as this would have affected the Tribunal’s result. Adjudicator Grieves ordered that the matter be sent back to the Tribunal to determine the reasonableness and necessity of the disputed treatments plans as the claimant was now out of the MIG.

H.M. v. Aviva Insurance Canada (18-004734)

The claimant sought reconsideration of the Tribunal’s decision finding that he was not entitlement to Non-Earner Benefits. Upon receipt of the reconsideration request, the Tribunal invited both parties to submit supplementary submissions. Neither party delivered supplementary submissions. Adjudicator Lake dismissed the claimant’s request for reconsideration. Adjudicator Lake found that the claimant’s request for reconsideration was vague and failed to provide any specific argument as to the alleged errors in the Tribunal’s decision.

V.D. v. Unifund Assurance Company (17-005656)

The claimant sought reconsideration of the Tribunal’s decision to reject her claims for a chronic pain program and a self-propelled lawn mower and snow blower. Adjudicator Paluch dismissed the reconsideration request. He concluded that the Tribunal had not misapprehended the evidence or erred in its legal analysis. The Tribunal was permitted to weigh the evidence as it saw fit, and to make a determination based on the weighing of evidence.

C.S. v. Aviva Insurance Company (18-007039)

The claimant sought reconsideration of a motion order denying the request to strike the insurer’s evidence. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

K.A. v. TD Insurance Company (18-009613)

The insurer sought reconsideration of a motion order denying the request to adjourn the scheduled hearing. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

G. I-F. v. Economical Insurance Company (19-001420)

The claimant sought reconsideration of a motion order denying the request to vary the hearing timetable. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

M.N. v. Aviva Insurance Canada (18-006097)

The claimant sought reconsideration of the Tribunal’s refusal to re-open her application for entitlement to certain psychological services. The claimant and the insurer had agreed to resolve entitlement to proposed psychological services that were proposed. The services proposed were to be provided by a psychologist at the Guideline rates. The claimant then incurred the treatment with a psychotherapist, but at the psychologist rates. Vice Chair Shapiro concluded that the Tribunal was correct in refusing to re-open the original application. The nature of the dispute was not whether the claimant was entitled to the proposed services, but rather, whether the claimant incurred services that had been approved by the insurer and the proper rate of payment for the services the claimant incurred.