Category: Reconsideration

S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal’s refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could have easily accommodated the request to make submissions, and the claim for NEBs was of considerable importance to the claimant, who was only receiving ODSP as her other source of income.

S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal’s refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could have easily accommodated the request to make submissions, and the claim for NEBs was of considerable importance to the claimant, who was only receiving ODSP as her other source of income.

D.M. v. Aviva Insurance Canada (17-006781)

The insurer sought reconsideration of the Tribunal’s award of an orthopaedic assessment. Vice Chair Mather granted the reconsideration and denied the claimed assessment. She held that the Tribunal made a significant error of law in concluding that section 38(8) required a “clear and unequivocal” denial of the goods and services it was not agreeing to pay for. She held that the denial satisfied the requirements of section 38(8), and that the claimant failed to attend an IE. Vice Chair Mathers reviewed the submissions of the parties and held that the claimant failed to prove that the orthopaedic assessment was reasonable and necessary. She noted that the claimant had refused a similar referral from his family physician, and his medical imaging did not show any abnormalities. Further, the clinical notes and records did not support the existence of any orthopaedic injury.

R.D. v. Aviva Insurance Company (18-000725)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from proceeding with his claim due to IE Non-Attendance. He argued that he was unable to attend due to mental and physical disabilities. Vice Chair Trojek dismissed the reconsideration. She found no support for the claimant’s position that the Tribunal did not consider the medical evidence of his ability to attend an IE. She also upheld the Tribunal’s decision that a paper review would unduly prejudice the insurer’s ability to present its case.

A.R. v. Aviva General Insurance (18-000838)

The insurer sought reconsideration of the Tribunal’s award psychological treatment and a psychological assessment, and the calculation of interest. Adjudicator Hines dismissed the reconsideration requests for the treatment plan and assessment, concluding that the Tribunal did not make an error in weighing the evidence. Adjudicator Hines granted the reconsideration in terms of interest, holding that interest accrued as of 10 days after the treatment plans were submitted, rather than the day they were submitted.

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

The claimant sought reconsideration of the Tribunal’s decision that the claimant’s injuries fell within the MIG and the denial of three treatment plans. Following the Tribunal’s decision, the insurer removed the claimant from the MIG. The claimant argued that this was new evidence that could not have reasonably been obtained earlier. Adjudicator Grieves granted the reconsideration and ordered that the claims for three treatment plans be determined by the adjudicator originally hearing the matter.

J.Y. v. Aviva Insurance Canada (17-009034)

The claimant sought reconsideration of the Tribunal’s decision to dismiss all of his claims. Adjudicator Watt dismissed the reconsideration request. He held that the claimant had failed to provide written submissions to the Tribunal as ordered by the hearing adjudicator; that the surveillance considered by the Tribunal was not improper; that the Tribunal considered the proper test for IRBs; and that the Tribunal was not required to accept the evidence of an assessor whose report was inconsistent and contrary to other evidence.

T.H. v. Aviva Insurance Company of Canada (17-001125)

The Tribunal dismissed the claim for NEBs and the claimant sought reconsideration arguing that he had been denied natural justice because he was not permitted to call additional witnesses at the hearing, despite agreeing to the procedure in the Case Conference. He also argued that the insurer failed to send an appropriate NEB denial. Member Jovanovic dismissed the reconsideration. He held that the claimant’s legitimate expectations were met because the hearing procedure had been agreed upon during the Case Conference. He also accepted that the insurer had sent an appropriate denial of NEBs. Finally, he held that the Tribunal had applied the correct NEB test.

S.G. v. Aviva General Insurance Company (18-007668)

The claimant sought reconsideration of the decision that his injuries fell within the MIG. Associate Chair Batty dismissed the reconsideration request, writing that the claimant failed to provide sufficient information to meet the criteria for reconsideration. There were no particulars provided as to the grounds for reconsideration.

M.D.H. v. Wawanesa Mutual Insurance Company (17-007887)

The claimant sought reconsideration of the decision that his injuries fell within the MIG. Adjudicator Neilson dismissed the reconsideration request. She was not persuaded that the Tribunal made a significant error of law or fact, or acted outside its jurisdiction or violated the rules of procedural fairness. She wrote that the Tribunal applied the correct legal test for the MIG and considered the medical evidence available.